Government Regulations Affecting Health Care in Hospice Capstone Project

Excerpt from Capstone Project :

Government Regulations and Hospice

Government Regulations Affecting Health Care in Hospice


Regulations Affecting Health Care in Hospice

Impact of rules on Hospice services

Annotated Bibliography

This paper focuses on how government regulations impact hospice. The paper starts off with an introduction to the hospice system that was revived by a nurse, Cecily Saunders, who then went on to become a physician, establishing one of the first modern hospices. The concept of total pain is explained in some detail. The body of the paper then includes the studies that have been conducted on patients and caregivers in hospice systems as well as on people who died after they were diagnosed with terminal illness resulting in death in six months following the prognosis. The overall conclusion that can be drawn here is that while in Japan there is a marked need for improving the Day hospice system, the American hospice industry is acting as a mature competing industry, which can be detrimental to the quality of services being provided.

The regulations and the changes in laws that affect patients in Medicare insurance in America being targeted are considered in some detail, to outline some issues of particular importance, which are expected to change some of the operations of hospice centers.

Recommendations are put forward, which are expected to help alleviate some issues faced by hospice centers in light of new regulations, as well as in light of the medical advances that make for lesser referrals for hospice systems.

The conclusion looks at the avenue of increasing the integrated services for palliative and curative care, as people have a right to both, and calls for reconsideration of the Medicare clause that disallows a hospice care patient to receive curative care in nursing homes.

Finally the annotated bibliography summarizes the research methodology, conclusion, limitations of the studies cited in this paper, and looks at how they will be useful in order to understand what is lacking in existing literature as well as to add to knowledge regarding hospice care.


The institution of hospice is as old as the Eleventh Century where care was given to the invalid, the travelers as well as pilgrims. The concept was revived again in the 17th century, and more recently in the 1950's by Cicely Saunders who belonged to the nursing profession. Cicely Saunders started a hospice after she took care of a polish refugee, and realized the need for the people who were terminally ill to lead a comfortable life, taking care of them by giving them physical as well as mental comfort.

Cicely Saunders has brought in many new concepts to taking care of patients, by focusing on the needs of the patients themselves, rather than the disease that they have. Saunders was aided in her mission to spread awareness about the inadequate facilities that were there in modern hospitals in America to care for the terminally ill, by Swiss psychiatrist Elisabeth Kubler-Ross who wrote a book titled 'On Death and Dying' in 1965. Their efforts helped to culminate the awareness of inadequacies in the current systems. (Meldrum & Clark, 2000)

In 1979, she worked with other experts in the field to publish her work 'Advances in Pain Research' where she used patient's drawings, some of which depicted being impaled by an iron, along with their case histories and research in order to develop her argument. She also argued that at home hospice care was just as effective as inpatient facility in order for the terminally ill to be able to lead a comfortable life till the end of their days.

Even so, the concept of hospice has been controversial, as people who are unfamiliar with aspects of hospice deem to consider some practices illegal, and question the existence of such institutions. Today, the hospice institutions are certified by Federal and State governments in order to ensure their legal insistence and to regulate them on medicinal and other treatment practices. The key figure in setting hospice systems as legal entities, and developing training facilities for them has been In Dr. Josefina Magno, who in 1984, sat as first executive director of the U.S. National Hospice Organization. She was the main figure who founded the International Association for Hospice and Palliative Care (IAHPC).

This paper will look
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at the laws and regulations affecting the practices of hospice, and how the practices and treatment measures have been impacted by these. The Federal and the state governments have set standards for hospice operations and according to the Social Security Act. Moreover, the U.S. Code of Federal Regulations defines the conditions under which the hospice agencies participate in the Medicare hospice benefit, and the hospices that want to be licensed and certified by the state and be allowed by the Centers for Medicare Services (CMS) to work as part of the Medicare hospice program have to meet the conditions of participation that are set out for them. (Hospice Patients Alliance, n.d.)


There is a variety of studies available on the impact that Hospice has had and how the institution has been able to alleviate the problems that terminally ill patients face in their lives.

According to a variety of studies that have been included as part of this paper, hospice care and palliative care are interrelated aspects, where hospice includes palliative care as well as care given to the patient's family and their loved ones. Palliative care on the other hand, is given to alleviate the physical, mental and spiritual discomfort that occurs to patients who are classified as terminally ill.

The concept of hospice has gained importance in legal avenues and the Federal and State Acts that govern the hospice look at the services and the treatments that can be provided to patients enrolled in hospice programs. Consider for example the rule by Medicare that the patients, who have opted for hospice care for its insurance program, cannot continue to receive curative care, and in signing up for hospice care, they have to forgo treatment.

There also is the concept of integrating palliative care with curative care, but there rise the issues of a conflict of interest between nursing home director initiatives and the hospice program directors. (American Medical Directors Association)

Enrollment in a hospice care involves considerations of various criteria which include the goals and objectives of the caregivers as well as the patient, who might have accepted that prolonging treatment will not elongate their lives. Studies have shown that hospice care whether aggressive or non-aggressive can give comparable or better results compared to patients who are not enrolled in hospice care. (Saito, Landrum, Neville, Ayanian, Weeks, & Earle, 2011)

Another study further indicates that hospice care results in lower rates of hospitalization in the last 30 days of life. (Gozalo & Miller, 2007) This indicates that patients are able to die in a comfortable environment and are not subjected to painful treatments. It has to be noted here that hospice care can be given at specialized centers or can be at home, where in Japan, it was observed that caregivers, more than patients in home hospice care believed that they should be receiving care from day hospice centers.

Among the studies conducted on the services provided by hospice centers it was noted that hospice centers that were larger had less restrictive admission policies for patients, (Lorenz, Asch, Rosenfeld, Liu, & Ettner, 2004) and were able to provide the full range of services including nursing care, physician care, medication management, psychosocial care, and caregiver support. (Carlson, Morrison, Holford, & Bradley, 2007)

Other studies that have focused upon the impact of hospice care for patients

Regulations Affecting Health Care in Hospice

The regulations that affect hospice care are stated under the U.S. Code of Federal Regulations and have been revised in 2008 and are stated in the Federal Register, which states that the need for revising the Certification of Participation for hospice care centers that want to participate in the Medicare and Medicaid programs.

The revision states, at the onset that the need for it arose, as previous regulations were focused on addressing problems rather than improving the quality of services provided. The current rules therefore state that 'Patient rights, comprehensive assessment, patient care planning and coordination by a hospice interdisciplinary group (IDG)' are core requirements for hospice centers. Moreover, these requirements will be required to be further improved through quality assessment and performance enhancement that will be locally developed by each care program.

Some of the rules that were introduced included that the nursing facilities and hospices, have a better relationship, as also recommended by the American Medical Directors Association, (American Medical Directors Association) and has been incorporated in rule 418.112 in the Federal Register. It also allows hospices to participate in-patient in care facilities that are participating in Medicare and allows for the 24-hour nursing services, and indicates that the hospice agreeing to participate will have to train the personnel that will be providing palliative care to patients in the nursing care facilities. Additionally the…

Sources Used in Documents:

Works Cited

American Medical Directors Association. (n.d.). White Paper on Palliative Care And Hospice In Long-Term Care. Retrieved March 10, 2012, from American Medical Directors Association:

Carlson, M.D., Morrison, R.S., Holford, T.R., & Bradley, E.H. (2007). Hospice Care: What Services Do Patients and Their Families Receive? Health Services Research, 42(4), 1672-1690.

Centers for Medicare & Medicaid Services. (2008). Medicare and Medicaid Programs: Hospice Conditions of Participation; Final Rule. Federal Register, 73(109), 32088-32220.

Christakis, N.A., & Escarce, J. j. (1996). Survival of Medicare patients after enrollment In hospice programs . The New England Journal of Medicine, 172-179.

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