Improving access to hospice care: informing the debate

The most frequently cited policy solution for improving access to hospice care for patients and families is to expand hospice eligibility criteria under the Medicare Hospice Benefit. However, the substantial implications of such a policy change have not been fully articulated or evaluated. This paper seeks to identify and describe the implications of expanding Medicare Hospice Benefit eligibility on the nature of hospice care, the cost of hospice care to the Medicare program, and the very structure of hospice and palliative care delivery in the United States. The growth in hospice has been dramatic and the central issue facing policymakers and the hospice industry is defining the appropriate target population for hospice care. As policymakers and the hospice industry discuss the future of hospice and potential changes to the Medicare Hospice Benefit, it is critical to clearly delineate the options--and the implications and challenges of each option--for improving access to hospice care for patients and families.     

Equity of access to adult hospice inpatient care within north-west England

There is a growing debate about the question of equity of access to hospice and palliative care services. Even countries with relatively well developed palliative care systems are considered to have problems of access and inequity of provision. Despite these concerns, we still lack a relevant evidence base to serve as a guide to action. We present an analysis of access to adult hospice inpatient provision in the north-west region of England that employs Geographical Information Systems (GIS). Measures of the possible demand for, and supply of, hospice inpatient services are used to determine the potential accessibility of cancer patients, assessed at the level of small areas (electoral wards). Further, the use of deprivation scores permits an analysis of the equity of access to adult inpatient hospice care, leading to the identification of areas where additional service provision may be warranted. Our research is subject to a number of caveats--it is limited to inpatient hospice provision and does not include other kinds of inpatient and community-based palliative care services. Likewise, we recognise that not everyone with cancer will require palliative care and also that palliative care needs exist among those with nonmalignant conditions. Nevertheless, our methodology is one that can also be applied more generally.     

Coding and reimbursement mechanisms for physician services in hospice and palliative care

Many physicians misperceive that the current coding system used to bill third-party payers in the United States does not include codes related to hospice and palliative care. This article will help physicians and hospice and palliative care providers to: 1) understand how to code for physician services related to hospice and palliative care; 2) review the documentation required to support such services; 3) understand the differences between the reimbursement mechanisms to be used when the patient is enrolled in the Medicare Hospice Benefit, and the usual reimbursement mechanisms; and 4) understand some of the approaches for funding non-physician palliative care services for patients not enrolled in the Medicare Hospice Benefit.     

Children's hospice care

Facing the inevitable death of a child is a difficult reality for many parents and health care providers as well. Children's Hospice International offers a variety of information and education services to support the provision of children's hospice care.     

安宁缓和医疗中的灵性照顾

灵性照顾是安宁缓和医疗实践的核心内容之一.本文以中国医科大学附属盛京医院宁养病房开展灵性照顾的实践经验为基础,阐述了灵性的概念和灵性照顾的意义,以及有效开展灵性照顾的相关要点,供安宁缓和医疗从业人员参考.     

Telenursing in hospice palliative care

During the last months of life, many people with advanced illness will be living in their homes. Coping with changing symptoms, and ultimately preparing for death, becomes part of daily life. Whether the ill person is at home for days or for months, they depend on family or friends to be primary caregivers, supported by home-based services. However, after physician and home health offices close, many patients and their caregivers are left to cope alone. The authors describe an innovative partnership between B.C. NurseLine (a provincial tele-triage and health information call centre), the British Columbia Ministry of Health and Fraser Health Hospice Palliative Care program that created after-hours access to care for dying patients and their families in one of Canada's largest health authorities. The article outlines how information and communications technology enabled merging the capacity and expertise of B.C. NurseLine with the expertise of specialized community-based palliative care services to achieve outcomes of improved symptom management, decreased visits to emergency rooms and enhanced support for families who are caring for loved ones at home. For nurses caring for home-based patients, there are lessons to be learned about how to maximize technology to create systems that both improve access to care and are sustainable in the future.     

Occupational therapy in hospice care

As hospice care becomes more integrated in the overall health care delivery system, the profession of occupational therapy needs to analyze further its potential within this unique system. This article briefly discusses the goals and philosophy of the hospice concept from the perspective of the National Hospice Organization. Occupational therapy intervention in terminal care is examined, with emphasis on locus of control and occupation as determinants in enhancing quality of life for the terminally ill in a nontraditional rehabilitative environment. A brief case study illustrates some of the general principles discussed throughout the article.