Unit
- Hospice philosophy: This approach focuses on comfort and quality of life rather than curative treatment for patients with a terminal prognosis. The goal is to manage symptoms, provide emotional support, and help patients live as fully as possible until death.
- Patient-centered care: Care plans are developed around the patient's values, preferences, and goals. The patient and family are considered the unit of care, with decisions made collaboratively among the interdisciplinary team.
- Palliative versus hospice care: Palliative care can be offered at any stage of serious illness alongside curative treatments, while hospice is specifically for patients who have chosen to forgo curative therapies and have a life expectancy of six months or less.
- Historical development: The modern hospice movement began with Dame Cicely Saunders in the 1960s, emphasizing whole-person care. In the United States, the Medicare Hospice Benefit was established in 1982, creating a standardized payment model.
- Eligibility criteria: Patients must have a terminal illness with a prognosis of six months or less, certified by two physicians. They must elect to receive hospice care in lieu of Medicare-covered curative treatments.
- Levels of hospice care: Routine home care is the most common; continuous home care for crisis management; inpatient respite care for caregiver relief; and general inpatient care for symptom management that cannot be managed at home.
- Core services: Hospice programs provide nursing, physician services, medical social work, chaplaincy, bereavement counseling, and volunteer support. These services are offered regardless of the patient's ability to pay.
- Setting of care: Most hospice care is delivered in the patient's home, but it can also be provided in nursing facilities, assisted living, freestanding hospice houses, or acute care hospitals under contract.
- Interdisciplinary team composition: The core team includes the hospice medical director, registered nurse, social worker, chaplain, and volunteer coordinator. Additional members such as dietitians, physical therapists, and speech therapists are added based on patient needs and care plan goals.
- Bereavement services: Hospice provides grief support to the patient's family and loved ones for at least 13 months after death. Services can include individual counseling, support groups, memorial events, and educational resources to help navigate the grieving process.
- Volunteer involvement: Medicare requires that volunteers provide at least 5 percent of patient care hours. Volunteers offer companionship, respite for caregivers, light homemaking, and transportation. They are trained in confidentiality, infection control, and the hospice philosophy of care.
Scope of Practice
Role: Hospice Administrator
Within scope:
- Developing and enforcing policies aligned with hospice philosophy and regulatory standards
- Ensuring the interdisciplinary team has adequate resources and training
- Overseeing patient intake and eligibility verification processes
- Maintaining compliance with Medicare Conditions of Participation
Outside scope:
- Making medical determinations about terminal prognosis or treatment options
- Directly providing clinical care (nursing, physician orders) unless licensed to do so
- Altering care plans without input from the clinical team and patient
Quick Revision
- Hospice philosophy prioritizes comfort and quality of life over curative treatment for terminally ill patients.
- Care is patient-centered, with the patient and family as the unit of care.
- Hospice differs from palliative care in that it forgoes curative treatments and requires a six-month prognosis.
- Core services include nursing, social work, chaplaincy, bereavement, and volunteer support across various settings.