Hospice care in the United States
In the United States, it is distinguished by extensive use of volunteers and a greater emphasis on the patient's psychological needs in coming to terms with dying.
Under hospice, medical and social services are supplied to patients and their families by an interdisciplinary team of professional providers and volunteers, who take a patient-directed approach to managing illness.
With practices largely defined by the Medicare system, a social insurance program in the United States, and other health insurance providers, hospice care is made available in the United States to patients of any age with any terminal prognosis who are medically certified to have less than six months to live.
In such countries, the term hospice is more likely to refer to a particular type of institution, rather than specifically to care in the final months or weeks of life.
The first hospices are believed to have originated in the 11th century, when for the first time the terminally ill were permitted into places dedicated to treatment by Crusaders.
[1] In the early 14th century, the order of the Knights Hospitaller of St. John of Jerusalem opened the first hospice in Rhodes, meant to provide refuge for travelers and care for the ill and dying.
[5] In 1982 Medicare, a social insurance program in the United States, added hospice services to its coverage.
[7] According to 2007's Last Rights: Rescuing the End of Life from the Medical System, hospice sites are expanding at a national rate of about 3.5% per year.
[13] In February 2009, Buffalo News reported that the balance of non-profit and for-profit hospices was shifting, with the latter as "the fastest-growing slice of the industry.
[14] The goal of hospice agencies in the United States is to provide comfort to the patient and heighten quality of life.
Hospices typically do not perform treatments that are meant to diagnose or cure an illness,[16] and they do not seek to hasten death or, primarily or unduly, to extend life.
[24] The principle of not extending life and withdrawing diagnostic or curative treatments is often the greatest barrier for patients in accepting hospice care.
Hospices may provide treatments that have been traditionally regarded as curative, including radiation therapy or antibiotics, if these are administered to improve quality of life.
[31] In order to qualify for hospice care, patients must have certification from two physicians that they have less than six months to live if their disease runs its natural course.
Hospice in the United States developed around the model of cancer care, with a relatively predictable pattern of deterioration.
"[40] But, patients can be on hospice for numerous other illnesses, such as end-stage heart and lung diseases, stroke, renal failure, Alzheimers, or many other conditions.
At the end of these two benefit periods, the hospice team will evaluate whether or not the patient continues to have a prognosis of less than six months to live.
[46] The primary diagnosis for children in hospice treatment is cancer, but, like the adult population, children may enter hospice for a variety of conditions, including AIDS, prematurity, congenital disorder, cerebral palsy, cystic fibrosis, or "death-inducing trauma", such as automobile accidents.
Insurance providers may restrict access to hospice care to pediatric patients undergoing life-extending treatment.
[49] The cost of hospice care may be met by health insurance providers, including Medicare or Medicaid for eligible Americans.
Hospice is covered 100% with no co-pay or deductible by Medicare Part A except that patients are responsible for a copay for outpatient drugs and respite care, if needed.
[17] Interdisciplinary team members supply a variety of services during routine home care, including offering necessary supplies, such as durable medical equipment, medications related to the hospice diagnosis and incidentals like diapers, bed pads, gloves, and skin protectants.
[63] Typically this is provided after normal business hours by a registered nurse prepared to address urgent patient concerns.
[61] Once a patient is on continuous care, the hospice provides services in the home a minimum of eight hours a day.
[65] General inpatient criterion is for patients who are experiencing severe symptoms which require daily interventions from the hospice team to manage.
[60] Often, patients on this level of care have begun the "active phase" of dying, when their prognosis is measured in days as opposed to weeks or months.
Although there is a limit to how long Medicare will cover this level of care, it is usually provided for brief periods of time, with five to seven days being the average.
Team members include hospice medical directors, physicians, pharmacists, registered nurses, social workers, counselors, home health aides, and volunteers.
[86] Revocation could be due to hospitalization, if the patient chooses to pursue some type of curative treatment or experiences dissatisfaction with hospice care.
A 2009 study found that with proper case management hospice access could be liberalized without additional costs to insurers.
