scholarly journals Death and dying in the US: the barriers to the benefits of palliative and hospice care

2008 ◽  
Vol Volume 3 ◽  
pp. 595-599 ◽  
Author(s):  
Albert Finestone ◽  
G Inderwies
Keyword(s):  
Hospice Care ◽  
Death And Dying ◽  
The Us

scholarly journals Palliative Care in Advanced Dementia: Comparison of Strategies in Three Countries

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 44
Author(s):  
Shelley A. Sternberg ◽  
Shiri Shinan-Altman ◽  
Ladislav Volicer ◽  
David J. Casarett ◽  
Jenny T. van der Steen
Keyword(s):  
Palliative Care ◽  
The Netherlands ◽  
Hospice Care ◽  
The United States ◽  
Artificial Nutrition ◽  
Advanced Dementia ◽  
Case Scenario ◽  
Artificial Nutrition And Hydration ◽  
Positive Elements ◽  
The Us

Palliative care including hospice care is appropriate for advanced dementia, but policy initiatives and implementation have lagged, while treatment may vary. We compare care for people with advanced dementia in the United States (US), the Netherlands, and Israel. We conducted a narrative literature review and expert physician consultation around a case scenario focusing on three domains in the care of people with advanced dementia: (1) place of residence, (2) access to palliative care, and (3) treatment. We found that most people with advanced dementia live in nursing homes in the US and the Netherlands, and in the community in Israel. Access to specialist palliative and hospice care is improving in the US but is limited in the Netherlands and Israel. The two data sources consistently showed that treatment varies considerably between countries with, for example, artificial nutrition and hydration differing by state in the US, strongly discouraged in the Netherlands, and widely used in Israel. We conclude that care in each country has positive elements: hospice availability in the US, the general palliative approach in the Netherlands, and home care in Israel. National Dementia Plans should include policy regarding palliative care, and public and professional awareness must be increased.

The Good Death, Virtue, and Physician-Assisted Death: An Examination of the Hospice Way of Death

1995 ◽  
Vol 4 (1) ◽  
pp. 92-97 ◽  
Author(s):  
Franklin G. Miller
Keyword(s):  
Terminal Illness ◽  
Assisted Suicide ◽  
Hospice Care ◽  
Death And Dying ◽  
Good Death ◽  
Voluntary Euthanasia ◽  
Assisted Death ◽  
Comfort Care ◽  
The Face ◽  
The Right

The problem of physician-assisted death (PAD), assisted suicide and active euthanasia, has been debated predominantly in the ethically familiar vocabulary of rights, duties, and consequences. Patient autonomy and the right to die with dignity vie with the duty of physicians to heal, but not to kill, and the specter of “the slippery slope” from voluntary euthanasia as a last resort for patients suffering from terminal illness to PAD on demand and mercy killing of “hopeless” incompetent patients. Another dimension of the debate over PAD concerns the evaluative question of what constitutes a good death. At stake are Issues of character and virtue in the face of death and dying and their Implications for legitimizing the practice of PAD. Critics of PAD argue that “natural” death in the context of comfort care, as provided by hospice programs, is the good death. In contrast, PAD amounts to an easy way out, an evasion of the ultimate human challenge and task of dying. Because hospice care is clearly preferable to PAD, the former should be encouraged and the latter remain prohibited.

Charitable contributions and quality in the us hospice care setting

2014 ◽  
Vol 26 (4) ◽  
pp. 539-556 ◽  
Author(s):  
Kelly Noe ◽  
Dana A. Forgione
Keyword(s):  
Quality Of Care ◽  
Hospice Care ◽  
The United States ◽  
Charitable Contributions ◽  
The Us ◽  
Home Health Aide ◽  
Report Data ◽  
Worker Quality ◽  
Cost Report

This paper examines the association of charitable donations with quality of care proxies for nonprofit hospice providers in the United States (US). An estimated 1.45 million patients received hospice care in the US in 2008. Medicare hospice spending exceeded $10 billion in 2007 and is expected to more than double over the next 10 years. Using Guidestar and Medicare Hospice Cost Report data, we find donations are positively associated with proxies for nurse and social worker quality of care, but not with our home-health aide quality proxy. This research adds to our understanding of charitable contributions in hospice provider organizations.

scholarly journals Rural-Urban Disparities in Place of Death in Hematologic Malignancies in the US from 2003 to 2019

Blood ◽  
2021 ◽  
Vol 138 (Supplement 1) ◽  
pp. 4137-4137
Author(s):  
Syed M. Qasim Hussaini ◽  
Arjun Gupta
Keyword(s):  
United States ◽  
Metropolitan Area ◽  
Rural Areas ◽  
Hospice Care ◽  
Metropolitan Areas ◽  
Hematologic Malignancies ◽  
The United States ◽  
Medical Facility ◽  
Nursing Facility ◽  
The Us

Abstract Background: more than 60,000 people die annually from hematologic malignancies in the united states (us). Patients with hematologic malignancies more frequently receive aggressive care toward the end-of-life and are more likely to die in a hospital compared to those with a solid tumor. Appropriate care of such patients is very dependent on an existing healthcare infrastructure. There are notable challenges to rural healthcare in the united states which contains less than 1/5th of all hospices in the us. In this study, we sought to investigate rural-urban disparities in place of death the us in individuals that died from hematologic malignancies. Methods: we utilized the us centers for disease control and prevention wide-ranging online data for epidemiologic research database to analyze all deaths from hematologic malignancies in the us from 2003 to 2019. A population classification utilizing the 2013 us census was made using the national center for health statistics urban-rural classification scheme. These classifications included: large metropolitan area (1 million), small- or medium-sized metropolitan area (50 000-999 999), and rural area (<50 000). We estimated deaths in a medical facility, hospice, home, or nursing care facility. We stratified the results by age, sex, and race/ethnicity. The annual percentage change (apc) in deaths was estimated. All data was publicly available and de-identified. Findings: from 2003-2019, there were a total 1,088,589 deaths form hematologic malignancies in the united states, predominantly in large metropolitan areas (50.2%), followed by small or medium sized metropolitan areas (31.7%) and rural areas (18.2%). All regions noted decreases in medical facility and nursing facility related deaths, and increase in hospice and home deaths. While rural areas demonstrated the quickest uptake of hospice care (apc 61.5), they had the lowest overall presence of hospice care (8.3% of all rural deaths in 2019 vs. 14.9% for small or medium metropolitan vs. 12% for large metropolitan) and larger share of nursing facility related deaths (15.8% of all rural deaths in 2019 vs 12.3% for small or medium metropolitan vs 10.6% for large metropolitan). Discussion: we demonstrate end-of-life disparities in hematologic malignancies based on where an individual resides in the us with rural areas having notably lower share of deaths in hospice facilities. Older infrastructure, inadequate access to care, and financial barriers add to the medical complexity of care for all patients, and especially hematologic patients with high needs and complex treatment planning. These have been aggravated by rural hospital closures in the previous 18 months. The us senate is currently debating a bipartisan infrastructure that may add billions in building rural healthcare infrastructure to state budgets. Our findings are timely in helping inform congressional policy. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

scholarly journals 大乘中觀哲學的生死觀

2016 ◽  
Vol 14 (2) ◽  
pp. 65-86
Author(s):  
Ellen Y. ZHANG
Keyword(s):  
Hospice Care ◽  
Death And Dying ◽  
Well Being ◽  
The Body ◽  
Religious Support ◽  
Religious Traditions ◽  
Life And Death ◽  
Philosophy Of Life ◽  
Other World ◽  
General Desire

LANGUAGE NOTE | Document text in Chinese; abstract also in English.生死是任何哲學和宗教都不能迴避的問題，佛教更是如此。相比中國傳統的儒家思想，佛教對死亡，甚至如何去死具有更詳盡的梳理和論證。而佛教的生死觀又源於佛教的核心的教義以及其背後的哲學思考。根據佛教的教義，覺悟、解脫或涅槃意味著從根本上去除人生的煩惱，而佛教認為，人生最大的煩惱便是生死輪迴之煩惱。但大乘佛教的反對將覺悟與紅塵、涅槃與輪迴看作絕對的二元對立，因此強調在生死煩惱中體驗超越的時空和宇宙的真理。本文以大乘中觀學派為主，從其「緣起性空」的哲學脈絡和「相即不二」的辦證思維，審視大乘佛教的生死觀以及它對中國儒道傳統的補充與融合。最後，文章論述中觀學的生死觀在當代臨終關懷中的啟示意義。Death is one of the major issues for all religious traditions; it is especially so for Buddhism, as Buddhist teaching is centered upon death and the impermanence of life. This essay discusses death and dying from the framework of the philosophy of life and death, as outlined in the Māhayānic Buddhism of China. The discussion centers on early Madhyāmika Buddhism and its non-dualist approach to samsara and nirvana, this world and the other world, and life and death. The essay shows that the notions of reincarnation and karmic action offer an alternative perspective on the finitude of human existence and reflection upon life’s uncertainty pertaining to the experience of death. The author contends that the theory of interdependent origination explicated by Madhyāmika Buddhism helps Buddhists to develop adaptive qualities that enable a person to remain balanced in the maelstrom of change and impermanence. This realization of the impermanence of life and the emptiness of interdependent origination leads to the Buddhist ethical positions of no self and non-attachment.The essay also addresses the question of hospice care from the perspective of Buddhism as a religious support system. Although Buddhists understand that suffering is a part of life, there is a general desire to avoid suffering whenever possible. Hospice care is important in Buddhism not only because Buddhists recognize the weakness and fragility of the body and mind in the process of death and dying, but also because Buddhists see the connection between the patient’s end-of-life needs, both physical and spiritual, and the well-being of other people associated with the patient. The essay argues that a positive attitude toward life and death, as presented in Madhyāmika Buddhism, can help patients and their families to deal with the pain and anxiety of terminal illness.DOWNLOAD HISTORY | This article has been downloaded 1527 times in Digital Commons before migrating into this platform.

scholarly journals Hospice Employees’ Perceptions of Their Work Environment: A Focus Group Perspective

2020 ◽  
Vol 17 (17) ◽  
pp. 6147 ◽  
Author(s):  
Rebecca H. Lehto ◽  
Carrie Heeter ◽  
Jeffrey Forman ◽  
Tait Shanafelt ◽  
Arif Kamal ◽  
...  
Keyword(s):  
Mental Health ◽  
Terminal Illness ◽  
Hospice Care ◽  
Death And Dying ◽  
Structured Interview ◽  
Organizational Level ◽  
Physical And Mental Health ◽  
Care Workers ◽  
Hospice Workers ◽  
And Coping

Burnout in healthcare professionals can lead to adverse effects on physical and mental health, lower quality of care, and workforce shortages as employees leave the profession. Hospice professionals are thought to be at particularly high risk for burnout. The purpose of the study was to evaluate workplace perceptions of interdisciplinary hospice care workers who provide care to patients at end of life. Six focus groups and one semi-structured interview were conducted with mixed group of social workers, managers, nurses, hospice aides, chaplains, support staff, and a physician (n = 19). Findings from the groups depicted both rewards and challenges of hospice caregiving. Benefits included intrinsic satisfaction from the work, receiving positive patient and family feedback, and teamwork. Challenges reflected issues with workload, technology issues, administrative demands, travel-related problems, communication and interruptions, difficulties with taking time off from work and maintaining work-life integration, and coping with witnessing grief/loss. Hospice workers glean satisfaction from making meaningful differences in the lives of patients with terminal illness and their family members. It is an expected part of the job that certain patients and situations are particularly distressing; team support and targeted grief support is available for those times. Participants indicated that workload and administrative demands rather than dealing with death and dying were the biggest contributors to burnout. Participants reported episodic symptoms of burnout followed by deliberate steps to alleviate these symptoms. Notably, for all except one of the participants, burnout was cyclical. Symptoms would begin, they would take steps to deal with it (e.g., taking a mental health day), and they recovered. At an organizational level, a multipronged approach that includes both personal and occupational strategies is needed to support professional caregivers and help mitigate the stressors associated with hospice work.

scholarly journals Situation, possibilities and difficulties of the hospice and palliative care in Hungary

2014 ◽  
Vol 155 (38) ◽  
pp. 1504-1509 ◽  
Author(s):  
Katalin Hegedűs ◽  
Miklós Lukács ◽  
Judit Schaffer ◽  
Ágnes Csikós
Keyword(s):  
Palliative Care ◽  
Hospice Care ◽  
Service Providers ◽  
Death And Dying ◽  
National Data ◽  
Terminally Ill Cancer Patients ◽  
Lack Of Information ◽  
Institutional Supply ◽  
Hospice And Palliative Care ◽  
Hospice Palliative Care

Hospice-palliative care has existed in Hungary for more than 20 years but physicians know very little about it. The objective of the study is to give detailed practical information about the possibilities and the reasonability of hospice care and the process of how to have access to it. The authors review and analyze the database of the national Hospice-Palliative Association database to provide most recent national data on hospice-palliative care. In addition, legal, financial and educational issues are also discussed. At present there are 90 active hospice providers in Hungary, which provide service for more than 8000 terminally ill cancer patients. According to WHO recommendations there would be a need for much more service providers, institutional supply and more beds. There are also problems concerning the attitude and, therefore, patients are admitted into hospice care too late. Hospice care is often confused with chronic or nursing care due to lack of information. The situation may be improved with proper forms of education such as palliative licence and compulsory, 40-hour palliative training for residents. The authors conclude that a broad dissemination of data may help to overcome misbeliefs concerning hospice and raise awareness concerning death and dying. Orv. Hetil., 2014, 155(38), 1504–1509.

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