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This article intervenes in the debate, among US disability rights advocates, about physician-assisted suicide (PAS). Through an ethnographic study, I situate this debate in the context of the dominant form of end-of-life care in the US hospice. Based on this analysis, I argue that PAS should be an issue of secondary concern to disability rights advocates, and that their primary concern, at the end-of-life, should be the improvement of US hospice care. By thus “putting the ‘right to die’ in its place,” they can achieve consensus among themselves and leverage this consensus to achieve the most substantial advancement of disability rights.

This viewpoint paper focuses on the important role played by hospices in the UK in providing specialised end-of-life care for older people with complex needs – particularly for the growing number who choose to die at home. With demand for such care growing, the paper highlights the funding issues facing the independent hospice sector and the implications for hospices of receiving more state funding. The purpose of this paper is to highlight the challenges that hospices in the UK face in providing home-based palliative and end of life care for older people.

This a viewpoint paper informed by recent reports and research findings, as well as the author’s own work within the hospice sector.

The demand for specialised community-based and home-based palliative and end-of-life care is growing. The Covid-19 pandemic prompted wider discussion about what constitutes both “a good death” and good end-of-life care. This confirmed that most older people would prefer to end their lives free from pain, in familiar surroundings and not in hospital.

The specialised end-of-life care provided by hospices is rated highly by the regulator and the communities which they serve. In recent years, more attention has been given to providing “hospice at home” services, but coverage is limited largely due to lack of funding, the bulk of which comes from charitable fundraising. To provide a more equitable service, the fragility of the hospice funding model needs to be addressed.

If the state expands its funding of hospice care, it is important that charitable fundraising also continues to take place and is encouraged. This will help ensure that the good links between hospices and local stakeholders are maintained.

The funding of the hospice sector in the UK has been the subject of several reports both by governmental and non-governmental bodies, several in the last year. However, it is an issue of growing importance and the whole subject needs a fuller airing in academic circles.

The purpose of this paper is to determine the cost effectiveness of palliative care on patients in a home health and hospice setting. Secondary data set was utilized to test the hypotheses of this study. Home health care and hospice care services have the potential to avert hospital admissions in patients requiring palliative care, which significantly affects medicare spending. With the aging population, it has become evident that demand of palliative care will increase four-fold. It was determined that current spending on end-of-life care is radically emptying medicare funds and fiscally weakening numerous families who have patients under palliative care during life-threatening illnesses. The study found that a majority of people registering for palliative and hospice care settings are above the age group of 55 years old.

Different variables like length of stay, mode of payment and disease diagnosis were used to filter the available data set. Secondary data were utilized to test the hypothesis of this study. There are very few studies on hospice and palliative care services and no study focuses on the cost associated with this care. Since a very large number of the USA, population is turning 65 and over, it is very important to analyze the cost of care for palliative and hospice care. For the purpose of this analysis, data were utilized from the National Home and Hospice Care Survey (NHHCS), which has been conducted periodically by the Centers for Disease Control and Prevention’s National Center for Health Statistics. Descriptive statistics, χ² tests and t-tests were used to test for statistical significance at the p<0.05 level.

The Statistical Package for Social Sciences (SPSS) was utilized for this result. H1 predicted that patients in the age group of 65 years and up have the highest utilization of home and hospice care. This study examined various demographic variables in hospice and home health care which may help to evaluate the cost of care and the modes of payments. This section of the result presents the descriptive analysis of dependent, independent and covariate variables that provide the overall national estimates on differences in use of home and hospice care in various age groups and sex.

The data set used was from the 2007 NHHCS survey, no data have been collected thereafter, and therefore, gap in data analysis may give inaccurate findings. To compensate for this gap in the data set, recent studies were reviewed which analyzed cost in palliative care in the USA. There has been a lack of evidence to prove the cost savings and improved quality of life in palliative/hospice care. There is a need for new research on the various cost factors affecting palliative care services as well as considering the quality of life. Although, it is evident that palliative care treatment is less expensive as compared to the regular care, since it eliminates the direct hospitalization cost, but there is inadequate research to prove that it improves the quality of life. A detailed research is required considering the additional cost incurred in palliative/hospice care services and a cost-benefit analysis of the same.

While various studies reporting information applicable to the expenses and effect of family caregiving toward the end-of-life were distinguished, none of the previous research discussed this issue as their central focus. Most studies addressed more extensive financial effect of palliative and end-of-life care, including expenses borne by the patients themselves, the medicinal services framework and safety net providers or beneficent/willful suppliers. This shows a significant hole in the current writing.

With the aging population, it has become evident that demand of palliative/hospice care will increase four-fold. The NHHCS have stopped keeping track of the palliative care requirements after 2007, which has a negative impact on the growing needs. Cost analysis can only be performed by analyzing existing data. This review has recognized a huge niche in the evidence base with respect to the cost cares of giving care and supporting a relative inside a palliative/hospice care setting.

The study exhibited that cost diminishments in aggressive medications can take care of the expenses of palliative/hospice care services. The issue of evaluating result in such a physically measurable way is complicated by the impalpable nature of large portions of the individual components of outcome. Although physical and mental well-being can be evaluated to a certain degree, it is significantly more difficult to gauge in a quantifiable way, the social and profound measurements of care that help fundamentally to general quality of care.

Non-profit management and corporate strategy.

The case is appropriate for teaching undergraduate students, executive MBAs and graduate students. The case is useful for an overview of hospice and palliative care in the developed and developing world, and for class room discussions of external analysis of non-profit organizations' ecosystems, funding needs and industry analysis.

Hospice care in the developed parts of the world is well established but in most developing countries, there are no organized hospice care facilities. This case focuses on a charitable organization, Brthya – Add Value to Life (Brthya – AVTL), that established and operates hospice care in Chennai, India. The Indian context for hospice care, and the ecosystem needed to sustain ongoing operations, are described along with a summary of four different models of hospice care used in other parts of the world.

The case will help students to understand: what hospice care is and its various forms; management issues related to funding and operating hospice care in particular and a non-profit in general; ecosystems that make non-profits sustainable in emerging economies; and managing expansion and growth in non-profit organizations, in emerging economies and globally.

Teaching notes are available; please consult your librarian for access.

Palliative care requires integration between services, organisations and the community. A series of community engagement programmes, named “Listening Events”, were conducted across the Isle of Man. The aim was to involve the community in the development of Hospice strategy by sharing their views on the future of palliative and end of life care.

Three Listening Event programmes were conducted in community settings, secondary schools and the Isle of Man’s University College. The investigators facilitated discussions on current knowledge of Hospice services, what would matter to people should they need to use these, and how Hospice could best serve the community in the future. Participants and investigators noted thoughts and comments. Data were analysed using thematic analysis.

In total, 899 people participated from across the community. Main themes surrounded effective care, person-centred care and integrated care. Most themes agreed across the three programmes, despite some nuances.

The results were used as an evidence base from which Hospice Isle of Man’s new strategy was derived in order to ensure that it aligned with the community’s needs. By initiating conversations and discussions in the community, the Listening Events may have also increased understanding about hospice care.

This paper aims to highlight current finding issues relating to the provision of hospice care services which are largely provided by the independent sector and heavily reliant on charitable fund raising. The primary focus is on the UK, but it is an issue of relevance to many other countries around the world.

The paper is an opinion piece informed by contemporary reports, official publications and research findings, as well as the author’s own work within the hospice sector.

As with many other countries around the world, the bulk of hospice funding in the UK comes from charitable donations of various kinds. However, the impact of COVID-19 highlighted both the fragility of this funding model and the precarious nature of hospice sector finances currently.

This is an issue of growing importance that affects older people and their families not only in the UK but in all countries with ageing populations. Hospices play an important role in providing end-of-life care and, with demand for services steadily rising due to demographic trends, there are important questions about the sustainability of the current hospice funding model.

Issues of funding require a much higher level of engagement from policymakers if hospice care is going to continue to play a significant part in achieving a good death for people from all sections of society.

Although hotly debated within the hospice sector and in official reports, this issue has yet to be properly examined within academic circles.

We examine the association of for-profit (FP) and nonprofit (NP) economic incentives in hospice care providers with financial and nonfinancial metrics of management performance. Controlling for quality of patient care and differences in cost-efficiency, we find that FP providers (1) selectively admit patients with longer life-prognoses and billable days and hence lower average costs per day, (2) employ a lower average cost/skill mix of workers, and (3) have higher CEO compensation and profit. The NP providers admit more patients with the less profitable life-prognoses attributes, have lower CEO compensation, and reinvest their net earnings under the non-distribution constraint. While the profit incentive may be needed to attract providers into this rapidly growing and underserved market, the NP providers return a lower cost per patient served from the taxpayer's perspective.

As a result of a drastic increase in new patients, two major shifts are occurring in the US hospice care industry: an increase in the number of for‐profit providers, and hospices are increasing in size through acquisitions and mergers. Hospices are trying to both increase the number of innovative programs they offer and decrease their operating expenses to improve their margins and attract more patients. This study seeks to investigate if strategic groups exist within the industry as hospices try to become more innovative and efficient, which grouping factors are most significant, and to determine whether there is a relationship between group membership and performance.

Cluster analysis and ANOVA are used to analyze data from 93 California hospices.

Three strategic groups exist within the market, innovative practices significantly affect group membership, and innovation‐oriented groups outperform others in terms of quality of care.

Many hospices focus on innovation, and evidence suggests that continued pursuit of innovative practices is critical, whereas efficiency does not appear to have a significant impact on quality of care. Focus on such evidence‐based practices is important for long‐term success.

This is the first study to investigate strategic group formation in the hospice care industry.

This paper examines the association of charitable donations with quality of care proxies for nonprofit hospice providers in the United States (US). An estimated 1.45 million patients received hospice care in the US in 2008. Medicare hospice spending exceeded $10 billion in 2007 and is expected to more than double over the next 10 years. Using Guidestar and Medicare Hospice Cost Report data, we find donations are positively associated with proxies for nurse and social worker quality of care, but not with our home-health aide quality proxy. This research adds to our understanding of charitable contributions in hospice provider organizations.

A primary impetus of the modern hospice movement was the disparity, during the later 20th century, between the care provided to persons with illnesses considered “curable” and the treatment – or lack of it – accorded the incurably or terminally ill. In its transformation from a reform-oriented, interdisciplinary response to the needs of the dying to an integrated component of the American healthcare system, hospice care's original mission, target population, and modality of service delivery were all significantly altered in ways that generated new disparities in access to “death with dignity.” This chapter attempts to trace the political, economic, and institutional dimensions of this transformation as reflected in the experiences of one Northeastern hospice during a 6-month period in 2001. Using an analytic approach known as institutional ethnography (IE), the authors focus on the work of the Hospice's Interdisciplinary Group (IDG) to uncover the linkages between local problems in the delivery of hospice care and extra-local sites of power and constraint at the mezzo- and macrolevels of the American healthcare system. The significance of these linkages for patients, frontline workers, and other stakeholders are interpreted from several perspectives. Implications for change are discussed.