Thesis on "Long-Term Care"

r />The first hospice programs in North America operated in the 70s in New Haven, Connecticut and in northern California (Wexler & Frey, 2004). Health professionals gradually accepted the concept of death with dignity. Quality care at the end of life soon merged with grief counseling and bereavement care. The government stepped in to contain health-care costs when reimbursement for inpatient hospitalization was substantially reduced. Home-based hospice care also became popular as a more inexpensive alternative to hospitalization or care in a nursing facility (Wexler & Frey).

The hospice concept was not immediately accepted by conventional health professionals (Wexler & Frey, 2004). The concept emphasizes caring more than curing. It also allows interaction with complementary and alternative medicine practitioners. In response to the situation, the Academy of Hospice Physicians was organized in 1988 in order to cultivate interest in hospice care among medical specialists and address their concerns surrounding the practice (Wexler & Frey).

Services, Clients hospice's primary function or service is to enable the patient and his family to accept death as a natural part 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 regularly and before they are needed. The intention is to prevent 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 greatest degree possible (Wexler & Frey).

A second major service of a hospice is to relieve physical, psychological, emotional and spiritual discomfort to the patient's family and others close associates (Wexler & Frey, 2004). It relies on members of the clergy, pastoral counselors, social workers, psychiatrists, massage therapists and other trained 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 control of symptoms and in improving the patient's well-being. A 2002 study conducted on the inclusion of such therapies showed that patients who received 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 treatment 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 services they received (Carlson, 2007). It revealed that 22% of them received five major palliative care services, which varied among the hospices. These palliative care services were nursing care, physician care, medication management, psychological care, and caregiver support. Approximately 14% of the hospices provided all five services and 33% provided only one or two services. Only 59% of these patients received medication management services. These included administering medication, dispensing correct dosages, and setting and following dosage schedule.

Growth Projections

The National Hospice and Palliative Care Organization 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 Control 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. Most programs offer both 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 Organization reported that more than 4,100 hospice programs were operating nationwide (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 growing 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 same period. Despite this statistical increase, the hospice market has yet to be substantially tapped. Of the approximately 2 million apparent deaths in 2003, only 710,000 were in hospice. But new government regulations in the 80s boosted the growth of hospices. These regulations allowed hospice providers into assisted living centers and nursing facilities. Since their exposure to the patients, the industry became a more attractive enterprise. The hospice concept has grown from a voluntary 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 Approaches

Hospices operate on thin investment margins of only 8 to 12% on the average and receive Medicare payments of only $125 per day per patient for routine home care (Marshall, 2007). They are lucky to have 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).

Most hospices require physicians to estimate that the patient is unlikely to survive to six months (Wexler & Frey, 2004). This intention is to maintain Medicare eligibility. This disqualifies terminal patients with uncertain prognoses, the homeless and isolated patients. Moreover, health care costs constrain patients to limit their stay in hospices. The shortened stay reduces the chance and time for pastoral and psychological counselors to help the patient and the family to deal with the situation effectively (Wexler & Frey). Short stay also incurs more and more costly care (Solnik, 2002). Medicare and private insurers pay per diem, which means that reimbursements remain the same and hospices must cover the rest of the expenses. Furthermore, the patient may not need much care at times and that increases the delivery cost per day. But hospices realize they have to live with this reality (Solnik).

Other problems arise when staying too long in a hospice (Solnik, 2002). Prior to admission, two physicians must agree that the patient probably has six months or less to live. The patient must also agree to replace 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 money because of the treatment modes applied to end-of-life care. Regulations must cover all the expenses incurred in all the stages of… READ MORE