Factors affecting hospice social work utilization among hospice patients: Focusing on place of care and economic status

Objective. Hospice social workers empower their patients and families as they journey through end of life. However, even when social work services are available, some hospice families choose not to use or fully utilize this service. Guided by the Anderson behavioral model, this study examined factors affecting utilization of hospice social work services with particular focus on two enabling factors - place of care and economic status. Method. Data came from the 2007 National Home and Hospice Care Survey. The sample was restricted to Medicare Hospice Benefit enrollees 65 years of age and older. Hospice social work utilization was categorized into six visit intervals (0= none, 5= more than two visits in a week). Bivariate and ordinal logistic regressions were used to examine associations between hospice social work utilization and 1) place of care (home vs. institution) and 2) economic status (low vs. not low). Results. The frequencies of hospice social work utilization were found to be significantly different between place of care (χ2(1)=92.86, p\u3c.001) and economic status (χ2(5)=11.28, p\u3c.05). Even after controlling for predisposing and need factors in ordinal logistic regressions, hospice patients receiving care at home (Coef.=-.58, p\u3c.001) and of low economic status (Coef.=-0.35, p\u3c.001) were found to use social work services less frequently than their counterparts. Discussion. This study adds to the limited body of literature on enabling factors associated with hospice social work utilization. Possible implications and suggestions aimed at addressing these disparities are discussed

Dying the Good Death: Cultural Competence and Variance in Hospice Care

This paper examines the intersections between death and culture in the context of hospice care. The patient demographics of modern hospice care are overwhelmingly White; through an analysis of the formation of Korean-American culture and its distinct values, I conclude that hospice as we know it today primarily adheres to the Western conceptualization of a “good death”, and therefore is not accessible to those who belong to different cultures. In order to remedy this and to explain the racial disparities among hospice patients, I apply a model of cultural competency that specifically caters to Korean-American death traditions. While the effects of implementation are unknown, this model reimagines hospice to be a critical nexus between cultural variance and a good death

Hospice utilization of Medicare beneficiaries in Hawai‘i compared to other states

The objective is to examine hospice utilization among Medicare beneficiaries in Hawai‘i compared to other states. Data were from the 2014 Medicare Hospice Utilization and Payment Public Use File, which included information on 4,025 hospice providers, more than 1.3 million hospice beneficiaries, and over $15 billion in Medicare payments. Multivariable linear regression models were estimated to compare hospice utilization in Hawai‘i to that of other states. Control variables included age, gender, and type of Medicare coverage. Medicare beneficiaries using hospice in Hawai‘i differed significantly from beneficiaries in other states in several ways. Hawai‘i beneficiaries were more likely to be Asian (57% vs. 1%, p \u3c .001) and “other race” (10% vs. 0.1%, p \u3c .001), and less likely to be White (28% vs. 84%, p \u3c .001). Hawai‘i beneficiaries were also more likely to have Medicare Advantage (55% vs. 30%, p = .05). Regarding primary diagnoses, hospice users in Hawai‘i were significantly more likely to have a primary diagnosis of stroke (11% vs. 8%, p = .03) and less likely to have respiratory disease (5% vs. 11%, p = .003). In addition, hospice users in Hawai‘i were more likely to use services in their homes (74% vs. 52%, p = .03). Hawai‘i hospice users were also less likely to die while in hospice (42% vs. 47%, p = .002). Characteristics of Medicare beneficiaries in Hawai‘i differ from those in other states, regarding demographic characteristics, type of coverage, primary diagnoses, likelihood of using services in their homes, and death rates. Further research is needed to better understand factors affecting these differences and whether these differences warrant changes in policy or practice

Provision of palliative care in Malta

The Malta Hospice Movement, within its young, fastdeveloping structure, is established as a Body within the Maltese Community that continues to expand its vision of Palliative Care, Palliative Medicine and Hospice Philosophy by increasing its human, structural and organisational resources. Through the multi-disciplinary team, it reaches out to cancer patients both as a voluntary, charitable organisation but more importantly as a professional one in a wide range of Hospice services.peer-reviewe

Local workshops on palliative care

The Malta Hospice Movement was established in 1989 with the aim to help in providing palliative care to cancer and motor neurone disease patients. Every year, professionals from Hayward House Palliative Care Unit in Nottingham visit the Malta Hospice Movement to carry out workshops and seminars. During the workshops organised the topics covered were: Time Management and Patient Assessment for Hospice staff as well as on Spirituality and Bereavement Services.peer-reviewe

Palliative Care Is More Care, Not Less

Educational Objectives: 1. Discuss the origins of hospice and palliative care. 2. Compare and contrast Curative, Palliative, and Hospice Models of Care. 3. Identify when palliative care is appropriate

Impact of a hospice rapid response service on preferred place of death, and costs

Background: Many people with a terminal illness would prefer to die at home. A new palliative rapid response service (RRS) provided by a large hospice provider in South East England was evaluated (2010) to provide evidence of impact on achieving preferred place of death and costs. The RRS was delivered by a team of trained health care assistants and available 24/7. The purpose of this study was to (i) compare the characteristics of RRS users and non-users, (ii) explore differences in the proportions of users and non-users dying in the place of their choice, (iii) monitor the whole system service utilisation of users and non-users, and compare costs. Methods: All hospice patients who died with a preferred place of death recorded during an 18 month period were included. Data (demographic, preferences for place of death) were obtained from hospice records. Dying in preferred place was modelled using stepwise logistic regression analysis. Service use data (period between referral to hospice and death) were obtained from general practitioners, community providers, hospitals, social services, hospice, and costs calculated using validated national tariffs. Results: Of 688 patients referred to the hospice when the RRS was operational, 247 (35.9 %) used it. Higher proportions of RRS users than non-users lived in their own homes with a co-resident carer (40.3 % vs. 23.7 %); more non-users lived alone or in residential care (58.8 % vs. 76.3 %). Chances of dying in the preferred place were enhanced 2.1 times by being a RRS user, compared to a non-user, and 1.5 times by having a co-resident carer, compared to living at home alone or in a care home. Total service costs did not differ between users and non-users, except when referred to hospice very close to death (users had higher costs). Conclusions: Use of the RRS was associated with increased likelihood of dying in the preferred place. The RRS is cost neutral

The place of volunteering in palliative care

This chapter discusses the place and development of volunteering in palliative care in the context of hospice service provision in the UK. It draws on recent qualitative research undertaken in a large hospice in England. The research explored a range of issues connected to the process and experience of voluntary work in this setting including who volunteers, what roles volunteers take up, how they are trained and supported and the ways in which role boundaries are established and maintained. The research revealed that hospice volunteering is rewarding but often emotionally challenging and is now highly routinised and closely monitored in ways paralleling practices in the paid labour market. Although volunteers freely give their time to the work of hospice, their activities are subject to significant management prescription, with hospices increasingly adopting sophisticated business models to underpin their operation and, in many cases, their expansion (Watts, 2010)

Equity of access to adult hospice inpatient care within north-west England.

There is a growing debate about the question of equity of access to hospice and palliative care services. Even countries with relatively well developed palliative care systems are considered to have problems of access and inequity of provision. Despite these concerns, we still lack a relevant evidence base to serve as a guide to action. We present an analysis of access to adult hospice inpatient provision in the north-west region of England that employs Geographical Information Systems (GIS). Measures of the possible demand for, and supply of, hospice inpatient services are used to determine the potential accessibility of cancer patients, assessed at the level of small areas (electoral wards). Further, the use of deprivation scores permits an analysis of the equity of access to adult inpatient hospice care, leading to the identification of areas where additional service provision may be warranted. Our research is subject to a number of caveats�it is limited to inpatient hospice provision and does not include other kinds of inpatient and community-based palliative care services. Likewise, we recognise that not everyone with cancer will require palliative care and also that palliative care needs exist among those with nonmalignant conditions. Nevertheless, our methodology is one that can also be applied more generally

Hospice Palliative Home Care in Canada: A Progress Report

This report is a snapshot of hospice palliative home care services available to Canadians in 2008. The information refers only to hospice palliative care services provided in the home. Other settings where Canadians die -- in hospital, long-term care homes and hospices, and on the street -- are equally important but were not covered in this survey