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Antea Worldwide Palliative Care Conference

Rome, 12-14 November 2008

ABSTRACT FORM

Presenting author TITLE: HOSPICE AND PALLIATIVE CARE IN THE UNITED STATES
Stephen Connor
Authors (max 6, presenting author included): Stephen Connor
Email:
sconnor@nhpco.org
Hospice care in the United States is both envied and criticized. It is an experiment that continues
Phone to evolve. What began as a version of inpatient hospice care transplanted from the St
Christopher’s Hospice model in the United Kingdom is now a large health care system that
greatly emphasizes home care rather than inpatient care. The most recent in-depth census data on
Mobile phone hospices from the NHPCO reveals that in 2008 there were about 4,750 unique locations
delivering hospice care. There were about 3,650 companies or organizations providing hospice
care with around 1,100 satellite locations. Satellite locations are multiple locations operated by
the same company. Given that there were a total of about 3,100 hospice locations in 1998 that is
Please underline the most over 50% growth in 10 years. Approximately 93% of hospices are Medicare certified. Hospices
appropriate category for your who are not certified for Medicare payment and primarily use volunteers continue to operate and
abstract represent about 7% of programs (NHPCO, 2008a). Medicare records indicate that in 2007 a total
of 49% of Medicare certified hospice organizations were non-profit entities, and 46% were for-
• Pain and other symptoms
profit. The remaining 5% were governmentally controlled (NHPCO, 2008a). This is a huge sea
• Palliative care for cancer patients change in the field of hospice care that has been historically almost all charitable organizations
• Palliative care for non cancer The vast majority of hospices are fairly small programs with an average daily patient census of 75
patients (median 46.5), and an average of 394 admissions a year (median 234). There is some skewing of
• Paediatric palliative care the group, with some very large hospices. The more accurate number is the median size for a
hospice. The greatest source of revenue for hospices is Medicare reimbursement, which accounts
• Palliative care for the elderly
for 83.7% of income based on admissions. Another 5% comes from Medicaid and 8% from
• The actors of palliative care
private insurance payments (NHPCO, 2008a). The average length of service in 2007 was 60 days
• Latest on drugs with 8.6% of hospice patients living more than 180 days and 25.7% of patients enrolled for 7
• Pain days or less. The median is a more accurate measure of central tendency in hospice length of stay
at only 20.6 days. In 2007 the proportion of hospice cancer patients had dropped to 41%. This is
• Illness and suffering through understandable as cancer represents only 24% of US deaths. The rise in non-cancer hospice
media patients was also driven by NHPCO’s policy recommendation to members that is was
discriminatory to refuse to admit non-cancer patients.
• Marginalisation and social stigma
at the end of life
Non-hospice palliative care has also grown significantly, especially in the last 10 years. By 2008
• Palliative care advocacy projects according to a Center to Advance Palliative Care (CAPC) analysis of the latest data released from
• Prognosis and diagnosis the 2008 American Hospital Association (AHA) Annual Survey of Hospitals, U.S. hospitals
communication in continue to implement palliative care programs at a rapid pace. The CAPC analysis showed that
different cultures 1299 hospitals (31%) nationwide provide palliative care programs. This was compared to just 632
programs in 2000. Most significantly, hospitals with over 50 beds – the most likely to have a
• Communication between doctor- program – show a penetration of 47%.
patient and patient-
equipe Up to date information on hospice and palliative care can be found at www.nhpco.org by
• Religions and cultures versus searching for the Facts and Figures on hospice care. Hospital based resources can also be found
suffering, death and at www.capc.org
bereavement
• Public institution in the world:
palliative care policies
and law
• Palliative care: from villages to
metropolies
• Space, light and gardens for the
terminally ill patient
• End-of-life ethics Session: Core curricula
• Complementary therapies Chair of the session: Dott. Giuseppe Casale, Dott. Franco De Conno
• Education, training and research
• Fund-raising and no-profit
• Bereavement support
• Volunteering in palliative care
• Rehabilitation in palliative care
• Core Curricula