INTRODUCTION
When a patient has a life-limiting illness, it affects not only the patient, but the entire family. Palliative care likely originated in Roman times, as members of the community wore a protective cloak called a pallium. Today, palliative care is defined as the protection of and prevention of suffering “through the early identification, correct assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual” (World Health Organization [WHO], 2020). Palliative care is the overarching supportive approach that helps seriously ill patients and families address problems and improve their quality of life (Mayo Foundation for Medical Education and Research [MFMER], 2021). Hospice is a type of palliative care What Is Hospice Care? The term hospice dates to medieval times and refers to a place where travelers, some of whom were sick, found a comfortable place to rest. The first modern hospice was founded by Dame Cicely Saunders in 1967 in England (St. Christopher’s, 2021). In 1974, Hospice, Inc., the first hospice in the U.S., opened its doors; it was later renamed Connecticut Hospice. Today, according to the National Hospice and Palliative Care Organization (NHPCO), 4,639 hospice agencies operate in the U.S. (2020). A subset of palliative care, hospice care is for Incidence and Distribution of Hospice Service To be eligible for hospice, two physicians (including the medical director of the hospice agency) must agree on a patient’s terminal diagnosis (NHPCO, 2020). Cancer remains the most common hospice primary diagnosis, while the most common noncancer primary diagnoses are heart and circulatory disorders, followed by dementia. The number and frequency of hospice services in the U.S. have increased during the past decade. The latest statistics show consistent growth of hospice providers in both urban (81%) and rural (19%) areas (Medicare Payment Advisory Commission [MedPAC], 2020). For-profit hospice providers continue to make up the majority of hospice organizations at 70% and also represent the majority of growth; 27% are not-for-profit, and 3% are government owned (NHPCO, 2020). In 2020, it was reported that hospices in the U.S. admitted a total 1.48 million Medicare hospice patients, which represent a 23.9% increase since 2014 (NHPCO, 2020). Of those patients, approximately half identified as female, and the majority (61.4%) of hospice-enrolled patients were 75 years of age or older (NPHCO, 2020). In hospice and palliative care, 82% of patients were White, followed by African American/Black (8.2%), Hispanic (6.7%), and Asian/Pacific Islander (1.8%). Since 2000, hospice services have grown across all racial and ethnic groups, but especially among minority older adults (Center to Advance Palliative Care [CAPC], 2021). Despite this growth, disparities still exist because of “cultural or religious beliefs, preferences for end-of- life care, socioeconomic factors, disparities in access to care or information about hospice, and mistrust of the medical system” (MedPAC, 2020, p. 335). Because of poor access to disease prevention and detection, along with lower quality curative care, patients from racial and ethnic minorities are often diagnosed with late-stage illness and have worse outcomes (CAPC, 2021). This issue is quite complex, as experts have found that those suffering from advanced illness are also limited by social inequities, “such as paying for expensive medications, reduced access to nutritious foods, transportation, translation services, and safe housing” (CAPC, 2021, p. 1). For Black, Hispanic, Latino, American Indian/Alaska Native (AI/AN) people and other persons of color, these barriers are much more common because of “generations of systemic racism; and, as a result, these populations experience significantly worse health outcomes than white Americans” (CAPC, 2021, p. 1). Hospice and palliative care organizations and healthcare professionals can help ensure access to and awareness of high-quality care by providing
specifically for those that have a terminal disease and life-limiting prognosis. Hospice and palliative care can improve a patient’s quality of life by (Livestrong, 2020): ● Providing relief from pain and other distressing symptoms such as nausea and fatigue ● Integrating emotional, psychological, and spiritual aspects of patient care ● Offering a support system to enhance quality of life as much as possible ● UOffering bereavement and grief counseling to help the family cope during the patient’s illness and after death
HOSPICE CARE
individuals who are facing a serious or life-limiting illness of six months or less and is provided by an interdisciplinary team (IDT) of clinicians. This team provides pain management and emotional and spiritual support that is expressly tailored to the patient’s needs and wishes at the end of life (EOL). Hospice care does not end with the patient’s death; bereavement and grief support continue for the family for up to 13 months (NHPCO, 2020). educational programs and outreach, and by meeting the cultural and language needs of various minority groups within their community. Social workers are healthcare providers who are the most prepared to advocate for these vulnerable populations and help other healthcare providers ensure equity and access. Social justice, dignity, integrity, and competence are a few of the core values that social workers work towards in their practice with patient and families (CAPC, 2021). The National Association of Social Work’s (NASW, 2021) Code of Ethics states that a social worker has the “ethical duty and responsibility to guide practice with clients of various cultures and be able to demonstrate skills in the provision of culturally informed services that empower marginalized individuals and groups” (NASW, 2021). This statement, with regard to social determinants of health (SDOH), equity, and access, means that social workers help to address the “barriers to equitable care for the most vulnerable persons in need of care for a serious illness” (CAPC, 2021). In addition to, and regarding the SDOH, social workers apply their knowledge of the person-in-environment framework, which is a holistic framework dedicated to providing care to the patient at several levels (CAPC, 2021). First is the micro-level, or family system, followed by the mezzo-level, which includes the local environment and relationships, and finally the macro- level, defined as systemic factors, all of which factor in to SDOH (CAPC, 2021). This comprehensive understanding about these levels and the SDOH within their practice highlight even more that the practice of social work is very closely linked to health and vulnerable populations (CAPC, 2021). Hospice and palliative care providers, therefore, can work to help support greater health equity and access. The Center to Advance Palliative Care provides action items to support this effort. These include (CAPC, 2021, p. 1): ● “[Asking] the social worker on your team about the greatest burdens and unmet needs in the population you serve. ● [Leading] with purpose and [developing] a vision and mission encompassing reducing health inequity. This requires development of and adherence to an equity strategic plan. ● [Listening] to patients and families about what matters most to them, and about their. greatest worries.”
Page 241
Book Code: PYFL4024
EliteLearning.com/Psychology
Powered by FlippingBook