care united_states care united_states type philosophy end life care focuses ill patient symptoms symptoms physical emotional spiritual social nature concept place treat ill evolving 11th century came united_states 1970s response work united_kingdom establishment industry rapidly expanded united_states distinguished extensive greater emphasis patient psychological needs coming terms dying practices largely defined system social insurance program united_states health insurance providers care available united_states patients age terminal medically certified months live treatment utilized million people united_states dying americans utilize service common length time patient receive care kinds illnesses covered result patients treatment thirty days care extend months long patient condition continues merit medical outlook medical social services supplied patients families team professional providers volunteers patient directed approach managing illness generally treatment patient choose treatment options intended life services covered providers provide access charitable resources patients lacking coverage care provided patient home designated facility nursing home hospital unit level care location based frequent evaluation patient needs primary levels care provided routine home care continuous care general respite care patients undergoing treatment discharged number reasons including improvement condition refusal cooperate providers return care circumstances change providers required provide patients notice pending discharge appeal outside united_states care terminal illnesses care general setting countries term likely refer particular type institution specifically care final months weeks life specific end life care likely included general term care history statistics believed originated 11th century time ill permitted places dedicated treatment early 14th century order opened rhodes meant provide refuge travelers care ill dying practice revived 17th century france later opened london england 1950s later founded london developed principles modern care founded united_states bringing principles modern care country 1970s implemented united_states movement united_states soon distinguished britain according practice promise greater emphasis use volunteers focus psychological preparation death social insurance program united_states added services coverage september request senate president ronald_reagan proclaimed week november november industry rapidly expanded billion industry billion funding patients programs certification year providers non profit operation development united_states puerto_rico according according rights rescuing end life medical system sites expanding national rate year million people united_states utilized dying americans utilizing service approximately pays treatment paid billion certified providers united_states industry expanded concept care saw opening children facility san_francisco february reported balance non profit profit shifting fastest growing slice industry philosophy practices goal agencies united_states provide comfort patient comfort defined patient patient patient family mean freedom physical emotional spiritual social pain typically perform treatments meant cure illness seek death primarily extend life required patients sign orders require condition acceptance patients decisions receive heart breathing stop patient decide request service provided family need contact provide decision extend life pulling treatments greatest barrier patients accepting care create conflicts medical professionals attempting provide confusion exists treatments patient receive qualify care provide treatments traditionally regarded including radiation therapy administered improve quality life determination appropriate treatment case case basis aspect philosophy patient centered care provide focus united_states shifted provider centered care healthcare agencies market patient centered patient directed care integral interwoven care provided regulations reflect philosophy demographic order qualify care patient certification physicians months live disease runs natural course usually patient primary physician director provide certification patients stay longer months long team continues supporting evidence patient terminal insurance companies usually continue pay care physicians slow refer care waiting absolutely certain terminal physicians believe patient month receive care overly optimistic assessment treatment effective result majority patients referred end stages diseases average length stay patient dies days days numbers increased term care continues average length stay days median length days patients admitted died seven days admission late admission inconsistent process requires time patients family members develop relationships team individuals suffering cancer aids receive care united_states evolve model cancer care predictable pattern deterioration according case assisted suicide right end life care patients cancer rest aids patients cancer end stage heart lung diseases stroke failure conditions diagnosis acceptable cause death death certificate expected terminal acceptable diagnosis care certification order qualify patient certified having months live patients live longer patients receive benefit benefits life provisions benefit months broken day benefit periods end benefit periods team evaluate patient continues months live following day benefit periods required evaluate closely review days commercial managed care program providers individual regulations certification month judge based start patient current condition care patients primarily elderly according handbook social work health aging patients united_states elderly primary population care available age groups including able serve population providers offered care number grown facility united_states george san_francisco opened options expanding adult oriented programs remained ill prepared handle younger populations primary diagnosis children treatment cancer like adult population children enter variety conditions including aids disorder cerebral death inducing trauma automobile accidents care intended treat family available families expecting child anticipated survive long delivery recommended model children differs adults committees hospital care jointly released recommendation care children provided life threatening condition point diagnosis death benefits care offered concurrently treatment virginia based recommends services children life threatening conditions seeking hopeful treatment enhance quality life child family federal standards set require months terminal insurance providers restrict access care patients undergoing life extending treatment expense cost care met health insurance providers including eligible americans covered pay patients responsible drugs respite care needed respite care necessary instance family member providing home care briefly unable perform duties alternative care provider necessary responsible payments providers differently county county higher rate care lower rate paid home care higher rate paid round clock nursing care order patient symptoms control commercial health benefit typically mirror benefit pay required commercial health insurance providers depending individual plans according article paid home based charges supplied private insurance providers pocket paid patient non profit agencies patients lack insurance coverage provide care patient free charge reduced rates said pocket expenses home based services year average patient patient enrolled insurance patient related illnesses words patient end stage heart failure responsible care related heart failure patient billed regular insurance providers competitive business given service area hundreds different non profit commercial providers small community based operations regional national corporations hospital health system data indicated agencies independent based hospitals geared home health care conjunction nursing homes mean number patients treated facilities given day providers admitted fewer patients year number profit non profit providers balanced profit sector grown agencies profit non profit remaining government owned providers order receive payments patients certified certified process seeking certification agencies seek certification voluntarily relinquish example agency entirely supported donations relies volunteer staff choose seek certification estimated volunteer programs operation united_states levels care primary levels care routine home care continuous care general respite respite united_states certified required offer levels care routine home care routine home care common level care provided spite title routine home care indicate location care level intensity care provided routine care provided nursing home assisted living facility majority patients treated home team members supply variety services routine home care including offering necessary supplies medical equipment related diagnosis like bed pads gloves skin hour services available needed typically provided normal business hours registered nurse prepared address urgent patient concerns continuous care service provided patient home patients experiencing severe symptoms need temporary extra support patient continuous care provides services home minimum hours day criteria continuous care similar general care challenges face extended day care home continuous care intended short periods time general care general care intensive level care provided nursing home specially contracted bed unit hospital free standing unit general criteria patients experiencing severe symptoms require daily team manage patients level care begun active phase dying measured days opposed weeks months limit long cover level care usually provided brief periods time seven days average respite respite care referred respite brief periodic level care patient receive respite unique benefit care provided needs family patient family member need break vacation planned level care provided respite patient transferred home setting nursing home assisted living hospital unit patient transferred assisted living facility nursing home hospital continue provide care patient par services provided routine home care benefit way difference respite routine care pays room board charges facility patient receive respite unit care similar patients unit receive respite provided maximum days benefit period team team core service provides patients families differs forms care core members team function team teams involve professionals independently treat issues patient problems treated relate issues addressed individual team members team approach involves members team working goal case afford patients comfortable dying experience families support need team approach role blending members core team tasks usually filled team members team required meet days team meeting patient needs discussed planned weeks additionally team reviews patient medical condition ensure patient meets criteria care team members team members include medical directors physicians registered nurses social workers home health aides volunteers director medical director physician provides support clinical staff providing care patient family medical director provide medical care primary physician unavailable patient primary care provider medical director required patients physician physicians involved patient care include primary physician provide valuable information patient medical history physicians connected team primarily provide support team members treat patient directly physician established provide expertise care patients life limiting advanced disease catastrophic injury relief symptoms coordination patient family centered care diverse settings use specialized care systems including management dying patient legal ethical decision making end life care registered nurses registered nurses responsible coordinating aspects patient care symptoms physical addressed managed primary care nurse visits minimum twice weekly content visit vary greatly patients experiencing symptoms early diseases visit short check patient symptoms nurse visit recommendations increasing changing medication intervention provide support education disease dying process patients require complex treatments respiratory care wound care therapy home cases nurse trained handle unique needs social worker patient assigned social worker visits time admission social worker function vary providing superficial support patients families intensive crisis oriented counseling additionally terminal illness comes complicated financial social worker instrumental connecting patient family community resources including services meals wheels lastly patient unable cared home social worker work find safer place patient receive care counselor required core team regulations typically role filled chaplain spiritual counselor social workers persons specially trained serve patient chaplain able provide regular consistent chaplain services chaplain available provide supportive counseling life review connect patient clergy comfortable times chaplain patient funeral home health aide home health aide core service patient means required patient receive aide patients receive service depended patient family aide typically visits days week approximately hours visit functions include providing respite primary physical support patient including bathing dressing feeding times aide develops closest relationship patient frequency visits aide licensed nurse administer treat wounds handle similar treatments oversee patient drug therapy includes filling monitoring drug interactions adverse effects anticipating problems assessing drug context patient oriented goals volunteers volunteers form major care united_states provide variety physical emotional patients family including providing health care spiritual counseling volunteers provide administrative assistance discharge majority death patient treatment end care provides period counseling family afterward scenarios patient discharged certification determined time review patient greater months patient certified discharged required law advance patient patient appeal decision usually plans weeks advance transition traumatic patients preparing die smooth possible patient condition discharged patient discharged chooses relinquish benefit patient chooses pursue type treatment experiences dissatisfaction care patients require admitting diagnosis hospital unrelated condition patient remain undergoing treatment transfer transfer involve discharge general discharge current provider discharge cause occasionally unable provide care patient philosophical differences patient safety issue causes include abusive behavior patient persons patient home refusal cooperate program patients discharged reason later date necessary barriers access indicated frequently utilized taken advantage late patient illness reasons financial considerations social difficulty choosing study found proper case management access additional costs physicians multiple aspects financially care difficult access relate physician reluctance stated previously enrolled patient transitions primary insurance having care managed directly typically limited budget expensive care permitted additionally physician visits complicated result non payment physicians difficulty authorizing expensive treatments lack payment visits reasons non physician nursing homes second aspect nursing home cases patients transferred nursing home hospital portion nursing home stay cases paying kind care room board coverage nursing home patients occasionally patients better served receiving care nursing home costs room board late prevalent problem early providers admit patients early scrutiny patients deemed long patient months aggressive inappropriate payment services simply worth trouble patients screened carefully prior admission stigma physicians medical care traditionally focused cure healing patient care seen true practice medicine physicians face persistent social stigma mistaken giving patient committing additionally perception changing thinking doctor focused patients cancer terminal diseases qualify care patients patients families simply want receive care common reason recognize comfort cure realistic goal framed care left instead different kind treatment patients believe choosing equivalent
Hospice care in the United States