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    Hospice Risk Management

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    Please provide ethical dilemma information on the areas below:

    1. Brief History/Background of services and ethical dilemma of Hospice
    2. List Risk Management of hospice including HIPAA issues
    3. Hospice Quality Assurance

    Provide 3 references.

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    Solution Preview


    Interesting questions! Let's take a closer look at these questions about hospices. I also attached two resources, which are referred to in this response.


    1. Brief History/Background of services and ethical dilemma of Hospice

    A Hospice is a program or facility that provides special care for people who are near the end of life and for their families. Hospice care can be provided at home, in a hospice or another freestanding facility, or within a hospital. See also: Hospice care. http://www.medterms.com/script/main/art.asp?articlekey=24266

    In 1967, hospice first applied to specialized care for dying patients by physician Dame Cicely Saunders, who founded the first modern hospice?St. Christopher's Hospice?in a residential suburb of London. Then, Saunders introduced the idea of specialized care for the dying to the United States during a 1963 visit with Yale University. Her lecture, given to medical students, nurses, social workers, and chaplains about the concept of holistic hospice care, included photos of terminally ill cancer patients and their families, showing the dramatic differences before and after the symptom control care. This lecture launched a following chain of events (see timeline below), which resulted in the development of hospice care as we know it today (http://www.nhpco.org/i4a/pages/index.cfm?pageid=3285).

    EXTRA INFORMATION: Timeline of Hospice Care (excerpt)

    Hospice: A Historical Perspective

    1965: Florence Wald, then Dean of the Yale School of Nursing, invites Saunders to become a visiting faculty member of the school for the spring term.

    1968: Wald takes a sabbatical from Yale to work at St. Christopher's and learn all she can about hospice.

    1969: A book based on more than 500 interviews with dying patients is published, entitled, On Death and Dying. Written by Dr. Elisabeth Kubler-Ross, it identifies the five stages through which many terminally ill patients progress. The book becomes an internationally known best seller. Within it, Kubler-Ross makes a plea for home care as opposed to treatment in an institutional setting and argues that patients should have a choice and the ability to participate in the decisions that affect their destiny.

    1972: Kubler-Ross testifies at the first national hearings on the subject of death with dignity, which are conducted by the U.S. Senate Special Committee on Aging. In her testimony, Kubler-Ross states, "We live in a very particular death-denying society. We isolate both the dying and the old, and it serves a purpose. They are reminders of our own mortality. We should not institutionalize people. We can give families more help with home care and visiting nurses, giving the families and the patients the spiritual, emotional, and financial help in order to facilitate the final care at home."

    1974: The first hospice legislation is introduced by Senators Frank Church and Frank E. Moss to provide federal funds for hospice programs. The legislation is not enacted.

    1978: A U.S. Department of Health, Education, and Welfare task force reports that "the hospice movement as a concept for the care of the terminally ill and their families is a viable concept and one which holds out a means of providing more humane care for Americans dying of terminal illness while possibly reducing costs. As such, it is the proper subject of federal support."

    1979: The Health Care Financing Administration (HCFA) initiates demonstration programs at 26 hospices across the country to assess the cost effectiveness of hospice care and to help determine what a hospice is and what it should provide.

    1980: The W.K. Kellogg Foundation awards a grant to the Joint Commission on Accreditation of Hospitals (JCAHO) to investigate the status of hospice and to develop standards for hospice accreditation.

    1982: Congress includes a provision to create a Medicare hospice benefit in the Tax Equity and Fiscal Responsibility Act of

    1982, with a 1986 sunset provision.

    1984: JCAHO initiates hospice accreditation.

    1986: The Medicare Hospice Benefit is made permanent by Congress and hospices are given a 10% increase in reimbursement rates. States are given the option of including hospice in their Medicaid programs. Hospice care is now available to terminally ill nursing home residents.

    1989: The Government Accounting Office releases a study stating that only about 35% of eligible hospices are Medicare-certified. There are several reasons listed, one of which is the low payment rates HCFA had established for hospices.

    1989: Congress gives ...

    Solution Summary

    This solution provides a brief History/Background of services and ethical dilemmas and risk management issues of a hospice including HIPAA issues, and hospice quality assurance. Supplemented with two articles on aspects of hospice management.