Most people with a terminal illness are eligible for hospice care that is paid for by Medicare, Medicaid, Veterans Benefits, or private insurance.National attention has belatedly turned to patient-centered care and improved care coordination, which have always been key tenets of hospice.Policies now aim to reduce unplanned hospital readmissions, excessive emergency visits, and overuse of services all of which contribute to a sharp rise in healthcare costs and all of which have been shown to be reduced by hospice.For four decades, hospice has been quietly modeling a patientfamily-centered approach to caring for people at the end of life.
This plan is re-visited weekly by the patient and his or her interdisciplinary hospice team. ![]() After the death, the family is offered bereavement support for at least one year. ![]() In England, hospice was a hospital-based medical model but when it was introduced in the United States, it was adapted to a home-based model. A patients home may be wherever he or she is living a private home, a nursing home, or an assisted living facility. Hospice patients are supported in a way that reduces emergency room visits and unplanned hospital admissions. While pain management is not a central focus in the health care system at large, hospice clinicians have considerable expertise in managing pain. Hospice contributes to better care, as its presence in nursing homes has been shown to correlate with better performance in pain management compared with nursing homes that do not partner with hospice providers. Medicare requires that bereavement support be made available to hospice family members for up to a year after a death. Some hospices go even further by offering support groups to the whole community, sponsoring grief camps, and training grief professionals. Recent examination by the Washington Post showed that the type and quality of offered services can vary. Thats why consumers need and want data to compare alternative hospices in their community. Without reliable data, those looking for care have only anecdotes to help them make what is arguably one of the most important healthcare decisions they will ever make. There is currently no way to answer the question about which hospice is most appropriate, because there is no available comparative data on quality of care. Even the most well informed hospice experts are uninformed consumers as to which hospice to choose for themselves, their friends, their relatives. ![]() CMS is building a survey tool to assess the experience of family caregivers, which will be used in a Hospice Compare website in the foreseeable future. These measures were designed for retrospective evaluation by family caregivers, but not for prospective comparisons among hospice providers. To ensure that the NQF measures would be useful to consumers in making prospective decisions, American Hospice Foundation, in collaboration with Altarum Institutes Center for Consumer Choice, conducted a study to determine which NQF measures would be useful in comparing hospices and how consumers want that information displayed. Entitled What Consumers Want to Know About Quality When Choosing a Hospice Provider, and funded by the Agency for Healthcare Research and Quality (AHRQ), this study confirmed that most of these measures would be useful for prospective decisions, though some consumers would need an educational module in a hospice report card that explains how hospice works. American Journal of Hospice and Palliative Care, March 4, 2014).
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