Middleboro Case Study Executive Summary

Caring Hospice is a company that will provide nursing care to patients that are terminally ill. The ultimate goal is to insure the patient is kept as comfortable as possible while maintaining dignity during the dying process. This company will send registered nurses to the patient’s home for routine physical assessments, medication teaching and administration, education about terminal diseases and the dying process. The nursing staff will also create and maintain appropriate plans of care for the multi-disciplinary team to provide holistic care to the patient.

Death is inevitable. It is one of the only certainties in life. Regardless, people are often uncomfortable discussing death. Nyatanga (2016) posits that the idea of no longer existing increases anxiety and emotional distress in relation to one’s mortality. Because of the difficulty in level of care for end-of-life patients, the patient and the family often need professional assistance for physical and emotional care. Many family caregivers are not professionally trained in medicine, and this is where hospice comes into play. Hospice aims to meet the holistic needs of both the patient and the patient’s family through treatment plans, education, and advocacy. There is a duality of care to the treatment provided by hospice staff in that they do not attempt to separate the patient’s care from the family’s care. Leming and Dickinson (2011) support that hospice, unlike other clinical fields, focuses on the patient and the family together instead of seeing the patient independent of the family. Many times in hospitals, the medical team focuses solely on the goal of returning the patient back to health in order for them to return to their normal lives. They do not take into account the psychological and spiritual components of the patient’s journey and the journey that the family must take as well. For treatment of the patient, Leming and Dickinson agree that hospice does not attempt to cure patients, and instead concentrates solely

Medicare covers hospice if you have a terminal illness and aren’t expected to live more than six months. However it doesn’t cover grief counseling.

A survey was conducted in 2000 on more than 9,000 patients discharged from more than 2,000 hospices on the services they received (Carlson, 2007). It revealed that 22% of them received five major palliative care services, which varied among the hospices. These palliative care services were nursing care, physician care, medication management, psychological care, and caregiver support. Approximately 14% of the hospices provided all five services and 33% provided only one or two services. Only 59% of these patients received medication management services. These included administering medication, dispensing correct dosages, and setting and following dosage schedule.

In contrast to the costs of standard medical care, hospice care provides an alternative that is both cost effective and caring. Unfortunately, it is actually difficult to quantify the cost savings associated with hospice care due to the fact that comparing costs during the last year of life are impacted by the variability in the length of hospice use. A study at Duke University went to extensive lengths to provide a comparison that provided an effective method for accurate comparisons. The comparison showed a reduced average Medicare expenditure of $2,309 per person from the time hospice care was initiated in comparison to the same situation handled through standard medical methods (Taylor, Ostermann, Houtven, Tulsky, & Steinhauser, 2007). The amount of cost savings varied depending on the primary health condition and the

Because the Board of Directors only meets four times a year, the day-to-day operations are managed by a Chief Executive Officer. The CEO has appointed five Chiefs as his

Great strides have been made to improve end-of-life care through palliative care and hospice programs, but sometimes that’s just not enough. In America, the care that is offered to the elderly and the chronically ill is less than ideal. Statistics show that an

Hospice is a philosophy of care. It treats the person rather than the disease and focuses on quality of life. It surrounds the patient and family with a team consisting of professionals who not only address physical distress, but emotional and spiritual issues as well. Hospice care is patient-centered because the needs of the patient and family drive the activities of the hospice team.

The first hospice care was established in 1974. A hospice must make physician, nursing, drugs, and medical supply services available 24/7. It must have social workers and counseling services available to the patient and the family. Hospice also provides therapy and homemaker services when needed in order to be qualified under Medicare certification. Hospice is a combination of special services for terminal ill patients. Beside the medical service, hospice care also supports patients and family psychologically and spiritually to put their emotional suffering at ease. The psychological suffering can weight more than physical suffering. Many terminal ill patients cannot accept the bad news and living under emotional distress. Certified chaplains can work with people from different religions, they focus on the world-view of the patient and family. Using patient personal goal as the measurement, chaplains are the

Rather, the hospice staff and the patient understand the patient is going to die and no further treatment options are available. Therefore, hospice care centers direct their attention towards providing a dignified ending to a patient’s life by delivering comfort and emotional support through a palliative care approach designated to alleviate pain and emotional distress. For example, at Hospice of Dayton, each patient residing at the care facility is provided their own room where their family is able to stay with them and the patient is able to receive the pain management and emotional support they need to die a little closer to peace and security. Additionally, at Hospice of Dayton, there are full-time doctors, nurses, counselors, and religious support-staff that provide patients the physical treatment they need to minimize their pain, as well as the emotional support they need to live the last moments of their life with dignity and emotional well-being. Most importantly, Hospice of Dayton because of its volunteers. Volunteers provide the invaluable service of listening, crying, and laughing with those who may not necessarily have someone to spend time with, while they undergo their long, arduous, and painful experience of

Hospice is compassionate care provided to patients facing terminal illness or illness for which there is no cure. These patients are diagnosed with an illness from which they will never recover and usually have a life prognosis of six months or less (Hospice Foundation of America, 2014). The goal of hospice care is improving quality of life and managing the symptoms of disease and the dying process. The care hospice offers is focused on pain management and emotional and spiritual support for both the patient and family (National Hospice and Palliative Care Organization, 2012). Hospice care can be provided in many different settings, often the patient’s own home. Hospice care can also be provided in hospitals, nursing homes, long-term care facilities and free-standing hospice centers and is available to patients of all ages (NHPCO, 2012). A patient receiving care in a hospice program has a team of healthcare individuals that can consist of the patients own physician, nurses, home health aides, clergy, social workers, and speech and physical therapists (NHPCO, 2012). Usually, a care plan is developed by the hospice team and care of the patient is provided by family members with the support of the hospice staff (NHPCO, 2012). Nurses make regular visits to the patient and family and are on call 24/7. Once enrolled in a hospice program hospice covers everything that will be needed to care for you, from medications to manage pain to

Hospice care is a model of care that focuses on relieving symptoms and supporting patients with a life expectancy of six months or less (Altshuler, 2013). For most nurses, caring for a dying elder (individual aged 65 years and above) is a discrete, time-limited experience that begins with first contact, often in a hospital, emergency room, or long term care facility, and ends with the death itself (Phillips & Reed, 2008).

Hospice care has not been around for very longs but it is one of the fastest growing medical fields in the country, with over 1.58 million patients being cared for in 2010 alone. Hospice is an important part of caring for terminally ill patients and helps the families and loved ones to grieve.

Planning for end of life care for a loved one can be a very difficult process for some families. Knowing that you are going to lose a loved one and planning for how they will be taken care of can be quite stressful. End of life planning can be used in two different scenarios one of which is for terminally ill patients and the other is for the aging and elderly. Planning for end of life care can be quite expensive with all of the doctor visits and counseling’s. In Obama’s Affordable Care Act there is some hope for the elderly for paying for some of these expenses.

Hospice is a component of palliative care. A person does not necessarily have to be dying in order to see a palliative care specialist. This is where the service is often underutilized in the hospital. In the 18 months I have been a nurse, I have cared for many patients with chronic illnesses who have dealt with symptoms that have severely impacted their quality of life. Most of the time, it seems as though the patient’s care providers are interested in treating the patient’s acute problems. My experience has been that the symptoms are often overlooked or are being treated in a manner that is to the dissatisfaction and discomfort of the patient.