Hospice care in the United States is a type of care and a philosophy of care which focuses on the palliation of a terminally ill patient's symptoms. These symptoms can be physical, emotional, spiritual or social in nature. The concept of hospice as a place to treat the incurably ill has been evolving since the 11th century and entered the United States in the 1970s in response to the work of Cicely Saunders in the United Kingdom. Since its first establishment, the industry has rapidly expanded. In the United States, it is distinguished by more extensive volunteerism and a greater emphasis on the patient's psychological needs in coming to terms with dying.
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 2007, hospice treatment was utilized by 1.4 million people in the United States. More than one-third of dying Americans utilize the service. However, common misperceptions regarding the length of time a patient may receive hospice care and the kinds of illnesses covered may result in hospice being underutilized. Although most hospice patients are in treatment for less than thirty days, care may extend beyond six months so long as a patient's condition continues to merit such medical outlook. 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. Generally, treatment is not diagnostic or curative, although the patient may choose some treatment options intended to prolong life, such as CPR. Most hospice services are covered by Medicare or other providers, and many hospices can provide access to charitable resources for patients lacking such coverage.
Care may be provided in a patient's home or in a designated facility, such as a nursing home, hospital unit or freestanding hospice, with level of care and sometimes location based upon frequent evaluation of the patient's needs. The four primary levels of care provided by hospice are routine home care, continuous care, general inpatient and respite care. Patients undergoing hospice treatment may be discharged for a number of reasons, including improvement of their condition and refusal to cooperate with providers, but may return to hospice care as their circumstances change. Providers are required by Medicare to provide to patients notice of pending discharge, which they may appeal.
History and statistics
The first hospices are believed to have originated in the 11th century when for the first time the incurably ill were permitted into places dedicated to treatment by Crusaders. 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. But the hospice practice languished until revived in the 17th century in France by the Daughters of Charity of Saint Vincent de Paul and, later, by the Irish Sisters of Charity, who opened St Joseph's Hospice in London, England in 1902. It was there in the 1950s that Cicely Saunders, who later founded St Christopher's Hospice in London, developed many of the foundational principles of modern hospice care.
In 1971, Hospice, Inc. was founded in the United States, first bringing the principles of modern hospice care to that country. Throughout the 1970s, the philosophies of hospice were being implemented throughout the United States. The hospice movement in the United States soon distinguished itself from that in Britain, according to Stephen Connor's Hospice: Practice, Pitfalls and Promise , by "a greater emphasis on use of volunteers and more focus on psychological preparation for death". Medicare, a social insurance program in the United States, added hospice services to its coverage in 1982. On September 13, 1982, by request of the senate, US President Ronald Reagan proclaimed the week of November 7 through November 14, 1982, as National Hospice Week.
Since then, the hospice industry has rapidly expanded. By 1995, hospices were a $2.8 billion industry, with $1.9 billion from Medicare alone funding patients in 1,857 hospice programs with Medicare certification. In that year, 72% of hospice providers were non-profit. By 1998, there were 3,200 hospices either in operation or under development throughout the United States and Puerto Rico, according to the National Hospice and Palliative Care Organization (NHPCO). 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. In 2007, 1.4 million people in the United States utilized hospice, with more than one-third of dying Americans utilizing the service, approximately 39%. In 2008, Medicare alone, which pays for 80% of hospice treatment, paid $10 billion to the 4,000 Medicare-certified providers in the United States.
As the hospice industry has expanded, so, too, has the concept of hospice care. 2003 saw the opening of the first US children's hospice facility, the George Mark Children's House Hospice in San Francisco. 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."
Philosophy and practices
The goal of all hospice agencies in the United States is to provide comfort to the patient. How comfort is defined is up to the patient or, if the patient is incapacitated, the patient's family. This can mean freedom from physical, emotional, spiritual and/or social pain. Hospices typically do not perform treatments that are meant to diagnose or cure an illness, and they do not seek to hasten death or, primarily or unduly, to extend life. While it is not required that patients sign "Do not resuscitate" orders to be on hospice, some hospices do require them as a condition of acceptance. Many hospice patients, though not all, have made decisions not to receive CPR should their heart or breathing stop. If a patient does decide to request CPR, that service may not be provided by the hospice; the family may need to contact Emergency Medical Services to provide CPR. The decision not to extend life as well as the pulling back of diagnostic or curative treatments is often the greatest barrier for patients in accepting hospice care; it can also create conflicts in medical professionals attempting to provide it.
Some confusion exists as to what treatments a patient may receive and still qualify for 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. Determination of appropriate treatment is made on a case-by-case basis.
Another aspect of the hospice philosophy is the patient-centered care they provide. As the focus throughout the United States has shifted from provider-centered care, many healthcare agencies market themselves as patient-centered; for hospice, this patient-directed care is integral and interwoven throughout the care which is provided, and Medicare regulations reflect this philosophy.
Hospice demographic
In order to qualify for hospice care, a patient must have certification from two physicians that he or she has less than six months to live if his or her disease runs its natural course; usually the patient's primary physician and the Hospice Medical Director will provide this certification. Patients can and do stay on hospice longer than six months, and as long as the hospice team continues to certify with supporting evidence that the patient is terminal, insurance companies will usually continue to pay for hospice care.
Many physicians are slow to refer to hospice care, waiting until they are absolutely certain of a terminal prognosis. Some physicians believe that the patient must have a six month prognosis or less to receive hospice care, while others are overly optimistic in their assessment of prognosis, presuming treatment will be more effective than it is. As a result, the majority of patients are referred to hospice in the very end-stages of their diseases. The average length of stay in hospice before a patient dies was 26 days in 1994, but only 19 days in 1998. Although these numbers have since increased, the term of care continues to be underutilized, with an average length of stay in 2004 of 57 days and a median length of 22 days. 33% of hospice patients admitted in 2004 died within seven days of admission. Such late admission is inconsistent with the process of hospice, which requires time for patients and family members to develop relationships with the hospice team.
A misperception regarding hospice is that only individuals suffering from cancer or AIDS can receive hospice care. Hospice in the United States did evolve around the model of cancer care, with its predictable pattern of deterioration, and according to 2002's The Case Against Assisted Suicide: For the Right to End-of-life Care , "60% of hospice patients have cancer and many of the rest have AIDS". However, patients can be on hospice for cancer, end-stage heart and lung diseases, stroke, renal failure, Alzheimers or many other conditions. Any diagnosis that would be an accepta
hospice definition of hospice in the Free Online Encyclopedia.
hospice, program of humane and supportive care for the terminally ill and their families; the term also applies to a professional facility that provides care to dying patients who ...
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hospice - Dictionary definition and pronunciation - Yahoo! Education
Find dictionary definitions, audio pronunciations, and spellings for hospice in the free online American Heritage Dictionary on Yahoo! Education
hospice - Medical Definition
A program or facility that provides palliative care and attends to the emotional, spiritual, social, and financial needs of terminally ill patients at a facility or at a patient's ...
hospice - Definition of hospice at YourDictionary.com
noun. a place of shelter for travelers, esp. such a shelter maintained by monks; a home for the sick or poor; a homelike facility to provide supportive care for terminally ill ...
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Providing care and support for people in last phase of terminal illness, We at AmHeart Hospice believe the end of life can be a meaningful time for patients and their loved ones.
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hos·pice (h s p s) n. 1. A shelter or lodging for travelers, pilgrims, foundlings, or the destitute, especially one maintained by a monastic order.
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Hospice Definition
Short definition of Hospice. ... Definition: A model of care that focuses on relieving symptoms and supporting patients with a life expectancy of six months or less.