Hospice organization and management

Organizational Behavior: Hospice

History of hospice: National Hospice and Palliative Care Organization (NHPC)

While many individuals are familiar with the notion of 'hospice care,' either because one of their family members have been in a hospice or because they have volunteered with the organization, few know its long history in the tradition of ancient medicine -- and its relatively short history in the United States. The term "hospice…can be traced back to medieval times when it referred to a place of shelter and rest for weary or ill travelers on a long journey. The name was first applied to specialized care for dying patients in 1967 by physician Dame Cicely Saunders, who founded the first modern hospice -- St. Christopher's Hospice -- in a residential suburb of London" ("History of hospice care," NHPCO, 2001). Saunders' ideas were based upon her work with a dying patient "who, at the end of life, requested words of comfort and acts of kindness and friendship. Dr. Saunders came to believe and to teach, 'We do not have to cure to heal'" ("Brief history of the hospice movement," Hospice of Michigan, 2010).

A key component of Saunders' work was appropriate pain management. To advocate hospice care, Saunders would show "photographs of patients that dramatically illustrated the difference in them once pain and symptoms were controlled" ("Brief history of the hospice movement," Hospice of Michigan, 2010). The first hospice in America opened in Connecticut in 1974. The philosophy of hospices was influenced by the ideas of Dr. Elisabeth Kubler-Ross' book On Death and Dying. "Based on interviews with dying patients, she identified five stages of grief - denial, anger, depression, bargaining and acceptance" of the dying and their loved ones ("Brief history of the hospice movement," Hospice of Michigan, 2010).

"Today there are more than 3,200 hospices across the country - some are part of hospitals or health systems, others are independent; some are nonprofit agencies, others are for-profit companies…in 2000 about one in every four Americans who died received hospice care at the end of life -- roughly 600,000 people" ("Brief history of the hospice movement," Hospice of Michigan, 2010). The growing acceptance of hospice was manifested when, "In the early 1980s, Congress created legislation establishing Medicare coverage for hospice care. The Medicare Hospice Benefit was made permanent in 1986. Today most states also provide hospice Medicaid coverage" ("Brief history of the hospice movement," Hospice of Michigan, 2010).

The primary advocate for hospices within the U.S. is the National Hospice and Palliative Care Organization (NHPCO), founded in 1978 as the National Hospice Organization. "The organization changed its name in February 2000 to include palliative care," which is a broader range of care and services provided by hospices: "Defined by the World Health Organization in 1990, palliative care seeks to address not only physical pain, but also emotional, social, and spiritual pain to achieve the best possible quality of life for patients and their families" ("About NHPCO," NHPCO, 2010).

Definition of hospice care

Hospice's aim is to provide care not cure. It is the dispensing of treatment to improve the quality of life for people facing a life-limiting illness or injury. Pain management and psychological and spiritual counseling is the core of hospice, as is support for the patient's loved ones. "At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so" ("What is hospice and palliative care," NHPCO, 2010). Whenever possible, care is provided at home and the patient's family is coached how to care for the patient, although in-patient care within a hospice facility is also available when this is appropriate.

Mission statement of Hospice

According to the preamble and philosophy of the National Hospice and Palliative Care Organization, "Hospice provides support and care for persons in the last phases of an incurable disease so that they may live as fully and as comfortably as possible. Hospice recognizes that the dying process is a part of the normal process of living and focuses on enhancing the quality of remaining life. Hospice affirms life and neither hastens nor postpones death" ("Preamble and Philosophy," NHPCO, 2010). The NHPCO formal mission statement is: "To lead and mobilize social change for improved care at the end of life" ("Mission & Vision," NHPCO, 2010).

Financial and economic statements

Hospices individually operate under a wide variety of financial models, including for-profit and not-for-profit systems. Most use "a managed-care model, with insurance companies providing per visit and per diem reimbursement" (Baxendale & Dornbusch 2000, p.1). "Hospices receive funds from government programs or private insurance, from donations made by the public or other corporations, and from grants donated by charitable foundations...Hospices are not reimbursed on a fee for service basis: rather, hospices are paid, on a basis of how many days the patient is enrolled in the program and received services…In return for payment, Medicare, Medicaid and private insurance companies expect the hospices to provide all services which the patient and family need which are related to the terminal illness"("Hospice Funding," Hospice Patient Alliance, 2001). "Shorter length of stays by patients closer to death and indigent care strain the managed-care model," given the expense of creating an initial pain management pain for the patient, which is necessary regardless of his or her length of the stay (Baxendale & Dornbusch, 2000, p.1).