Purpose: The purpose of this study was to investigate the hospice care compliance of nurses working at a hospice ward and provide meaningful data to improve the hospice care compliances. Methods: Participants included 104 nurses working at the hospice ward of the hospital located at P and D cities. Data was collected from February to March 2012. The level of hospice care compliance was measured using Bae (2000)'s questionnaires. Data were analyzed with descriptive statistics, t-test, one-way ANOVA and Scheffè test using SPSS/WIN 18.0 program. Results: The level of hospice care compliance in hospice nurses working at a hospice ward was high (3.25 out of 4). In hospice care compliance, the physical area was highest, followed by the emotional, spiritual, and social areas. Hospice care compliance was significantly different according to age, marital status, education, religion, importance of religion, job position, job satisfaction and life satisfaction. Hospice care compliance was also significantly different according to the nurses' experience of death, having license or certification related to hospice care and experiences related to clients' death. Conclusions: The findings of this study showed that the level of hospice care compliance was high and the hospice care compliance in South Korea was primarily focused on physical care. Considering that spiritual needs are important needs in hospice clients, hospice nurses need to focus on those aspects more. To improve the quality of hospice care compliance in the hospice nurses, programs to increase hospice nurses' job and life satisfaction are needed. KEYWORDS Hospice Care; Compliance; Nurses ; open
The last days of life for a substantial proportion of dying older adults are spent in nursing homes. Considering this, the provision of Medicare hospice care in nursing homes would appear to be an equitable use of Medicare expenditures as well as a valid investment in improving the quality of life for dying nursing home residents. However, government concerns regarding possible abuse of the hospice benefit in nursing homes, as well as suggestion that the payment for the benefit in nursing homes may be excessive, has perhaps slowed the adoption of hospice services into the nursing home setting. Currently, access to hospice care in nursing homes is inequitable across facilities, and across geographic areas. In nursing homes where hospice is available and present, however, recent research documents superior outcomes for residents enrolled in hospice, and perhaps for nonhospice residents. Still, more research is needed, particularly research focusing on the government costs associated with the provision of hospice care in nursing homes. If subsequent research continues to support the "added value" of hospice care in nursing homes and at the same or less total costs, the issue of foremost concern becomes how equitable access to Medicare hospice care in nursing homes can be achieved. Access may be increased to some extent by changing government policies, and conflicting regulations and interpretive guidelines, so they support and encourage the nursing home/hospice collaboration.
As the Korean government's recognition of the importance of hospice service grows, the government has initiated a variety of hospice services in Korea. Each hospice organization has shown a significant difference in its health care delivery methods, constitution and care content. Developing a clinical protocol is essential for establishing standardized hospice services. A preliminary protocol was drawn up by examining the records of terminal patients (n=541) in a home hospice organization while elucidating the health problems as well as classifying them through the Home Health Care Classification (HHCC), and by reviewing the relevant nursing interventions and medical treatments in the literature concerning the clinical protocols. Korea's leading hospice specialty groups participated in four rounds of content validity verification processes in order to establish a protocol. A guideline was developed through a team approach, integrating the opinions of doctors, nurses, ministers, volunteers, patients' families, nutritionists and pharmacists. Eighteen health problems and a total of 223 interventions (173 major treatments and nursing interventions, and 50 optional interventions) were included in the final clinical protocol. This study is expected to contribute to the overall qualitative improvement of home hospice care and the subsequent shortening of documentation time. Evaluation tools and a regulatory feedback system need to be developed in order to maintain consistent evaluation procedures based on the continuous promotion and use of the protocol. ; open
The differences in hospice care needs between United States veterans and non-veterans was explored using a systematic review research methodology that consisted of 18 articles. After a review of previous research studies, it was found that veterans tended to want their healthcare providers to be more open and to the point about their diagnosis than non-veterans did. Both non-veterans and veterans wanted to be in control of their end of life cares. Non-veterans were more likely to want their family and friends around compared to veterans who were less likely to want people around. Veterans who had post-traumatic stress disorder (PTSD) received a lower quality of care compared to hospice patients who did not have PTSD. Patients who received a palliative care consult reported having less discomfort compared to those who did not receive a palliative care consult. Patients who received extra services such as Reiki or music therapy or caregiver support had an increase in peacefulness and a decrease in pain. With the additional caregiver support, patients were able to stay at home longer or until their death. This study shows that there is not a lot of research done around hospice care with veterans, but it is a unique group that needs to be focused on more in order to increase the quality of care they receive.
Each hospice has its own policy, but Medicare requires 6 months or less life expectancy for certification of eligibility and reimbursement. Other important criteria include patient and family understanding and wishes. Evidence-based guidelines for determining prognosis in some noncancer diseases have been developed. However, despite their widespread use, limited data exist to support their accuracy (strength of recommendation: B). Moreover, a high degree of prognostic accuracy may be unattainable given the unpredictable course of common noncancer chronic diseases. Hospice eligibility for patients with nonmalignant disease is based on clinical judgment.
Medicare guidelines are used to determine eligibility for hospice care (strength of recommendation [SOR]: C, based on expert opinion), but they correlate with 6-month mortality no better than an experienced clinician's judgment (SOR: B, based on 1 cohort study). Recent studies, however, have identified additional criteria that may better predict survival in select populations.
Purpose The life expectancy in the United States is longer than ever before. However, as the Baby Boom generation ages and people die increasingly slow deaths from chronic conditions, there will be a growing need for partnerships and programs to ensure end of life patients get the care they need in the setting that they want. One partnership in particular that has a growing following is that between hospice agencies and the Emergency Medical Services. This paper will examine potential policies at the Federal, State, and systemic levels that hinder or prevent EMS agencies from participating in hospice services. Methods A review of literature was conducted. Academic literature from after 1974 – the date of the first American hospice agency – and grey literature from after 2007 were considered. SCOPUS, CINAHL, and the Himmelfarb Library database were queried with various combinations of MeSH terms. Those results were then screened by date and content for relevance. A variety of government agencies and relevant NGOs were also searched for applicable content. Results Significant barriers to EMS involvement in hospice services exist at the Federal and State levels. At the Federal level, there is a major problem with reimbursement for both EMS and Hospice services with regards to this type of care. The Drug Enforcement Administration also has policy barriers written into the Controlled Substances Act, but there is legislation waiting for the President's signature that may reverse these barriers. Additional barriers exist on a state by state basis, but these were more difficult to determine, and searching for each independently proved challenging. Conclusion Significant barriers to EMS involvement in Hospice care exist at Federal and State levels. Because some states allow for EMS agencies to provide home health services without transport, and because the major barriers to the federal controlled substance issue is expected to resolve soon, there is an opportunity for further research into EMS / hospice collaboration ...
OBJECTIVE: Although there has been an increasing emphasis on assisting nurses with providing quality hospice care to patients and family members, few studies have explored the challenges that oncology nurses face when delivering hospice care in the Chinese cultural context. The objective of this study was to elucidate the challenges for oncology nurses in providing hospice care for terminally ill cancer patients in mainland China. METHODS: A descriptive qualitative study with purposive sampling using audio-recorded fact-to-face interviews. A total of 13 hospice nurses from four hospitals in Beijing, mainland China, participated in this study. Data collection was from April to June 2019, and thematic analysis method was used to analyze the data. RESULTS: Challenges identified by hospice nurses in providing hospice care for terminally ill cancer patients included: (1) public misperception on hospice care, (2) lack of financial support, (3) fear of medical disputes and legal action, (4) shortage of human resources, (5) insufficient specialization and lack of "hierarchy" training on hospice care, (6) inexperience in communication skills, and (7) lack of self-care and stress management skills. CONCLUSIONS: It is imperative and critical for the government, health-care institutions, and hospice care providers to clearly understand the challenges that currently exist in providing hospice nursing. Joint efforts are needed to overcome those challenges, which might result in qualified hospice nurses and provide evidence for further development of hospice care in mainland China.
The article considers and covers the approaches of the development of palliative and hospice care in Ukraine, namely the departments of palliative and hospice medical institutions have extremely limited resources and are not able to provide patients with even the most necessary . An important problem is the creation of a system of personnel training in Ukraine that is involved in providing the service of palliative and hospice care. The duty of the state to ensure access to palliative care for all patients, regardless of age, the nosological category of the disease, social status, nationality, religious and political beliefs, place of residence, etc. ; У статті розглянуто та висвітлено питання, повязані з розвитком паліативної та хоспісної допомоги в Україні, а саме, відділення паліативного та хоспісних лікувально-профілактичних закладів є вкрай обмежені ресурси та не мають можливості забезпечити хворих навіть найнеобхіднішим. Важливою проблемою є створення в Україні системи підготовки кадрів, які беруть участь у наданні послуг паліативної та хоспісної допомоги. Обов'язок держави забезпечити доступ до паліативної допомоги всім пацієнтам, незалежно від віку, нозологічної категорії захворювання, соціального статусу, національності, релігійних та політичних переконань, місця перебування тощо. Якщо суспільство вважає себе цивілізованим, то неодмінно зобов'язане подбати про те, щоб невиліковно хворі отримали якісний і належний догляд. Байдуже суспільство немає майбутнього!
The article considers and covers the approaches of the development of palliative and hospice care in Ukraine, namely the departments of palliative and hospice medical institutions have extremely limited resources and are not able to provide patients with even the most necessary . An important problem is the creation of a system of personnel training in Ukraine that is involved in providing the service of palliative and hospice care. The duty of the state to ensure access to palliative care for all patients, regardless of age, the nosological category of the disease, social status, nationality, religious and political beliefs, place of residence, etc. ; У статті розглянуто та висвітлено питання, повязані з розвитком паліативної та хоспісної допомоги в Україні, а саме, відділення паліативного та хоспісних лікувально-профілактичних закладів є вкрай обмежені ресурси та не мають можливості забезпечити хворих навіть найнеобхіднішим. Важливою проблемою є створення в Україні системи підготовки кадрів, які беруть участь у наданні послуг паліативної та хоспісної допомоги. Обов'язок держави забезпечити доступ до паліативної допомоги всім пацієнтам, незалежно від віку, нозологічної категорії захворювання, соціального статусу, національності, релігійних та політичних переконань, місця перебування тощо. Якщо суспільство вважає себе цивілізованим, то неодмінно зобов'язане подбати про те, щоб невиліковно хворі отримали якісний і належний догляд. Байдуже суспільство немає майбутнього!
The article deals with the political and legal problems of palliative and hospice care for incurable patients in Ukraine. The author considered the basic concepts in this area («incurable patient», «palliative care», «hospice», «palliative policy»), analyzed the legal framework for hospice care in Ukraine. The author notes that all people hope for a good death, or rather, «a good life to the very end». Unfortunately, this doesn't happen to everyone. Many people have to be in pain and suffering at the end of their lives. The goal of the palliative care is to prevent suffering and to alleviate the condition of the patient suffering from an incurable disease – by active identification of syndromes, like pain, and by providing adequate treatment that will balance the syndromes as much as possible during day and night. Public engagement and policy interventionsto improve the quality of death through the provision of high quality palliative care have gained momentum in recent years, and some countries have made greatstridesin improving affordable accessto palliative care. Unfortunately, Ukraine is a country with a low index of «quality of death», due to lack of political will, imperfection of legislative and regulatory framework, practical lack of funding, as well as informational silence on this topic. So thousands of Ukrainian's citizens today do not receive any palliative care in the end of their lives. This situation is violates their constitutional rights to health, life, honor and dignity. Palliative care is aimed primarily at alleviating pain and painful symptoms, and includes social, psychological and moral support that enables the patient to maintain the most fulfilling and active life until her last day. In addition, it includes a support system for near patient to help them cope with the loss when it will happen. ; Стаття присвячена розгляду політико-правових проблем надання паліативної та хоспісної допомоги інкурабельним хворим в Україні. Автором були розглянуті основні поняття в цій сфері («інкурабельний хворий», «паліативна допомога», «хоспіс», «паліативна політика»), зроблений огляд нормативно-правової бази, яка регулює цю сферу в Україні. Кожна людина сподіваються на добру смерть, чи, якщо бути точнішими, на «добре життя до самого кінця». На жаль, це відбувається не з кожним. Багато людей змушені проходити в кінці свого життя через біль та страждання. Мета паліативної допомоги полягає в запобіганні стражданню та полегшені стану пацієнта, який страждає невиліковною хворобою – шляхом активного медичного втручання з метою зняття больових синдромів, та наданням адекватного лікування, яке дозволить збалансувати ці синдроми протягом доби. На жаль, Україна є країною з низьким індексом «якості смерті», через відсутність політичної волі, недосконалість законодавчої та нормативно-правової бази, практичну відсутність фінансування, а також інформаційне замовчування цієї теми. Всі ці фактори створюють ситуацію, коли тисячі громадян України щодня потерпають від страждань, не отримуючи належної паліативної допомоги, що призводить до порушення реалізації їх конституційних прав на охорону здоров'я, життя, честь і гідність, а також підриву довіри суспільства до політичної влади в країні, яка вважає таку ситуацію «нормальною». Паліативна допомога спрямована, перш за все, на ослаблення болю та болісних симптомів, а також включає в себе соціальну, психологічну і моральну підтримку, що надає можливість хворому зберегти максимально повноцінне та активне життя до останнього її дня. Крім того, вона включає в себе систему підтримки для близьких хворого, щоб також допомогти їм справитися з його втратою, коли це відбудеться. В статті наголошується, що тематика паліативної та хоспісної допомоги, як правило, ігнорується науковцями політологами та є недостатньо дослідженою ними. Також в роботі окреслені основні напрями, в яких, на нашу думку, має розвиватися паліативна політика України на сучасному етапі її розвитку.
The article deals with the political and legal problems of palliative and hospice care for incurable patients in Ukraine. The author considered the basic concepts in this area («incurable patient», «palliative care», «hospice», «palliative policy»), analyzed the legal framework for hospice care in Ukraine. The author notes that all people hope for a good death, or rather, «a good life to the very end». Unfortunately, this doesn't happen to everyone. Many people have to be in pain and suffering at the end of their lives. The goal of the palliative care is to prevent suffering and to alleviate the condition of the patient suffering from an incurable disease – by active identification of syndromes, like pain, and by providing adequate treatment that will balance the syndromes as much as possible during day and night. Public engagement and policy interventionsto improve the quality of death through the provision of high quality palliative care have gained momentum in recent years, and some countries have made greatstridesin improving affordable accessto palliative care. Unfortunately, Ukraine is a country with a low index of «quality of death», due to lack of political will, imperfection of legislative and regulatory framework, practical lack of funding, as well as informational silence on this topic. So thousands of Ukrainian's citizens today do not receive any palliative care in the end of their lives. This situation is violates their constitutional rights to health, life, honor and dignity. Palliative care is aimed primarily at alleviating pain and painful symptoms, and includes social, psychological and moral support that enables the patient to maintain the most fulfilling and active life until her last day. In addition, it includes a support system for near patient to help them cope with the loss when it will happen. ; Стаття присвячена розгляду політико-правових проблем надання паліативної та хоспісної допомоги інкурабельним хворим в Україні. Автором були розглянуті основні поняття в цій сфері («інкурабельний хворий», «паліативна допомога», «хоспіс», «паліативна політика»), зроблений огляд нормативно-правової бази, яка регулює цю сферу в Україні. Кожна людина сподіваються на добру смерть, чи, якщо бути точнішими, на «добре життя до самого кінця». На жаль, це відбувається не з кожним. Багато людей змушені проходити в кінці свого життя через біль та страждання. Мета паліативної допомоги полягає в запобіганні стражданню та полегшені стану пацієнта, який страждає невиліковною хворобою – шляхом активного медичного втручання з метою зняття больових синдромів, та наданням адекватного лікування, яке дозволить збалансувати ці синдроми протягом доби. На жаль, Україна є країною з низьким індексом «якості смерті», через відсутність політичної волі, недосконалість законодавчої та нормативно-правової бази, практичну відсутність фінансування, а також інформаційне замовчування цієї теми. Всі ці фактори створюють ситуацію, коли тисячі громадян України щодня потерпають від страждань, не отримуючи належної паліативної допомоги, що призводить до порушення реалізації їх конституційних прав на охорону здоров'я, життя, честь і гідність, а також підриву довіри суспільства до політичної влади в країні, яка вважає таку ситуацію «нормальною». Паліативна допомога спрямована, перш за все, на ослаблення болю та болісних симптомів, а також включає в себе соціальну, психологічну і моральну підтримку, що надає можливість хворому зберегти максимально повноцінне та активне життя до останнього її дня. Крім того, вона включає в себе систему підтримки для близьких хворого, щоб також допомогти їм справитися з його втратою, коли це відбудеться. В статті наголошується, що тематика паліативної та хоспісної допомоги, як правило, ігнорується науковцями політологами та є недостатньо дослідженою ними. Також в роботі окреслені основні напрями, в яких, на нашу думку, має розвиватися паліативна політика України на сучасному етапі її розвитку.
The article of record as published may be found at https://doi.org/10.1177/027507h4t0tp1s6:/6/d8o2i.8o6rg8/ ; This study sheds light on the effects of policies that introduce competition into the marketplace of the provision of government services. The outcomes indicate that both nonprofit and government market share in a state are negatively affected by for- profit entry, a substitution relationship. The framing of the article in the New Public Management era and the Balanced Budget Act (BBA) of 1997 provides context in which to assess the policy consequences in hospice care. Given the budgetary challenges and growing cost of health care, this analysis begins a discussion of the effects of for-profit entry into the provision of government services, providing a glimpse into what the future holds for hospice care in the reforms of the Affordable Care Act (ACA) of 2010.
The article of record as published may be found at http://dx.doi.org/10.1177/027507h4t0tp1s6:/6/d8o2i.8o6rg8 ; This study sheds light on the effects of policies that introduce competition into the marketplace of the provision of government services. The outcomes indicate that both nonprofit and government market share in a state are negatively affected by for-profit entry, a substitution relationship. The framing of the article in the New Public Management era and the Balanced Budget Act (BBA) of 1997 provides context in which to assess the policy consequences in hospice care. Given the budgetary challenges and growing cost of health care, this analysis begins a discussion of the effects of for-profit entry into the provision of government services,providing a glimpse into what the future holds for hospice care in the reforms of the AffordableCare Act (ACA) of 2010.
The Korean government has implemented a pilot project that introduces a new type of hospice care program called "Consultative Hospice Care" (COHC) since August 2017. The COHC is a new type of hospice program for terminally ill patients in acute care wards, which is different from the Independent Hospice Unit (IHU) care. This study aimed to compare the characteristics of two groups of hospice patients: COHC care only and both IHU care and COHC groups. Healthcare claim data from 1 April 2018 to 31 March 2020 were retrieved from the HIRA data warehouse system. The main outcome variable was patients receiving COHC only or both COHC and IHU care. The total number of hospice patients was 6482. A multivariate logistic regression analysis was used. Of 6482 hospice care recipients, 3789 (58.5%) received both COHC and IHU care. Those who received both COHC and IHU care were significantly associated with several factors: period from the first evaluation to death (adjusted odds ratio (aOR), 1.026; 95% confidence internal (CI), 1.024–1.029; p < 0.0001), disease severity measured by the Charlson Comorbidity Index (aOR, 1.032; CI, 1.017–1.047; p < 0.0001), consciousness (aOR, 3.654; CI, 3.269–4.085; p < 0.0001), and awareness of end-stage disease (aOR, 1.422; CI, 1.226–1.650; p < 0.0001). The COHC program had a critical role in hospice delivery to terminally ill patients. Policymakers on hospice care need to establish plans that promote efficient hospice care delivery systems.