Hospice And Palliative Care

In Stephen R Connor’s article “Development of Hospice ad Palliative Care in the United States,” Connor reviews the history and growth of hospice and palliative care in the U.S., the Medicare benefit’s relation to hospice, challenges that these end-of-life care services are facing, and strategies to improve the quality of hospice and palliative care.
In 1963, Dr. Cicely Saunders from the United Kingdom introduced hospice and the concept of treating terminally ill patients in a holistic manner to the United States. In both countries, the goal was to provide support and comfort for those near death, but in the U.S. there was a greater emphasis on at-home care while the U.K focused on inpatient settings. Like we discussed in class, Americans

tend to deny the idea of death. If it is accepted, it is seen as a frightening or sad experience. Hospice provides an outlet for the patient and their family to discuss death and dying, learn coping mechanisms, and acknowledge that the patient was near the end of their life, which reflected the changing attitude of U.S. society around the 1970s.
The Hospice Medicare Benefit (MHB) was established in 1982, “creating a set payment for hospice care so that the government was sharing the risks with a provider” (Connor 91).

The MHB also set certain regulations for hospices: (1) patients are eligible only if they have a prognosis of six months or less to live and choose to stop curative treatment, (2) hospices need a governing body, plan for each patient, quality assurance, and use of volunteers, (3) and must provide fundamental services by hospice employees (Connor 91). The integration of hospice and the U.S. government has improved fiscal details, but the regulations and requirements also create logistic

challenges.
Over the past 30 years, hospice has substantially expanded in the United States, and with this growth there have been significant changes along the way. In the past, patients in hospice were mainly comprised of cancer patients but over time, admissions have encompassed people with other progressive illnesses like organ failure, neurological disease, or stroke. Length of stay has also changed as the average time in hospice has dropped from 70 to 50 days. In addition, more than 30% of patients receive service for seven days or less. The number of locations where hospice care is offered has increased, due to the MHB and acceptance of this type of care. There has also been dramatic growth in palliative care programs. The American Board of Medical Specialties now recognizes both hospice and palliative care as a sub-specialty. Since hospice and palliative care have been introduced the services have flourished in the U.S.
With the development and changes in end-of-life care, various challenges arise.

These challenges are due to the Medicare benefit, workforce issues, and access and quality of the services. Medicare’s regulations state that hospice is only offered to those near death (six months or less to live) and that the admitted patients stop the treatments with the purpose of curing the illness. The purpose of these restrictions is to keep costs low, but there is also the ethical responsibility of hospice to provide the best end-of-life care possible for patients and their families. Another issue with hospice and palliative care is the lack of workforce while this field is growing. Currently, social workers provide the majority of psychological services, but psychologists and psychiatrists are also needed for effective psychosocial care. Since hospice and palliative care is now recognized as a sub-specialty, there is hope that this will increase physicians entering this medical field. Spiritual and religious services are other areas within hospice and palliative care that needs expansion. “If current projections are correct, then more than twice as many hospice professionals and volunteers will be needed in the next 20 years to meet the unmet need for palliative care and the growing numbers of older people in our society” (Connor 98). The last problem with end-of-life care programs is the access and quality. For example, African Americans are 7% less likely to receive hospice

care than whites (Connor 99). Patients with non-cancer diagnosis are also less likely to have access to hospice – but this has been improving over the last several years. Geographic location also influences admittance to hospice and palliative care; very rural areas have the least access. By analyzing the history, growth, and challenges of hospice and palliative care, lessons learned can pave the way improving these end-of-life care services.
This source is valuable because it provides details on the history, growth, problems, and relation to Medicare benefits of hospice and palliative care in the United States. By encompassing a variety of topics about end-of-life care in the U.S., we can understand the evolution of these services and how they can be improved.