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ON YOUR BEHALF: Home Hospice Programs 
Are Getting Stronger

By Connie Ford, RN, MPA
(Page 1 of 2)

When you learn to die, you learn to live. That is the compelling theme of the well-known book, Tuesdays with Morrie. Learning to die is a personal process; no one else can do it for us. It is possible, however, that caring for another during his or her end of life pilgrimage may help with our own process of learning.

One day while touring a new senior housing complex, a local minister commented that the people he used to visit in nursing homes are now being cared for at home. His casual observations are pretty accurate. Nursing home professionals would not only agree, but they would also relate that their frail residents are living longer with chronic illnesses and require more care and caring than in years past.

Can nursing homes really provide the needed care and caring? Nursing home admissions for extended stays are declining. People are finding ways to stay at home. They desperately wish to preserve personal dignity. They also fear a loss of control, poor care and perhaps a painful death. Various state initiatives provide care services so people may successfully stay home and ‘age in place.’

When people encounter the end of life, we typically do not hear about fears relating to care and caring when hospice is helping the family. hospice programs generally receive great accolades for their work. hospice extends to some nursing homes so eligible residents can receive the program benefits. In an ideal world, one would think that hospice in a nursing home shouldn't be necessary; a nursing home should always be a premier residence for a ‘good death.’

Why do some nursing homes have arrangements with hospice programs and others don't? One possible reason is financial. Government programs such as Medicare and Medicaid pay a daily rate for hospice. When hospice provides a nursing home resident with end of life care, the nursing home becomes a partner with hospice. They share the daily payment and therefore receive less money than when they individually provide all of the care. Now more than ever, because of changes in government reimbursement and increasing insurance costs, nursing homes are struggling to survive.

Therefore, we must take an active role in assuring appropriate end of life care. There are several national efforts that are helping; two are especially relevant at this time. In 1999, a national foundation, the Milbank Memorial Fund, published an important document, Principles for Care of Patients at the End of Life: An Emerging Consensus among the Specialties of Medicine. As caregivers and as mortal human beings, it is reassuring to know that 14 major societies, including the American Medical Association and the Joint Commission on Accreditation of Health Care Organizations (JCAHO), have created policy that incorporate these principles. The principles for professional practice include:

    Respect for the dignity of both patients and caregivers

    Sensitivity to and respect for the patient's and family's wishes

    Use of appropriate measures consistent with patient choices

    Alleviation of pain and other physical symptoms

    Assessment and management of psychological, social and spiritual/religious problems

    Offering continuity. The patient should be able to continue to be cared for by his/her primary care and specialist providers

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