Chapter 8

Question 1

in 1960s and 1970s, studies conducted in Great Britain, Canada, and the United States indicate

Answer 1

• caregivers did not always realize the pain experienced by dying
• did not have or think they had resources to help the dying
• dying worried that their wishes would be ignored

Question 2

the Hospice Philosophy: 10 central principles

Answer 2

1. Is a philosophy, not a facility
2. It affirms life, not death
3. strives to maximize present quality in living
4. offers care to the patient and family unit
5. holistic care
6. offers continuing care to family members
7. combines professional skills and human presence thru interdisciplinary teamwork
8. 24 hr a day 7 days a week
9. participants support other participants
10. can be applied to life threatening illness, dying, death, or bereavement

Question 3

four programs of care for persons who are coping with dying

Answer 3

1. Acute care: hospitals
2. Chronic care: long-term care facilities
3. Home care: Home health care programs
4. End-of-life care: Hospice programs

Question 4

Acute Care: Hospitals

Answer 4

• short term facilities
• treat specific diseases and return ppl to society
• medical professionals who see themselves involves with curing ppl
• where 37% of people died

Question 5

Chronic care: Long-term facilities

Answer 5

• provide place to live with help
• nurses 24 hour care
• paid for by medicare, medicaid, private insurance, and out of pocket payments
• less than 3% of older adults
• 20% of all deaths

Question 6

Home care: home health care programs

Answer 6

• rapid growth over the past
• services in the home
• medicare, medicaid, and personal resources mostly pay for services
• offer care for dying but don’t claim specialized expertise

Question 7

end of life care: hospice programs

Answer 7

• recent addition
• In London England first
• began in Connecticut in US
• 6,100 programs in all 50 states, District of Columbia, Puerto Rico, Guam, and virgin islands

Question 8

Hospice programs in the United States?

Answer 8

• independent freestanding agencies
• hospital based
• home health agencies
• long term care facilities

Question 9

Types of agencies of hospice in the US?

Answer 9

28 % nonprofit
68% for profit
4% governmental

Question 10

medicare benefit in hospice programs

Answer 10

federal entitlement for 65 years or older

private insurance, medicaid, and charitable donations cover costs

Question 11

bundled services in hospice programs

Answer 11

reimbursement is on a prospective flat rate

only services in the care plan are reimbersed

Question 12

admission criteria for hospice programs

Answer 12

physician order

life limiting illness with 6 months or less to live

Question 13

four basic categories of hospice services

Answer 13

1. routine home care
2. general impatient care
3. continuous in home care
4. short term in patient respite care

Question 14

hospice programs served between _____ patients

Answer 14

1.5 and 1.6 million

Question 15

about ____ American died while receiving hospice care

about ___ % died in a hospice facility

only ____ % dies in acute facility

Answer 15

1.2 million

32%

9.3%

Question 16

about ___ % of patients in hospice were discharged alive

Answer 16

15%

Question 17

about ____% of patients in hospice died in a place they call home

Answer 17

59%

Question 18

average length of enrollment in hospice was ____ days

median length was ____

Answer 18

71. 3 days

17. 4 days

Question 19

hospice care patients were

% male %female

_____% were older than 65

____% were Caucasian
_____% were minority

Answer 19

46. 3% male
47. 7% female

84%

76%
24%

Question 20

leading diagnosis in hospice programs

Answer 20

advanced cancer 36.6%
dementia 14.8%
heart disease 14.7%
lung disease 9.3%
debility unspecified 5.4%

Question 21

volunteers of hospice

Answer 21

about 430,000 volunteers that worked 19 million hours giving support to patients and families.

Question 22

bereavement car in hospice programs

Answer 22

provided for one year minimum to an average of 2 family members

92% of programs provide bereavement

Question 23

finding in hospice care in the US

Answer 23

• extends life
• reduces medicare costs
• improved quality of care
• African Americans perceived disparities in care

Question 24

pediatric palliative and hospice care

Answer 24

• a philosophy and organized method for delivering care to ill children and families
• focused on minimizing suffering
• provided with concurrent disease modifying therapy or as the main focus

Question 25

palliative care or medicine definitions

Answer 25

broad
- used to designate a type of medical care that addresses the relief of distressing symptoms with or without relationship to death and dying

narrow
- emphasis on physician, pain, symptom management, and hospital based care.