Hospice Today

The National Quality Forum (2006) definition of hospice care

Hospice is a patient service delivery system that provides palliative care for patients who have a limited life expectancy and require comprehensive biomedical, psychosocial, and spiritual support as they enter the terminal stage of an illness or condition. It also supports family members coping with the complex consequences of illness, disability, and aging as death nears (p.3). In 2014, approximately 1.6 to 1.7 million people received hospice services (NHPCO, 2015).

Hospice care team

Hospice care is provided by a coordinated team of health care professionals, caregivers and family/friends all focused on the comfort needs and care preferences of the patient. The health care team members communicate regularly to adjust the plan of care to meet the changing needs and preferences of the patient and to promote therapeutic family participation. Health care team professionals will usually include:

Hospice clients

Hospice is a program of care for the terminally ill patient, regardless of the type of illness. According to the National Hospice and Palliative Care Organization in 2014 a cancer diagnosis made up 36.6% of all patients in hospice programs. Non-cancer diagnoses were 63.4%. The most common non-cancer diagnoses were dementia (14.8%), heart disease (14.7%), lung disease (9.0%), and stroke or coma (6.4%). (http://www.nhpco.org/sites/default/files/public/Statistics_Research/2015_Facts_
Figures.pdf )

Hospice provides palliative care focused on management of symptoms caused by a terminal illness. Symptoms treated by palliative care can include: pain, nausea, GI upsets, excessive secretions and so forth. The patient care approach is on support and comfort, not on curing the terminal illness. The emphasis is caring for the ‘whole person’ including physical, emotional, social and spiritual care.

In a study by the Pew Research Center (2013) while 57% of adults would prefer to stop treatment so they could die if they had an incurable, painful disease, 35% would tell their doctors to do everything to save their lives. The remaining 8% were uncertain. It is important for health professionals to provide information about hospice while respecting the preferences of the patient.

When an illness has advanced beyond the possibility of a cure, research has shown that early enrollment in hospice care helps patient live longer with better quality of life (Connor, Pyenson, Fitch, Spence & Iwasaki, 2007). Other benefits include assistance for the family that may decrease complicated bereavement and increase preparation for the death of a loved one. Nilsson et al. (2011) found younger patients who were white, without a DNR order and in the ICU during the last week of life had the worse quality of life at the end of life. Patients who reached a feeling of inner peace and were cared for by an oncologist who saw them as a person were more likely to have a better quality of life.

Core Components of Quality End-of-Life Care

The Institute of Medicine (IOM, 2015) authors list the following as core components of quality end of-life care:

  1. Frequent assessment of the patient’s physical, emotional, social, and spiritual well-being
  2. Management of emotional distress
  3. Referral to expert-level palliative care
  4. Referral to hospice if the patient has a prognosis of 6 months or less
  5. Management of care and direct contact with patient and family for complex situations by a specialist- level palliative care physician
  6. Round-the-clock access to coordinated care and services
  7. Management of pain and other symptoms
  8. Counseling of patient and family
  9. Family caregiver support
  10. Attention to the patient’s social context and social needs
  11. Attention to the patient’s spiritual and religious needs
  12. Regular personalized revision of the care plan and access to services based on the changing needs of the patient and family

Hospice Quality Reporting

Section 3004 of the Patient Protection Affordable Care Act, 2010, requires that all Medicare certified hospices submit quality of care data to the Centers for Medicare and Medicaid Services (CMS). Hospice providers that fail to meet reporting requirements will receive a 2-percentage point reduction in reimbursement. The CMS uses this data to calculate quality compliance with measures endorsed by the National Quality Forum (NQF).

The current quality measures include: