Hospice care is the provision of care, maintaining quality life and comfort for clients suffering from terminal illness, who are facing end-of-life issues. The term “hospice care” comes from “hospes” (Daniels & Daniels, 2004) and was used in earlier times to describe the place of rest for weary travelers. First hospice care center was created by Dr. Cecily Saunders in 1967 near London; this hospice was called St. Christopher’s Hospice (Daniels & Daniels, 2004). In the US, the movement of hospice care started in 1974, when a home care program in Connecticut was launched (Kuebler, Davis & Moore, 2005).
Hospice care involves supportive and palliative services, and is focused on non-curative care rather than on aggressive therapy or treatment. The clients are allowed to choose the setting, and more than 80% of hospice care programs are home-based or take place in nursing homes (Kuebler, Davis & Moore, 2005). In the US, hospice care has evolved into a separate part of the healthcare system, this type of care is almost fully covered by Medicare; Medicaid and other insurance plans also cover a significant portion of hospice care costs. The number of hospice centers and sites is increasing at the approximate rate of 3.5% per year (Daniels & Daniels, 2004), and more than 34% of dying people use the services of hospice care (Daniels & Daniels, 2004). This type of care provides not only medical services, but also emotional support for dying people, and often helps the families of these people to manage the challenges and care about their loved ones in the best way.
The services of hospice care might include basic medical care, provision of necessary equipment and supplies, support and counseling for the patients and family members, volunteer support, and guidance on dealing with the end-of-life issues. Hospices are funded from governmental programs or private insurance sources (depending on what the patient uses), by public donations and grants provided by charitable foundations (Green & Bowie, 2010).
Reimbursement of hospice care expenses comes from healthcare insurance programs for terminally ill patients. There are regulations for hospice care centers related to what services should be provided to the patients and their families. Medicare, Medicaid and private insurance programs pay for hospice care expenses on a per diem basis (Green & Bowie, 2010); the only exception is the continuous home nursing care services, which are paid on a per-hour basis. Certain nonprofit hospices can provide free hospice care to patients without a healthcare insurance plan as part of their charitable mission. Visits to physicians and care plan oversight services, according to Medicare, are billable per diem under Medicare Part A and directly billable under Medicare Part A (Green & Bowie, 2010).
Hospice care has many advantages: professional interdisciplinary help, availability of 24/7 care teams, coverage of hospice care expenses by common healthcare insurance plans, and possibilities to avoid aggressive hospitalization, procedures and treatments (Kuebler, Davis & Moore, 2005). However, there also are disadvantages of hospice care, mostly associated with the methods of funding of hospice care programs. Since there is a flat daily rate of funding, according to Medicare, it means that medical expenses and the choice of procedures are the responsibility of the hospice agency.
Such procedures as diagnostic tests might not be approved in all necessary cases because they are expensive (Kuebler, Davis & Moore, 2005); hospitalizations might be discouraged for financial purposes, and the patients of hospice care are not usually allowed to participate in clinical trials or experimental treatments. Certain life-prolonging procedures might also not be allowed at hospice care agencies. These disadvantages do outweigh the advantages of hospice care for many patients, and the choice between hospice care and frequent hospitalizations depends on the awareness of the patient and on the reputation of the hospice agency.
Daniels, R. & Daniels, R. (2004). Nursing fundamentals: caring & clinical decision making. Cengage Learning.
Green, M.A. & Bowie, M.J. (2010). Essentials of Health Information Management: Principles and Practices. Cengage Learning.
Kuebler, K.K. & Davis, M.P. & Moore, C.D. (2005). Palliative practices: an interdisciplinary approach. Elsevier Health Sciences.