Issues in prison hospice: toward a model for the delivery of hospice care in a correctional setting

This paper examines issues in prison hospice care based on the author's nine years experience as a prison hospice worker and trainer and on data gathered by the National Prison Hospice Association (NPHA) from a number of federal and state prison medical facilities with operational or developing hospice programs, including both scatter-bed and hospice unit models, employing inmate hospice volunteers and the services of outside community hospice agencies and volunteers. The paper discusses DNR orders and curative vs. palliative care decisions, pain management, AIDS care, interdisciplinary care teams, staff and volunteer training and supervision, and the need for compassionate early release and community placement programs. The author proposes a set of preliminary guidelines for the delivery of hospice care in the correctional setting.     

Hospice the adjective, not the noun: The future of a national priority.

Reviews the development of the hospice movement and examines some current policy issues relating to hospice care, such as who is eligible for such care. Two issues related to who can receive hospice services are explored: the requirement for a lay primary caregiver and the diagnosis requirement for admission. Possible roles for psychologists as providers and researchers are considered, and the cognitive and personality behaviors of hospice patients are discussed. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hospices: Perspectives on the public policy debate.

The public policy debate on hospice care centers on the appropriate mix of medical and supportive services for terminal cancer patients and how such services should be paid for within existing insurance programs. Past decisions to change health care reimbursement that are applicable to the hospice debate are reviewed, the benefits and costs of hospice care are examined, and the role of research in the formulation of social policy is discussed. (36 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A federal role in hospice care?

Discusses the advantages of hospice care for dying patients and how the federal government should support such care. Support could include the use of restricted drugs (such as heroin) to relieve pain in terminal illness, the allowance of Medicare patients to transfer their coverage from hospital to hospice if they so choose, and the initiation of a meaningful debate on the appropriate federal role in hospice funding and support. Current bills pending in Congress that concern such measures are described. (1 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

To supplant, supplement or support? Organisational issues for hospices

This paper provides an analysis of organisational issues in palliative care. Palliative care services have spread to many parts of the world and in the process have adapted to the context in which they are situated. This analysis draws on data from a small study of 18 hospices in the North Island of New Zealand. Key informants were interviewed about the organisation of health care workers, the range and nature of services offered and use of volunteers. Data collection and analysis were guided by the methodological principles of qualitative evaluation. Four main types of hospice were identified; (1) in-patient units with medical staff, (2) nurse led services, (3) volunteer led services which employed no health professionals and (4) hospital based palliative care teams. This paper proposes a conceptual analysis of the role of hospices in health care around three major issues: to supplant, supplement or support. Comparisons are drawn between the development and organisation of British and New Zealand hospices.     

Ethics in hospice care.

Discusses 4 ethical issues that arise in hospice care: (1) What are the ethical responsibilities to the patient, family, and authorities when hospice workers discover that a patient has been given incompetent and shoddy care at a previous institution? (2) Hospices that advertise themselves as offering complete care should be prepared to deal with psychological and legal issues as well as medical ones. (3) The idea of treating the entire person must include responding to the likelihood that the patient and family may raise profound philosophical and religious questions. (4) Hospice staff should periodically examine themselves on a spiritual or philosophical level. (3 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Comparison of the high-tech service delivery experiences of hospice and non-hospice home health providers

This study examined the degree to which national samples of hospice and non-hospice home health care agencies (N = 154) present different organizational profiles and grapple with different patient capacity issues when delivering technology-enhanced services to incapacitated elderly. Hospice agencies employ more part-time staff, make more in-home visits, see more high-tech patients, and provide a wider range of high-tech services than non-hospice providers. Factor analysis of index data confirms that hospice staff have more experience (p < .05) addressing the legal/ethical dimensions of care. Specifically, hospices deal with "right to die" issues more often (p < .05), but not with "delegation of authority" and "patient rights" issues. More agencies of both types have policies for handling decisions about life-sustaining treatment than for dealing with patients having questionable decision-making capacity. Needed agency policies for dealing with limited patient decision-making capacity in hospice and non-hospice home care agencies are reviewed.     

Professional psychology's role in hospice care.

This article explores the existing and potential contributions that professional psychology brings to the growing hospice movement. It explores hospice care's unique philosophy in treating dying patients and their families and provides a psychologically based justification for this philosophy. To do so, the author draws on the literature of health psychology, behavioral medicine, and thanatology (death studies). The article ends with a discussion of recent developments in hospice care that provide expanding opportunities for professional psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differentiating recruitment strategies for direct patient care, clerical, and fundraising hospice volunteers

A survey of direct patient care and nondirect patient care volunteers in two hospice programs generated information about various aspects of their volunteer experience. This paper focuses on the effectiveness of identified recruitment strategies for direct patient care, clerical, and fundraising volunteers. People learned about the opportunity to volunteer at hospice most frequently from personal experiences, friends, and newspapers. Significantly more direct patient care volunteers learned about the volunteer opportunity through newspaper feature stories than did nondirect volunteers. Friends recruited significantly more fundraising volunteers than direct patient care or clerical volunteers. The events triggering direct care and clerical volunteers to serve were most often personal experiences, whereas friends appear to have triggered direct care and fundraising volunteers to serve.     

Characterization of antigenic epitopes in anti-ulcer pectic polysaccharides from Bupleurum falcatum L. using several carbohydrases

This paper traces the development and evaluation of day care hospice provision through analysis of the available literature. The CD-ROM was utilized to access and review the Medline, CINAHL and Healthstar databases. In addition, a hand search of Progress in Palliative Care was conducted. The literature describes the provision of a service within a day hospice, and access to day hospice services. Issues regarding the provision of a day hospice as a mechanism to meet consumer needs are explored. The literature reveals little evaluation of evidence-based practice or of the cost-effectiveness of day hospice provision. There is a dearth of research relating to day care, evaluation studies in particular. It is clearly important that future research compares outcomes with other models of service provision.     

Feasible criteria for enrolling end-stage dementia patients in home hospice care

Hospice care is considered appropriate for end-stage dementia patients (Luchins & Hanrahan, 1993), yet less than 1 percent of hospice patients have a primary diagnosis of dementia (Hanrahan & Luchins, 1995). This pilot study tested the feasibility of providing palliative care for dementia patients. A common eligibility requirement for admission to hospice is that the patient is likely to die within six to seven months. The uncertain survival time of dementia patients thus prevents access to hospice programs. Therefore, enrollment criteria were developed based on the characteristics of advanced dementia and a history of medical complications. With these criteria established, it was then possible to enroll 11 patients over two years. The enrollment criteria proved successful in that the median survival time was five months, with an average of seven months. Eight of the 11 patients died during the study. Hospice care was well accepted by family caregivers and appeared to meet the patient's needs.     

The Sacred Circle: a conceptual framework for spiritual care in hospice

Hospice care has consistently recognized the need to integrate spiritual care into holistic plans of care for dying patients and their families. Designing and implementing spiritual care interventions can be potentially difficult for hospice practitioners who have not had specific training in theology or pastoral care. Matthew Fox, a theologian, has developed a model of spiritual development that utilizes an ecumenical, ethical framework that can be directly applied to the care of hospice patients and families. This model employs a Sacred Circle approach that begins with an emphasis upon the sense of awe and wonder (the Via Positiva), moves into the next cycle by recognizing problems and negative emotions (the Via Negativa), that then flows into the creative solutions to problems (the Via Creativa), which finally transforms the problem into a new level of understanding (the Via Transformativa).     

Differential utilization of hospice services in nursing homes

During the completion of an interpretive evaluation project, differences in rates of dying patients using hospice services between nursing homes were examined. Rates were found to vary from 2% to 39% in 23 nursing homes owned by one company. Twenty of the 23 administrators responded to a survey regarding attitudes toward hospice care in the nursing home. Nursing homes with administrators most sympathetic to hospice care had rates three times higher than nursing homes with administrators least sympathetic. Specific concerns were discussed in interviews with four of the least sympathetic administrators. The findings are congruent with program implementation theory which describes the discretionary power of local administrators to limit access to new programs that they find problematic.     

Meeting the social service needs of persons with AIDS: hospices' response

A national sample of 148 directors of hospice social service departments (or persons most familiar with the delivery of social services in the hospice) participated in an exploratory study investigating the effects of the acquired immune deficiency syndrome (AIDS) epidemic on the delivery of hospice social services. Findings suggest, as does the literature, that the psychosocial needs of persons dying from AIDS present different challenges than those of traditional hospice patients. Furthermore, the results indicate the need for greater collaborative efforts among community agencies as well as specific and ongoing training for staff and volunteers who work with persons with AIDS (PWAs). Implications for the delivery of hospice social services to this population are discussed.     

Advances in hospice care

Hospice care developed in part as a reaction to the impersonal and technology-dependent end-of-life care offered by modern medicine. Unique approaches to care that emphasize interdisciplinary team management of troublesome symptoms and the promotion of quality of life as defined by the patient, are finding their way into all aspects of health care. Symptom control measures have expanded to include chemotherapy, radiation therapy, and multimodal therapies. Both the development of a unique knowledge base and advances in research have fostered the integration of hospice and palliative care into mainstream medicine.     

Barriers to effective palliative care of terminal patients. An international perspective

Barriers to palliative care around the world include: underutilization of and lack of access to opiates; the separation of palliative (hospice) care from the usual health care system in much of the world; cultural barriers to discussing death and dying; and, especially for the developing countries, financial barriers to good palliative care. Palliative care education for health care providers, pain initiatives as well as flexibility and adaptation of palliative care principles to local resources may help overcome these barriers.     

Emergency department-based home care

STUDY OBJECTIVE: To assess the feasibility of coordinating home care services from an inner-city emergency department. INTERVENTION: In a preintervention survey, the home care needs of 650 consecutive patients being discharged from the ED were evaluated. A nurse-coordinator who arranged and managed rapidly deployed home care services then was assigned to the ED for eight months. Patients were referred, and home care services were provided regardless of insurance status. SETTING: Teaching hospital serving a large indigent population. PARTICIPANTS: Adult patients about to be discharged home from the ED. MAIN RESULTS: Forty-five of 650 (7%) surveyed patients were not receiving home care services for which they were eligible. In the subsequent eight-month period, 670 patients were referred for home care on discharge from the ED (2% of all discharges). Seventy-six percent of these patients were women, and the average age was 73.5 years. Four hundred fifty patients (67%) received visits from home care providers managed by the ED coordinator. For 99 of these patients (22%), the availability of rapidly deployed home care services obviated the need for emergency admission to the hospital. Net billings to third-party payers exceeded the costs of the program. CONCLUSION: A significant proportion of elderly patients being discharged from the ED need home health services. Access to rapidly deployed home care services can obviate the need for hospital admission for a select group of debilitated patients. The provision of home care services from the ED is economically feasible.     

Transcranial power mode Doppler duplex sonography of intracranial aneurysms

Recent events have challenged our health system to increase access to and provide high quality care for patients near the end of life. Simultaneously, Medicare is developing review policies to determine eligibility for hospice patients with select noncancer diagnoses. The purpose of this study was to determine whether the proposed policies met one of their chief goals: accurate identification of patients with a less-than-six-months prognosis. Only 35 percent of 104 patients who died within six months of admission to the hospice used for this study, LifePath Hospice, met the Medicare proposed criteria for hospice eligibility. The median and mean survival time of the sample was 14 and 30 days respectively. Based on this review, it is recommended that Medicare alter their proposed review policies and not limit access to hospice eligible patients who desire and are in need of such services.     

Psychologists and hospice: Where we are and where we can be.

Since the early days of the hospice movement, the role of psychologists in hospice care has been discussed. This study is based on questionnaire responses from hospice programs randomly drawn from those who were members of the National Hospice and Palliative Care Organization. The results clearly demonstrate the need for psychology's role in hospice, but there is much to do to clarify and develop this role. Although psychologists have much to offer in the hospice field and end-of-life care in general, this study found that there are not many psychologists actively working in these settings. Suggestions are made for how psychologists can become more involved in the provision of hospice and other end-of-life care. (PsycINFO Database Record (c) 2010 APA, all rights reserved)