Innovative Care Philosophies: The Hospice Model

While improving end-of-life care has been a goal in the public health spotlight for many years, attention continues to focus primarily on clinical treatment and efforts to sustain life at all cost. Multiple reports have been issued dealing with these issues, urging the use of meaningful ethical guidelines, better clinician education, and thoughtful advance care planning.  Hospice and palliative care programs are valuable elements in the process. Efforts such as the APHA’s new policy in support of these programs will help spread the word. However, much more needs to be done in educating clinicians, psychological counselors, health and aging professionals, clergy, and caregivers in order to disperse information about these forms of care much more broadly.

In addition, there are financial incentives to provide varying levels and forms of care to those with differing coverage. Even hospice care, which originated as a form of charity service but now has Medicare coverage, has become sufficiently lucrative to require much closer scrutiny on a systemic level. CMS is in the process of implementing a survey of primary caregivers of deceased hospice patients, examining the quality of care provided. Ideally, combined with the Quality Assessment and Performance Improvement (QAPI) data, this will provide valuable information about hospice care overall, and lead to the development of clearer standards for providers.  The ongoing systemic reluctance to approach these questions continues, but progress is being made, however slowly.