connor stephen
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8/14/2019 Connor Stephen
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ABSTRACT FORM
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• Pain and other symptoms
• Palliative care for cancer patients
• Palliative care for non cancer
patients
• Paediatric palliative care
• Palliative care for the elderly
• The actors of palliative care
• Latest on drugs
• Pain
• Illness and suffering through
media
• Marginalisation and social stigma
at the end of life
• Palliative care advocacy projects
• Prognosis and diagnosis
communication in
different cultures
• Communication between doctor-
patient and patient-
equipe
• Religions and cultures versus
suffering, death and
bereavement
• Public institution in the world:
palliative care policies
and law
• Palliative care: from villages to
metropolies
• Space, light and gardens for the
terminally ill patient
• End-of-life ethics
• Complementary therapies
• Education, training and research
• Fund-raising and no-profit
• Bereavement support• Volunteering in palliative care
TITLE: HOSPICE AND PALLIATIVE CARE IN THE UNITED STATES
Authors (max 6, presenting author included): Stephen Connor
Hospice care in the United States is both envied and criticized. It is an experiment that continuesto evolve. What began as a version of inpatient hospice care transplanted from the StChristopher’s Hospice model in the United Kingdom is now a large health care system thatgreatly emphasizes home care rather than inpatient care. The most recent in-depth census data onhospices from the NHPCO reveals that in 2008 there were about 4,750 unique locationsdelivering hospice care. There were about 3,650 companies or organizations providing hospicecare with around 1,100 satellite locations. Satellite locations are multiple locations operated bythe same company. Given that there were a total of about 3,100 hospice locations in 1998 that isover 50% growth in 10 years. Approximately 93% of hospices are Medicare certified. Hospiceswho are not certified for Medicare payment and primarily use volunteers continue to operate andrepresent about 7% of programs (NHPCO, 2008a). Medicare records indicate that in 2007 a total
of 49% of Medicare certified hospice organizations were non-profit entities, and 46% were for- profit. The remaining 5% were governmentally controlled (NHPCO, 2008a). This is a huge seachange in the field of hospice care that has been historically almost all charitable organizationsThe vast majority of hospices are fairly small programs with an average daily patient census of 75(median 46.5), and an average of 394 admissions a year (median 234). There is some skewing of the group, with some very large hospices. The more accurate number is the median size for ahospice. The greatest source of revenue for hospices is Medicare reimbursement, which accountsfor 83.7% of income based on admissions. Another 5% comes from Medicaid and 8% from
private insurance payments (NHPCO, 2008a). The average length of service in 2007 was 60 dayswith 8.6% of hospice patients living more than 180 days and 25.7% of patients enrolled for 7days or less. The median is a more accurate measure of central tendency in hospice length of stayat only 20.6 days. In 2007 the proportion of hospice cancer patients had dropped to 41%. This isunderstandable as cancer represents only 24% of US deaths. The rise in non-cancer hospice
patients was also driven by NHPCO’s policy recommendation to members that is was
discriminatory to refuse to admit non-cancer patients.
Non-hospice palliative care has also grown significantly, especially in the last 10 years. By 2008according to a Center to Advance Palliative Care (CAPC) analysis of the latest data released fromthe 2008 American Hospital Association (AHA) Annual Survey of Hospitals, U.S. hospitalscontinue to implement palliative care programs at a rapid pace. The CAPC analysis showed that1299 hospitals (31%) nationwide provide palliative care programs. This was compared to just 632
programs in 2000. Most significantly, hospitals with over 50 beds – the most likely to have a program – show a penetration of 47%.
Up to date information on hospice and palliative care can be found at www.nhpco.org bysearching for the Facts and Figures on hospice care. Hospital based resources can also be foundat www.capc.org
Session: Core curricula
Chair of the session: Dott. Giuseppe Casale, Dott. Franco De Conno
Antea Worldwide Palliative Care ConferenceRome, 12-14 November 2008
Stephen Connor
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• Rehabilitation in palliative care
• Core Curricula