There is also a notable racial disparity in the timing of referral to hospice, which impacts LOS. The median LOS in hospice in 2016 was 24 days, while the average was 71 days. While longer Lengths of Stay (LOS) in hospice have been shown to be more beneficial to patient and family, family satisfaction with hospice care is more closely associated with the quality of hospice care, meaning fewer unmet needs and fewer reported concerns. Almost 50% of Whites who died in 2016 used hospice care compared to 31% to 37% of African American, Asian, or Native American descent. Hospice utilization also varies by race and ethnicity. For example, the proportion of Medicare decedents enrolled in hospice at the time of death varied across states from a low of 23% (Puerto Rico) to a high of 58% (Utah). On closer examination, there is tremendous geographic variation in the availability and use of hospice services. Over 50% of patients were cared for at home, with 42% cared for in a nursing home setting. In 2016, there were 4382 Medicare-certified hospices in operation.Īn estimated 1.4 million people received hospice care in the US, with almost half being older than 84 years and 27.2% (the largest portion) having cancer as their terminal diagnosis. The most recent decade has seen significant growth in the number of hospice programs and hospice utilization. Table 1: Eligibility Criteria for hospice care in the US under the Medicare hospice benefit Since 1983 hospice services have become available through Medicare, Medicaid, and almost all US insurance plans (see Table 1). US hospice programs follow a model that emphasizes care in the patient’s home and supports patients to die at home. Christopher’s Hospice. Both programs were in an inpatient setting. The first hospice program established in the US was Connecticut Hospice in 1974, spearheaded by Florence Wald, RN, who modeled it on St. Christopher’s Hospice in South London and is now credited with developing the principles of hospice care that have become the core values reflected in hospice program policies worldwide. The hospice movement began with the work of Dame Cicely Saunders, whose predominant concern was alleviating the suffering of dying patients. This chapter will review hospice care in the US, its structure and delivery, and its growth and barriers to utilization. Hospice also provides emotional support to the patient’s loved ones even into bereavement. It provides expert medical care, pain and symptom management, and emotional and spiritual support tailored to the patient’s needs and wishes. Hospice is a model of high-quality, compassionate care for people suffering from a life-limiting illness. Similarly, caregivers want their loved ones to receive care that is concordant with their wishes and comfort. Hospice helps to achieve these goals for terminally ill patients. Seriously ill patients often state preferences for receiving adequate pain and symptom management, avoiding inappropriate prolongation of dying, achieving a sense of control, and strengthening their relationships with their loved ones. Most Americans prefer to die at home or in a home-like setting, yet over 30% die in acute care hospitals.
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