1. Hospice Care in the Aging Population Mary Rossio Principals of Health Behavior MPH 515 Danielle Hartigan February 20, 2015

2. Hospice Hospice is care designed to give supportive care to people in the final phase of a terminal illness and focus on comfort and quality of life, rather than cure. Hospice is a service not a place. Hospice care can be provided in a home environment, nursing homes, assisted livings, supported livings, hospitals, other inpatient settings (hospice home). Methods of payment for hospice services include Medicare, Medicaid, private insurance, and private pay. There is not an age requirement to qualify for hospice Although the aging population is underutilizing it, when it is a benefit under the Medicare Part A Plan.

3. Hospice continued Currently in the United States, at least half of all adults experiencing pain and suffering in the final months and days of their lives at excessive financial cost and with intense resource utilization, and these outcomes, ripple out beyond the dying person to their families, loved ones, caregivers, and communities. Hospice has a stigma for only being for people suffering from cancer with a limited time to live When in fact there are multiple diagnosis and the time frame estimated at 6 months or less.

4. Hospice Diagnosis’s Non-Cancer Diagnoses62.3%64.4% Debility Unspecified13.9%13.0% Dementia12.5%13.0% Heart Disease11.4%14.3% Lung Disease8.5%8.3% Other4.8%5.4% Stroke or Coma4.1%4.2% Kidney Disease (ESRD2.7%2.4% Liver Disease2.1%1.9% Non-ALS Motor Neuron1.6%1.2% Amyotrophic Lateral Sclerosis (ALS)0.4% HIV / AIDS 0.2%0.3%

5. Hospice Population There are 5,513,000 death the United States each year. Roughly only 1,059,000 are utilizing hospice services. Patient Age Category Less than 24 years 2011 0.4% 2010 0.4% 25 - 34 years0.4%0.9% 35 - 64 years16.0%16.1% 65 - 74 years16.3%15.9% 75 - 84 years27.6%27.9% 85+ years39.3%38.9%

6. Health Belief Model Perceived Threat of why someone may not choose hospice at end of life Denial that oneself or loved one is in fact approaching end of life Fear of how much services will cost and p a financial burden on loved ones Net gain for utilizing hospice clinical support and emotional support for the patient Emotional support for the patients loved one’s Additional care Guidance with end of life decisions and help with bereavement planning

7. Other Models and Pilots Improving End of Life Care Ecological Model of Behavior Comparing a “good death from a bad death” Enhancing Awareness of Hospice Health Belief Model Raising awareness through physician training National Care Planning Council Health Belief Model Advanced Directive planning to prepare for future decision making

8. Dying with Comfort and Dignity Highlights of the pilot program Ability to request more information about hospice upon applying for Medicare. A clinic workshop for Advanced Directives and Power of Attorney paperwork to be completed so people are prepared for the future. Education programs for medical staff and hospitals with the potential to earn continuing education points. Community workshops about Medicare benefits for those eligible or soon to be eligible through the health department, local Chamber of Commerce, hospitals, long term care facilities, and churches. Introducing Palliative Care as an initial step for those in denial or not ready to stop aggressive treatment.

9. Hospice Conclusion Hospice services can be very beneficial to dying patients and their families. With the help of the Health Belief Model and The Dying with Comfort and Dignity Pilot, we have the power to change the perception of the public by minimizing the perceived threat and maximizing their net gain. Our aging population is continuing to grow and hospice care is a Medicare and Medicaid benefit that should be utilized if and when possible. Death is inevitable. So there for, let’s plan for what we know is eventually coming at some point and allow ourselves and our loved ones the opportunity to die with dignity and as comfortable as possible.