P2-083: Hospice care in U.S. nursing homes for persons with end-stage dementia: How U.S. medicare payment policy influences hospice election and end-of-life hospitalizations

2010 ◽  
Vol 6 ◽  
pp. S337-S337
Author(s):  
Susan C. Miller ◽  
Julie C. Lima ◽  
Susan L. Mitchell
Keyword(s):  
Nursing Homes ◽  
End Of Life ◽  
Hospice Care ◽  
Medicare Payment ◽  
Payment Policy ◽  
End Stage

Serious Mental Illness and Hospice Care

2021 ◽  
pp. 082585972110220
Author(s):  
Gwen Levitt
Keyword(s):  
Mental Health ◽  
End Of Life ◽  
End Of Life Care ◽  
Psychiatric Illness ◽  
Hospice Care ◽  
Treatment Options ◽  
Life Care ◽  
Case Review ◽  
Health Community ◽  
End Stage

There are a small number of articles in the literature discussing palliative and end-of-life care in the SMI population. Most tackle the questions relating to competency to refuse care in end-stage anorexia or terminal medical conditions. This is a case review of a 55 year old patient with a complex psychiatric and medical history, who despite extensive treatment and long hospitalizations has failed to regain any ability to care for her basic needs. She has exhausted all available treatment options and her prognosis is extremely poor. The mental health community is resistant to discussing and/ or confronting the fact that such a patient faces with the need for end-of-life care directly related to chronic psychiatric illness.

Does Receipt of Hospice Care in Nursing Homes Improve the Management of Pain at the End of Life?

2002 ◽  
Vol 50 (3) ◽  
pp. 507-515 ◽  
Author(s):  
Susan C. Miller ◽  
Vincent Mor ◽  
Ning Wu ◽  
Pedro Gozalo ◽  
Kate Lapane
Keyword(s):  
Nursing Homes ◽  
End Of Life ◽  
Hospice Care

End-of-Life Care in Nursing Homes: Residents in Hospice Compared to Other End-Stage Residents

2004 ◽  
Vol 7 (2) ◽  
pp. 221-232 ◽  
Author(s):  
Robert J. Buchanan ◽  
Maryann Choi ◽  
Suojin Wang ◽  
Hyunsu Ju
Keyword(s):  
Nursing Homes ◽  
End Of Life ◽  
End Of Life Care ◽  
Life Care ◽  
End Stage

scholarly journals NQPC-10 END-OF-LIFE PHASE OF GLIOBLASTOMA

2019 ◽  
Vol 1 (Supplement_2) ◽  
pp. ii31-ii31
Author(s):  
Tomoko Omura ◽  
Yasuji Miyakita ◽  
Takaki Omura ◽  
Makoto Ohno ◽  
Masamichi Takahashi ◽  
...  
Keyword(s):  
Nursing Homes ◽  
End Of Life ◽  
Hospice Care ◽  
Deep Coma ◽  
Term Care ◽  
Home Based ◽  
Prognosis Group ◽  
Eol Care ◽  
At Home

Abstract BACKGROUND Despite aggressive treatment with surgery and chemo-radiation therapy, it is difficult to cure patients with glioblastoma (GBM). The end-of-life (EOL) phase of patients with GBM, and related problems, have not yet been adequately studied. Most cancer patients died in the hospital (84%) in 2017, but the Japanese government has recommended palliative home-care and the number of deaths at home has recently been increasing. This study explores the current situation of EOL care for GBM patients in our hospital. METHODS We retrospectively examined the clinical course and EOL phase of 166 consecutive patients who were treated in our hospital between 2010 and 2017. RESULT In total, 107 patients died; 28 (26%) at home, 25 (23%) in hospice care, 9(9%) in nursing homes, 21(20%) in long-term care hospitals (LTCH), 13(12%) in our hospital, and 11(10%) in other neurosurgical hospitals. The median survival time and length of EOL phase for patients who died at home were 596 and 77 days; 469 and 103 days in hospice care; 528 days and 149 days in LTCH; 388 days and 52 days in our hospital; 802 and 91 days in other neurosurgical hospital; and 565 days and 55 days in nursing homes, respectively. The KPS of patients who transferred to LTCH or was started palliative care in other neurological hospital was 60. That of other patients was 50.The patients who died at home entered deep coma in the last 3.5 days (n=24) of life and could not take oral feeds for 7 days (n=26). CONCLUSION According to cancer patient study, the home-based palliative time of longer prognosis group were 59 days. EOL phase of GBM may be longer than other cancer. We must consider the problems of the EOL phase and improve the quality of EOL care.

scholarly journals QOLP-40. END-OF-LIFE CARE FOR GLIOBLASTOMA PATIENTS IN JAPAN

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi206-vi207
Author(s):  
Tomoko Omura ◽  
Yasuji Miyakita ◽  
Makoto Ohno ◽  
Masamichi Takahashi ◽  
Kenji Fujimoto ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Home Care ◽  
End Of Life ◽  
Hospice Care ◽  
Term Care ◽  
Palliative Home Care ◽  
Eol Care ◽  
At Home

Abstract BACKGROUND Despite aggressive treatment with surgery and chemo-radiation therapy, it is difficult to cure patients with glioblastoma (GBM). The end-of-life (EOL) phase of patients with GBM, and related problems, have not yet been adequately studied. Unlike in other countries, most cancer patients died in the hospital (84%) in 2017, but the Japanese government has recommended palliative home care and the number of deaths at home has recently been increasing. This study explores the current situation of EOL care for GBM patients in Japan. METHODS We retrospectively examined the clinical course and EOL phase of 166 consecutive patients who were treated in our hospital between 2010 and 2017. RESULT: In total, 107 patients died; 27 (25.7%) at home, 24 (22.8%) in hospice care, 8 (7.6%) in nursing homes, 46 (43.9%) in hospitals (long-term care hospitals [LTCH; 19.8%], our hospital [13.3%], and other neurosurgical hospitals [10.4%]). According to our previous research, in 2001–2005, 6% of GBM patients died at home, 3% in hospice case, and 91% in the hospital. The KPSof patients who started palliative home care or transferred to another hospital was 50–60. The median survival time and length of EOL phase for patients who died at home were 498 and 76.5 days; 395 and 103 days in hospice care; 533 days and 149 days in LTCH; 374 days and 52 days in our hospital; 338 and 75.5 days in other neurosurgical hospital; and 557 days and 37 days in nursing homes, respectively. CONCLUSION The number of GBM patients who died at home in Japan is increasing, and we must consider the problems of the EOL phase and improve the quality of EOL care.

Reducing costs at the end of life through provider incentives for hospice care: A retrospective cohort study

2018 ◽  
Vol 32 (8) ◽  
pp. 1389-1400 ◽  
Author(s):  
Bradley Chen ◽  
Chin-Chi Kuo ◽  
Nicole Huang ◽  
Victoria Y Fan
Keyword(s):  
Renal Disease ◽  
End Of Life ◽  
End Stage Renal Disease ◽  
Hospice Care ◽  
Cost Savings ◽  
Research Database ◽  
Reducing Costs ◽  
Stage Renal Disease ◽  
End Stage ◽  
The Cost

Background: Costs of medical care have been found to be highest at the end of life. Aim: To evaluate the effect of provider reimbursement for hospice care on end-of-life costs. Design: The policy expanded access to hospice care for end-stage renal disease patients, a policy previously limited to cancer patients only. This study employed a difference-in-differences analysis using a generalized linear model. The main outcome is inpatient expenditures in the last 30 days of life. Setting/participants: A cohort of 151,509 patients with chronic kidney disease or cancer, aged 65 years or older, who died between 2005 and 2012 in the National Health Insurance Research Database, which contains all enrollment and inpatient claims data for Taiwan. Results: Even as end-of-life costs for cancer are declining over time, expanding hospice care benefits to end-stage renal disease patients is associated with an additional reduction of 7.3% in end-of-life costs per decedent, holding constant patient and provider characteristics. On average, end-of-life costs are also high for end-stage renal disease (1.88 times higher than those for cancer). The cost savings were larger among older patients—among those who died at 80 years of age or higher, the cost reduction was 9.8%. Conclusion: By expanding hospice care benefits through a provider reimbursement policy, significant costs at the end of life were saved.

scholarly journals Dying in America — An Examination of Policies that Deter Adequate End-of-life Care in Nursing Homes

2005 ◽  
Vol 33 (2) ◽  
pp. 294-309 ◽  
Author(s):  
Diane E. Hoffmann ◽  
Anita J. Tarzian
Keyword(s):  
Nursing Homes ◽  
End Of Life ◽  
End Of Life Care ◽  
Care Setting ◽  
Hospice Care ◽  
Life Care ◽  
Public Attention ◽  
Term Care

The quality of end-of-life care in this country is often poor. There is abundant literature indicating that dying individuals do not receive adequate pain medication or palliative care, are tethered to machines and tubes in a way that challenges their dignity and autonomy, and are not helped to deal with the emotional grief and psychological angst that may accompany the dying process. While this is true for individuals in many settings, it seems to be especially true for individuals in nursing homes. This is somewhat puzzling given that (1) considerable resources have been devoted to bringing public attention to this problem, (2) we have the knowledge and expertise to provide such care, and (3) we have a government-financed benefit that covers this type of care - the Medicare hospice benefit (MHB).While utilization of hospice care has increased during the last decade, there is considerable evidence that hospice care remains underutilized particularly in the long term care setting.

Dysphagia in Hospice Care: The Roles of Social Work and Speech-Language Pathologists

2014 ◽  
Vol 23 (4) ◽  
pp. 173-186 ◽  
Author(s):  
Deborah Hinson ◽  
Aaron J. Goldsmith ◽  
Joseph Murray
Keyword(s):  
Social Work ◽  
End Of Life ◽  
Case Studies ◽  
End Of Life Care ◽  
Hospice Care ◽  
Patient Communication ◽  
Life Care ◽  
Speech Language Pathologists ◽  
Four Levels

This article addresses the unique roles of social work and speech-language pathologists (SLPs) in end-of-life and hospice care settings. The four levels of hospice care are explained. Suggested social work and SLP interventions for end-of-life nutrition and approaches to patient communication are offered. Case studies are used to illustrate the specialized roles that social work and SLP have in end-of-life care settings.

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