Hospice care for minorities: an analysis of a hospital-based inner city palliative care service.

Abstract

A lackof servicesfor tenninally ill patientspersists despitethe growing awareness of theiruniqueneeds.Moreover,while innovativemodelsof care havebeenshownto result in ahigher level of patientandfamily satisfaction whencomparedto conventionalcare, theseprogramstendto beunavailable tothemajorityof thepopulation.’3For mostdyingpatients,isolation,neglect, and inappropriatemedical treatment continuesto bethenonn.’ In a responseto theunmetneedsof terminal cancerpatients in Great Britain,Dr. CicelySaundersin thelate l960s foundeda model of care in which the focus of treatmentbecame the managementof chronic pain in orderto enablepatientsto live to their maximumpotential.4Sheadoptedthe term, “hospicecare,” to describeher protocolsdesignedto promote:physical and psychologicalcomfort using themostmodemtechniquesavailable. Impressedby hertreatmentoutcomes, Americanhealthplannersin the mid l970s beganto establishsimilar programs,andat aboutthe sametime her principleswere introduced into Canadaas“palliative care.” By 1983,whenthe federalgovernmentpublishedregulationsforhospice certification under Medicare, there were an estimated1500 programsin the United States.5Although the Medicarealternativewasoriginallyintendedtoextendutilizationof terminal careservices,criticsfearedthatexpensive eligibility requirementsandstrict reimbursement policies mandatedin the regulationswould havean adverse effecton access.68At present,increasinggovernmental restraintscontinueto severelychallengethe survival of manyof thepioneeringprograms.9 Nationwide,aminorityof programs havesoughtMedicarecertification,but in New York state the responsewas strong. Not only did many programs becomecertified, but Albany reinforcedthe federallegislationby limiting the designation“hospice” to Medicarecertifiedprograms.This unexpectedoutcomeof the certification processled to the creationof a second categoryof terminal care delivery. Sinceprogramsunable to operate under the Medicare reimbursement restrictionswereno longerallowedto usethename“hospice,” theyarenow generally referred to as “palliative care”programs,adoptingthepreferred Canadianterm. This articledefmesapalliativecare serviceand explainshow this kind of servicediffers from a Medicarecertified hospicemodel. The authors describethe goals,objectives,admissioncriteria,andoperatingpoliciesand proceduresof the St. Luke’s Hospital Palliative CareService.They present an analysisof recentoperatingexperienceat the St. Luke’s Palliative CareServicebasedon data gathered from the program’s recordsandmake comparisonswith parametersderived fromtheNationalHospiceStudyanda recentNew York State Hospice Associationstudy. They examine averagelength of stay, the inpatienthomecaredaysratio,locationof death, minority groupstatus,income status, availability of primarycarepersonin the home, and other important variables.