Long Term Care-Hospice Essay Example for Free

Long Term C ar-Hospice EssayHospice is a process to end-of-life headache and a kind of rear facility for terminally ill uncomplainings. It provides comforting fretting, patient-centered c be and related operate. Comforting conduct relieves discomfort without improving the patients condition or curing his illness. Hospice is extended in a tumescenessc ar facility or at home. Its objective is to provide compassionate, emotional, and un force outny care for the dying patient. The inauguration of the word hospice in medieval times meant way station for weary travelers (Perry). The first hospices were run by members of religious orders in the medieval times that cared for weary travelers whom ground refuge with them until their closing. Modern hospices are believed to oblige started in the United Kingdom in the mid-19th century in capital of Ireland, Ireland. Roman Catholic Sisters of Charity provided a clean and care place for the terminally ill. The rear hospice was f irst applied to the care of dying patients by Mme Jeanne Garnier who founded the Dames de Calaire in Lyon, France, in 1842. The name was next introduced by the Irish Sisters of Charity when they opened Our Ladys Hospice in Dublin in 1879 and St Josephs Hospice in Hackney, London 1905.The practice became popular in England, Asia, Australia and Africa. It was exclusively in the early 70s that the hospice excogitation was introduced and accepted in the United States through the efforts of medical students Cicely Saunders and Elisabeth Kobler-Ross. These practices included effective pain concern, comprehensive home care work, counseling for the patient, and acceptance of goal as the natural end of the care delivery by wellness care professionals, bereavement counseling after the patients death, and continued research and education (Wexler Frey). theatrical role care at the end of life soon combined with grief counseling and bereavement care. The presidency stepped in to contain health-care be when reimbursement for inpatient hospitalization was significantly reduced. Home- ground hospice care similarly became popular as a more inexpensive alternative to hospitalization or care in a care for facility (Wexler Frey).The hospice concept was non immediately accepted by conservative health professionals. The concept emphasizes caring more than curing. It also allows interaction with complementary and alternative medicine practitioners. A hospices primary turn or service is to enable the patient and his family to accept death as a natural map of the life cycle (Wexler Frey, 2004). In addition, it provides pain management and psycho-spiritual support and complementary and alternative therapies. Approximately 80% of hospice patients are in the terminal or end-stage of cancer. Traditional medical facilities provide pain medications when requested, a hospice administers these medications on a regular basis and before they are needed. The intention is to prev ent pain from recurring. Furthermore, the problem of addiction and other long-term consequences is not a concern in the case of terminal illness. The concern is to provide effective relief to the great degree possible (Wexler Frey).A second major service of a hospice is to relieve physical, psychological, emotional and spiritual discomfort to the patients family and others c pull back associates (Wexler Frey, 2004). It relies on members of the clergy, pastoral counselors, social workers, psychiatrists, corrade therapists and other skilful volunteers to alleviate the discomfort. A hospice also provides grief and bereavement counseling and support groups to assist family members in expressing or resolving emotional tensions. And it allows the use of complementary and alternative therapies, in addition to conventional medicine, in the defy of symptoms and in improving the patients well-being. A 2002 study conducted on the inclusion of such therapies showed that patients who autho rized them expressed more satisfaction with hospice care than those who did not receive them.These therapies include acupuncture, music therapy, pet therapy, bodywork, massage therapy, aromatherapy, Reiki or energy healing, Native American rites, herbal intervention and similar methods intended to soothe the patient and his family and friends (Wexler Frey). A survey was conducted in 2000 on more than 9,000 patients discharged from more than 2,000 hospices on the operate they acquire (Carlson, 2007). It revealed that 22% of them received five major alleviant care services, which varied among the hospices. These palliative care services were nursing care, medico care, medication management, psychological care, and caregiver support. Approximately 14% of the hospices provided all five services and 33% provided tho one or dickens services. Only 59% of these patients received medication management services. These included administering medication, dispensing correct dosages, and good dealting and following dosage schedule.Growth ProjectionsThe National Hospice and mitigatory precaution memorial tablet reported that, as of 2003, there were 3,139 hospice programs in operation in the United States, Guam and Puerto Rico (Wexler Frey, 2004). The Centers for Disease prevail and Prevention National Center for Health Statistics said that, in 2000, there were 11,400 combined home health and hospice care agencies, which served 1.5 million patients. It also reported that, at present, more than 90% of hospice care is delivered at home, although based in medical facilities. Hospital-based programs often provide hospice care in a wing or a floor in the building. There are also independent and for-profit hospices exclusively for the care of the terminally ill. nearly programs strikeer several(prenominal)(prenominal) inpatient and home care and allow patients to use one or both types of service (Wexler Frey). In 2005, the National Hospice and Palliative Care Org anization reported that more than 4,100 hospice programs were operating nationally (Marshall, 2007).A third of these were for-profit companies. The rise in figures led financial analysts to view the hospice industry as among the strongest increment areas in healthcare. Hospice is cost-effective and more people are getting aware of the concept. Records showed that hospice spending had grown at 26% annually since 1989 as compared with 7% increase in overall health expenses in the akin period. Despite this statistical increase, the hospice market has yet to be substantially tapped. Of the approximately 2 million apparent(a) deaths in 2003, altogether 710,000 were in hospice. further new government regulations in the 80s boosted the growth of hospices.These regulations allowed hospice providers into assisted sprightliness centers and nursing facilities. Since their exposure to the patients, the industry became a more attractive enterprise. The hospice concept has grown from a u nbidden effort to a highly profitable industry worth $9 billion today. It is predicted to continue growing as baby boomers opt for the good death. Of the 47 hospices in Colorado, 53% are non-profit and 36% are for-profit. Nationwide, for-profit hospices multiplied four times between 1994 and 2004 at six times the growth of non-profit hospices (Marshall).Issues and ApproachesHospices operate on thin investment margins of only 8 to 12% on the average and receive Medicare payments of only $ one hundred twenty-five per day per patient for routine home care (Marshall, 2007). They are lucky to prepare thousands of volunteers to support operation. But making a profit can be difficult. Medicare regulations state that hospice can be used only up to six months. Yet many patients die just weeks from arrival. If death comes within two weeks of admission, the costs go quite high. Another problem that for-profit hospices confront is maintaining a level of quality care (Marshall). well-nigh hosp ices require physicians to estimate that the patient is un worryly to survive to six months (Wexler Frey, 2004). This intention is to maintain Medicare eligibility. This disqualifies terminal patients with changeful prognoses, the homeless and isolated patients. Moreover, health care costs constrain patients to limit their stay in hospices.The gelded stay reduces the chance and time for pastoral and psychological counselors to help the patient and the family to deal with the situation efficaciously (Wexler Frey). Short stay also incurs more and more costly care (Solnik, 2002). Medicare and private insurers pay per diem, which style that reimbursements remain the same and hospices must cover the rest of the expenses. Furthermore, the patient may not need a lot care at times and that increases the delivery cost per day. But hospices realize they have to live with this cosmos (Solnik). Other problems arise when staying too long in a hospice (Solnik, 2002). Prior to admission, t wo physicians must agree that the patient probably has six months or less to live. The patient must also agree to interchange the use of life-saving equipment and treatments with palliative ones.The purpose is to keep him comfortable. If he survives the six-month limit, Medicare payments drain and the hospice must eventually reimburse some of the payments (Solnik). The cost of more effective pain medication has added to the cost of hospice care (Solnik, 2002). Hospices admit they are losing notes because of the treatment modes applied to end-of-life care. Regulations must cover all the expenses incurred in all the stages of terminal illness. Medical procedures, like chemotherapy and radiation, are frequently used to alleviate pain and symptoms and for cure. Intravenous medications tackle pain but are also costlier than other forms. The appearance of new and costlier doses blurs the fine line between life-saving and mere comfort-giving. Chemotherapy can backlash a tumor to allow swallowing and radiation can ease or reduce pain. If the hospice is not well financed, one or two patients who demand these procedures can bring cost problems to the hospice.Shareholders who fear that the return on their investment is jeopardized may decide to cut down on staff. They may also shed off community grief centers, extensive bereavement care, alternative therapies, and inpatient care centers. The multicultural view of death is another issue in hospices in the United States and Western Europe (Wexler Frey, 2004). Migrants with Easter cultures have an altogether different perspective from those with Western cultures. The Chineses concept of death is a sharp example. The views of death and end-of-life values of other cultures should be incorporated into the policies of hospice care programs (Wexler Frey). The low rate and significant increase of physician services are additional troubles for hospices (Carlson Morrison, 2007).In most cases, hospice physicians expositici pate only in care planning meetings, not in direct or actual patient care. The 6% increase in the subjugate of patients receiving physician services was not considered significant. Still less than a third of these patients received hands-on physician services. This could be the offshoot of the original and non-medical concept of hospice care (Carlson Morrison). The range of hospice services provided in different regions has also been found to vary by region (Solnik, 2002 Wexler Frey, 2004). Patients in the Northeast received a significantly narrower set of services than those in other regions. Alternative forms of palliative care for end-of-life patients are quite common in the Northeast. These forms have recently reach outed as hospital-based palliative care programs more than in other regions. This cut back could have influenced the role and scope of hospice care offered in that region (Solnik, Wexler Frey).One more issue or problem is regulation of hospices itself (Solnik, 2002). In order to pay for hospice care, Medicare or a private insurer requires two physicians to sign a document that the patient has only six months or less to live. It then pays only for palliative treatment or management of symptoms and pain, not for the cure of the disease. This compels the patient to choose comfort or care over cure. The hospice industry has been by lobbying for a change in the regulation to allow or include curative treatment in hospice care. In collaboration with this initiative, the National Hospice and Palliative Care joining has also been lobbying for increased insurance reimbursements to include payments for costly procedures, like chemotherapy and radiation therapy (Solnik). Some approaches to these issues have been noted. increase disease complexity, the diversity of diagnoses and symptom burden are likely to increase direct physician care (Carlson Morrison, 2007).The patients primary care physician may continue to monitor the patients condition but he is also unlikely to possess appropriate training, knowledge and skills on palliative care (Carlson Morrison). Consolidation efforts in the industry has helped hospice care providers gain greater access to fund sources (Solnik, 2002). This is illustrated by the merging of hospice services among the Charles Hospital and Rehabilitation Center, Mercy Medical Center and Good Samaritan. They created Good Shepherd. They, however, found that reducing the costs of products and services would not sustain them without extensive financing or fund-raising (Solnik). Some studies concentrate on the availability of hospice care to the gray in the rural areas (Solnik, 2002). Findings showed that the range of hospice services in the areas were parallel with those in the urban areas. The probability of fewer services in the rural areas can be dealt with by increasing reimbursement to cover travel expenses and attract skilled health professionals (Solnik).A New York legislation would expand Med icaid payment for disjoined hospices in response to the six-month limit requirement (Solnik, 2003). The initiative encouraged the construction of freestanding hospices, such as The Visiting Nurse Service Hospice of Suffolk, Inc. on Long Island and the Hospice Care Network in Manhasset. Freestanding hospices would create and provide facilities for the exclusive use of hospice care. Hospice beds in hospitals and nursing homes are currently only a small part of the overall facility. This would provide family support to take care of patients who do not have it and need it in their condition. Hospice care providers consider freestanding hospices a potentially important part of their industry (Solnik).Community AssessmentThe City of South Bend in Indiana is the seat of St. Joseph County in a region known as Michiana (Answers.com, 2008). The region covers counties in Indiana and Michigan. South Bend is famous for the University of Notre Dame and the winning football team, The Fighting Ir ish. It has a 107,789 population as of 2000. The Citys has niner medical centers, prominently the Hospice of St. Joseph County (McMahon, 2008). Employment in the health care and social services is 13.4% of the total.(McMahon). The Indiana Hospice Palliative Care Organization supervises hospice care in the City. Among the issues it confronts are treating the homeless at the end-of-life, the costs of end-of-life care to elderly patients, pain management, care-giving at the end-of-life, and futile care (2007). Treating the homeless at the end-of-life is a major concern for the City. They can seldom access hospice service for lack of resources for inpatient hospice, a home or social support (Indiana Hospice Palliative Care Organization, 2007). In addition, these homeless are already beset with substance abuse problems and psychical illness.Their need for hospital care is 3-4 times greater than expected and 36% longer than poor patients who have homes and encounter similar health pro blems. Some organizations offer them medical respite, short-term shelter with basic services for those too sick to function on the street. These organizations cannot, however, care for those who are nearing death. (Indiana Hospice Palliative Care Organization). Keeping to a medication regimen is a critical problem among homeless patients. They lack the money to buy them, lose their rifleings or suffer from symptoms of mental illness or substance abuse (Indiana Hospice Palliative Care Organization, 2007). Other problems they confront are the control of pain, the inability to discuss death and dying at home. Because of drug abuse, they may be opioid-tolerant and, thus, may need higher doses.If they stop taking drugs, they need specific treatment to handle withdrawal reactions. The homeless also less willing to discuss death on nib of what they have been denied in life. A study found that the homeless expect to die suddenly and violently. This prospect affects their willingness to discuss death. The homeless are also unlikely to have a surrogate or confidant who can make decisions for them in the event of incapacitation. Ethics committees or court-appointed guardians take their place for the function. And dying at home is not an option because they have no home. They are also unlikely to observe theater of operations rules in hospices. Experts recommend that homeless patients at the end-of-life be encouraged to form trusting relationships to insure or enhance curative and palliative care at that period (Indiana Hospice Palliative Care Organization).City laws are slated for revision to respond to these issues ((Indiana Hospice Palliative Care Organization, 2007). One will direct the Health Department to name a commission, which will enact rules for physicians to order for life-sustaining treatment. The other revision will further prove healthcare powers of attorney. Living wills merely provide instructions concerning life-sustaining treatment. Powers of a ttorney concerning the end-of-life wishes of a patient belong to the spouse as first priority, followed by adult children and then close friends ((Indiana Hospice Palliative Care Organization).BIBLIOGRAPHYCarlson, M. D. A., et al (2007). Hospice care what services do patients and theirFamilies receive? Health Services Research Health Research and educational Trust.Retrieved on November 20, 2008 fromhttp//findarticles.com./articles/p/mi_m4149/os_4_46/ai_n27331524?tag= substancecol1Indiana Hospice Palliative Care (2007). Crossroads. Indiana Hospice PalliativeCare, Inc. Retrieved on November 20, 2008 fromhttp//www.ihpco.org/January%2007%20crossroads.pdfMcMahon, P. M. (2008). Economic development for South Bend, Mishawaka and St.Joseph County. Project Future. Retrieved on November 20, 2008 fromhttp//www.projectfuture.org/index.htmMarshall, L. (2007). The business of dying. ColoradoBiz WiesnerPublications, Inc.Retrieved on November 20, 2008 fromhttp//findarticles.com/articles/p/mi_hb6 416/is_8_34/ai_n29369110?tag=contentcol1Solnik, C. (2002). Hospice industry struggling despite being busier than ever. LongIsland Business News Dolan Media Newswires. Retrieved on November 20, 2008 from