The role of hospice and palliative care facilities in the home hospice care system

Abstract Background Due to the emergence of COVID-19 and resulting pandemic, there is an increased demand for palliative care and hospice care services. However, the impact of COVID-19 on the hospice and palliative agencies is unknown. Methods An electronic survey was disseminated via the Hospice & Palliative Nurses Association newsletter, posted to the Sigma Theta Tau Hospice and Palliative Care Community Group discussion board and advertised through social media from May 7–28, 2020. Summary statistics were computed. Results We collected 36 surveys representing all U.S. regions. Most respondents (78%) reported that their agency has cared for confirmed COVID-19 patients. Only half of agencies had access to laboratory facilities for surveillance and detection of the presence of outbreaks in both patients and staff (58%) and the ability to test patients and providers for COVID-19 (55%). Due to COVID-19, participants stated that the agency added new protocols regarding aerosol-generating procedures policies (58%), use of surface barriers (61%) and PPE usage (e.g. donning and doffing) in patient homes (56%). The majority (76%) reported that their agency required field clinicians to call ahead to ascertain COVID-19 exposure/symptoms before a home visit. More than half (58%) reported that their agency lacked supplies, including N95 respirators (45%), cleaning/disinfectant product (23%), alcohol based sanitizer (18%), eye protection (18%), gowns (18%), and surgical masks (14%). Overall, participants shared that field clinicians had to reuse (76%), extend (73%) or ration (30%) PPE supplies. Respondents reported that their agency accessed supplemental PPE through state/local resources (67%), private/community donations (67%), and do-it-yourself efforts (55%). One third (31%) reported that their agency was experiencing staffing shortages due to COVID-19; of these, 60% reported that shortages were due to staff infected with/quarantined due to COVID-19. Conclusion Our findings suggest that COVID-19 has presented significant challenges for palliative care and hospice agencies as they provide care to patients and families at an unprecedented rate. Disclosures All Authors: No reported disclosures

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Palliative Care as Response to Suffering at End of Life

Review of Ecumenical Studies Sibiu ◽

10.2478/ress-2014-0118 ◽

2014 ◽

Vol 6 (2) ◽

pp. 227-245

Author(s):

Daniela Moşoiu

Keyword(s):

Health Care ◽

Palliative Care ◽

End Of Life ◽

Health Care System ◽

Spiritual Distress ◽

History Of Development ◽

History Of ◽

Hospice And Palliative Care ◽

Care System

Abstract Persons suffering from chronic and life limiting illnesses often have unrelieved symptoms such as pain, depression, fatigue, and psychosocial and spiritual distress. In Romania they are frequently left in the care of their families with little support from the health care system. It seems a paradox that those who are the sickest persons in a country find little place in the health care system. This article presents palliative care as a solution to the suffering for these patients and their families by describing the concept, models of services, its beneficiaries and benefits and presenting the history of development of hospice and palliative care worldwide and in Romania.

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The Role of Primary Caregiver Denial in Inpatient Placement During Home Hospice Care

The Hospice Journal ◽

10.1080/0742-969x.2000.11882945 ◽

2000 ◽

Vol 15 (1) ◽

pp. 15-33

Author(s):

Dona J. Reese

Keyword(s):

Hospice Care ◽

Primary Caregiver ◽

Home Hospice Care

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INNOVATIVE STRATEGIES TO SUPPORT OLDER ADULTS AND THEIR FAMILIES IN HOSPICE AND PALLIATIVE CARE

Innovation in Aging ◽

10.1093/geroni/igz038.718 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S199-S199

Author(s):

George Demiris ◽

Karen Hirschman

Keyword(s):

Older Adults ◽

Palliative Care ◽

Hospice Care ◽

Geographic Distance ◽

Smart Phone ◽

Evidence Base ◽

Lessons Learned ◽

Ethical Challenges ◽

Rural Settings ◽

Hospice And Palliative Care

Abstract In order to better support older adults with life-limiting illness and their families, many initiatives utilize information technology and other innovative platforms to increase access to supportive services and bridge geographic distance. Such technologies cover a broad range of systems ranging from smart phone applications to wearables and traditional telehealth platforms. There is a growing evidence base for such interventions but technical, clinical and ethical challenges remain when utilizing technology in the context of hospice and palliative care especially for older adults, including the concerns for caregiver burden, privacy, security, confidentiality, obtrusiveness and accessibility. In this symposium we provide an overview of innovative tools available for interventions in palliative and hospice care designed for patients and/or family caregivers in urban and rural settings. We provide lessons learned from three NIH funded studies testing different technology-based interventions in various settings including home hospice and outpatient palliative care. Discussion will follow focused on the clinical, ethical and practical challenges of innovation and the unique considerations for technology-mediated intervention design in a variety of palliative and hospice care settings. This symposium aims to provide: 1. an overview of existing technology-based interventions for older adults and their families in palliative care and hospice 2. evidence-based recommendations resulting from clinical trials in urban and rural settings for the design and implementation of innovative tools in hospice and palliative care 3. a discussion of challenges and opportunities for the use of technology to support older adults and their families

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Accounts of Family Conflict in Home Hospice Care: The Central Role of Autonomy for Informal Caregiver Resilience

Journal of Family Nursing ◽

10.1177/1074840719828091 ◽

2019 ◽

Vol 25 (2) ◽

pp. 190-218 ◽

Cited By ~ 2

Author(s):

Jacquelyn J. Benson ◽

Debra Parker Oliver ◽

George Demiris ◽

Karla Washington

Keyword(s):

Family Conflict ◽

Health Care Professionals ◽

Hospice Care ◽

Secondary Analysis ◽

Relational Dialectics ◽

Relational Dialectics Theory ◽

Hospice Patients ◽

Stressful Experience ◽

Home Hospice Care

End-of-life caregiving is a highly stressful experience often fraught with conflict and tension. However, little is known about the ways family conflict manifests for informal caregivers of home hospice patients (IHCs). Framed by relational dialectics theory, the purpose of this study was to provide nurses and other health care professionals with an empirical understanding of how IHCs experience family conflict and tensions associated with caregiving. A second aim was to determine what strategies IHCs use to manage these family conflicts. Data used in this qualitative secondary analysis were originally collected as part of a randomized clinical trial of an IHC support intervention. Based on thematic analysis of data from 25 IHCs who reported family conflict, a conceptual model of caregiver resilience was developed from the themes and categories that emerged during the coding stage. Autonomy was identified as a central tension. IHCs used several strategies to address family conflict including communication, formal support, and emotional self-care.

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Palliative and Hospice Care: Educational Needs of Inpatient Registered Nurses

Creative Nursing ◽

10.1891/1078-4535.22.2.114 ◽

2016 ◽

Vol 22 (2) ◽

pp. 114-120 ◽

Cited By ~ 1

Author(s):

Jennifer L. Ashley ◽

Tracy K. Fasolino

Keyword(s):

Quality Of Life ◽

Palliative Care ◽

Acute Care ◽

Formal Education ◽

Care Setting ◽

Hospice Care ◽

Acute Care Setting ◽

Life Threatening ◽

Hospice And Palliative Care

Hospice and palliative care aim to improve the quality of life for patients and families impacted by chronic, serious, and life-threatening illnesses. Patients and families benefit from earlier integration of palliative care and seamless transitions to hospice care. Nurses are an integral part of the care team, and their understanding of these services is critical. However, many nurses do not receive formal education in hospice and palliative care. This leads to lack of skills that nurses need to provide and discuss hospice and palliative care across care settings. Nurses in an acute care setting of a large health system were invited to participate in a survey, Attitudes Towards Care at the End-of-Life. The results of this survey revealed that nurses believe that patients and families need to be communicated with honestly regarding their disease, but nurses lack the knowledge of how to facilitate these discussions. Another key finding is that nurses feel less confident with non-pharmacologic interventions to relieve patients’ suffering. Education is urgently needed in these areas.

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The Role of Hospice and Palliative Care Nurses in Quality Improvement

Journal of Hospice and Palliative Nursing ◽

10.1097/njh.0000000000000324 ◽

2017 ◽

Vol 19 (2) ◽

pp. 160-165 ◽

Cited By ~ 2

Author(s):

Lisa C. Lindley ◽

Keela A. Herr ◽

Sally A. Norton

Keyword(s):

Palliative Care ◽

Quality Improvement ◽

Hospice And Palliative Care

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Communication in oncology pharmacy

10.1093/med/9780198736134.003.0051 ◽

2017 ◽

Author(s):

Bethan Tranter ◽

Simon Noble

Keyword(s):

Palliative Care ◽

Treatment Adherence ◽

Drug Safety ◽

Medication Compliance ◽

Healthcare Providers ◽

Optimal Drug ◽

Treatment Medication ◽

Hospice And Palliative Care ◽

Timely Treatment

Pharmacists are considered to have a pivotal role in the provision of information in oncology, and in hospice and palliative care. Effective communication is essential for optimal drug safety, timely treatment, medication compliance, and education. The role of the pharmacist has expanded to offer enhanced pharmaceutical care, which serves to improve the communication between healthcare providers and the function of the multidisciplinary team. Furthermore, through optimal communication with patients there will be increased treatment adherence and improved overall care. This chapter focuses on the breadth of communication issues faced by pharmacists involved in cancer care through the full length of the cancer journey, be it curative or palliative.

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The economic challenges of palliative medicine

10.1093/med/9780199656097.003.0010 ◽

2015 ◽

Author(s):

Thomas J. Smith ◽

J. Brian Cassel

Keyword(s):

Palliative Care ◽

Lower Cost ◽

Hospice Care ◽

Cost Minimization ◽

Cost Benefit ◽

Cost Utility ◽

Utility Analysis ◽

New Directions ◽

Hospice And Palliative Care ◽

Benefit Cost

The compelling reasons for palliative care continue to be better symptom management, better advanced care planning and medically appropriate goal setting, and transitions to hospice care. Other new-found compelling reasons include better survival with hospice care, better survival with concurrent palliative care, and lower cost to hospitals and government and insurance funders. In studies to date, hospice and palliative care have been associated with equal or better survival and equal or lower cost. This chapter defines the various types of cost and clinical studies (including cost minimization, cost-effectiveness, cost utility analysis, cost-benefit, cost avoidance) and discusses the available data about the economic challenges of palliative care, how to apply the available data, how to collect and present some useful and useable data, and new directions for research.

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