Antea Worldwide Palliative Care Conference
Rome, 12-14 November 2008
Presenting author
Stephen Connor
Email:
sconnor@nhpco.org
Phone
Mobile phone
Please underline the most
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abstract
• Pain and other symptoms
• Palliative care for cancer patients
• Palliative care for non cancer
patients
• Paediatric palliative care
• Palliative care for the elderly
• The actors of palliative care
• Latest on drugs
• Pain
• Illness and suffering through
media
• Marginalisation and social stigma
at the end of life
• Palliative care advocacy projects
• Prognosis and diagnosis
communication in
different cultures
• Communication between doctor-
patient and patient-
equipe
• Religions and cultures versus
suffering, death and
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
• Complementary therapies
• Education, training and research
• Fund-raising and no-profit
• Bereavement support
• Volunteering in palliative care
ABSTRACT FORM
TITLE: HOSPICE AND PALLIATIVE CARE IN THE UNITED STATES
Authors (max 6, presenting author included): Stephen Connor
Hospice care in the United States is both envied and criticized. It is an experiment that continues
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
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
over 50% growth in 10 years. Approximately 93% of hospices are Medicare certified. Hospices
who are not certified for Medicare payment and primarily use volunteers continue to operate and
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-
profit. The remaining 5% were governmentally controlled (NHPCO, 2008a). This is a huge sea
change in the field of hospice care that has been historically almost all charitable organizations
The vast majority of hospices are fairly small programs with an average daily patient census of 75
(median 46.5), and an average of 394 admissions a year (median 234). There is some skewing of
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
for 83.7% of income based on admissions. Another 5% comes from Medicaid and 8% from
private insurance payments (NHPCO, 2008a). The average length of service in 2007 was 60 days
with 8.6% of hospice patients living more than 180 days and 25.7% of patients enrolled for 7
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
understandable as cancer represents only 24% of US deaths. The rise in non-cancer hospice
patients was also driven by NHPCO’s policy recommendation to members that is was
discriminatory to refuse to admit non-cancer patients.
Non-hospice palliative care has also grown significantly, especially in the last 10 years. By 2008
according to a Center to Advance Palliative Care (CAPC) analysis of the latest data released from
the 2008 American Hospital Association (AHA) Annual Survey of Hospitals, U.S. hospitals
continue to implement palliative care programs at a rapid pace. The CAPC analysis showed that
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
program – show a penetration of 47%.
Up to date information on hospice and palliative care can be found at www.nhpco.org by
searching for the Facts and Figures on hospice care. Hospital based resources can also be found
at www.capc.org
Session: Core curricula
Chair of the session: Dott. Giuseppe Casale, Dott. Franco De Conno
• Rehabilitation in palliative care
• Core Curricula