Healthcare organizations and operational structures

Insured/Uninsured and the Effects on Hospice

As a Healthcare Organization

The United States healthcare system includes health plans, physicians, hospitals, clinics, consumers, and public health programs as well as hospice organizations. This report will present insights into how the insured and uninsured affect Hospice organizations in our healthcare system. As the median age of the population of the United States continues to rise, more Americans will need the services provided by a hospice organization. Hospice is not a process or facility for curing a fatal disease. Instead, hospice is a healthcare provider that has created an excellent reputation for dealing with the pressures related to the care of terminally-ill patients most of the time in the final stages of life. Hospice is also known for assisting those patients that have a confirmed life-threatening illness no matter what the stage of progression. The main objective of hospice care is to maintain the best quality of life possible for a patient and to keep that patient as comfortable or pain free as possible. Normally, these services are performed in the patient's home but more and more hospice organizations are required to attend healthcare facilities such as free clinics, hospitals and nursing homes.

The mission, structure, and current community position of the organization has not changed a great deal since inception. The hospice philosophy has been said to be a completely holistic, family and home centered approach to death and dying. This holistic approach has been very well received in our communities around the nation. The approach of focusing on the patient and not the illness has allowed hospice organizations help the families along with the patient in a cost-effective alternative to institutional care.

Hospice is well-known for providing individualized care plans for fatally ill patients and their families. A hospice team consists of a multidisciplinary health care approach. A team normally has a physician, a registered nurse, homecare aides, a social worker and other counselors, and a dedicated volunteer staff. Together, these hospice teams are trained to provide the emotional, spiritual, and psychological support while not neglecting the medical care a patient might need. Each team member has a specific duty:

Registered Nurse

Coordinates team care for patients

Provides direct patient nursing care

Provides patient and family education

Social Worker

Provides advice and counseling to both patient and family

Works with team with understanding of family dynamics

Accesses community resources

Physician

Provides physician care

Approves team health care plan for patient and family

Home Care Aid

Provides assistance with personal hygiene, such as bathing, shampooing, shaving, nail care

Home Maker

Provides light housekeeping and meal preparation

Volunteer

Provides emotional support

May offer services such as shopping, babysitting, and car pooling

Physical, Occupational, and Speech Therapies

Help patients develop new ways to conduct everyday tasks that may have become difficult, such as walking, dressing, bathing, or feeding oneself

Religious/Spiritual Counselor

Clergy and other spiritual counselors are made available at the patient's request

All of these responsibilities and more are seamlessly incorporated into the hospice process. Other available assistance includes nursing care that could be provided in home from eight to 24 hours per day in special circumstances. Respite care if needed can also be established by temporarily putting a patient in an in-patient facility in order to provide relief and rest for the patient's family. One of the more important aspects of the hospice program is that when necessary, medical appliances or supplies can be made available for the patient or family. This includes whatever necessary drugs or medical needs a patient may have such as biologicals. One death has occurred; families often need bereavement support so the hospice process has also incorporated those into the process. These bereavement programs are usually open to any person that has experienced a loss and even if they did not use hospice care prior to death.

One of the greatest aspects of the hospice program is eligibility. Hospice is one part of the healthcare system that does not put as much emphasis on the financial side of illness. To qualify for hospice, your only credential must be that you are in a fatally ill situation. In other words, all terminally ill patients classified as being in the final stage of life are eligible to receive hospice care. In addition, those individuals in the progressive stage of any life-threatening illness are also eligible. The hospice process does not discriminate against anyone. People of all ages from 1 to infinite whether they are insured or uninsured. The other good thing is that Medicare, Medicaid, and the majority of private insurances or health management organizations (HMO's) also cover any hospice related costs. For those insured, a patient only has to contact his insurance provider to get exact coverage amount. Patients or family usually only have to contact a local branch of the hospice care system as soon they are made aware of a fatal situation.

With all of the talk regarding the cost of healthcare in the media today, one rarely if ever hears about the hospice programs. "Governmental initiatives and not-for-profit foundation funding bolstered the spread of hospices here. In 1978, the National Cancer Institute awarded grants to three hospices as demonstration projects to investigate the costs associated with care and to describe the actual manner in which care was provided to patients. Shortly thereafter, the Health Care Financing Administration (HCFA) was charged by Congress and the Carter Administration to initiate a research and demonstration study to examine the costs, benefits, and feasibility of having Medicare pay for hospice care. Existing hospice programs were invited to apply." (Hospice Benefits and Utilization in the Large Employer Market) Around 1972, the first hospice programs were introduced in both the United States and Canada as a new type of formal service and around a decade later the program was accepted by the Medicare program giving it full support. "In 1977, the National Hospice Organization (NHO) was formed in the United States." (Hospice Benefits and Utilization in the Large Employer Market)

If hospice has to take in anyone whether the person is insured or uninsured, how do the programs get paid for? Originally, when the Congress accepted hospice as a Medicare accepted program, working individuals usually had lifetime limit of just over 200 days of coverage. When patients lived longer and still needed hospice services, hospice programs had to continue service by law without charging Medicare or the patient. This was a condition for providers to participate in the Medicare program. Congress also added that if a patient was not able to pay for services, hospice programs could not discharge the patient based on the basis of payment. The population demographics of the hospice service relating to the uninsured and underinsured is irrelevant therefore to the hospice process. Government figures show that only a small proportion of hospice patients are privately insured.

The trends in utilization patterns for the hospice organizations are driven by the Medicare process. Medicare has been shown to be paying for almost eighty percent of the hospice care in America. As the number of Medicare beneficiaries increases as the baby boom generation ages, the effects will continue effect the Medicare program. Currently, hospice figures show that only around twenty percent of all elderly individuals that die are enrolled in hospice.