End-of-Life Care in the United States: Current Reality and Future Promise - A Policy Review

By Giovanni, Lisa A. | Nursing Economics, May/June 2012 | Go to article overview

End-of-Life Care in the United States: Current Reality and Future Promise - A Policy Review


Giovanni, Lisa A., Nursing Economics


EXECUTIVE SUMMARY

* Data collection and analysis of that data are vital to developing effective outcome measures when it comes to improvements in the cost and quality of delivered health care.

* The present state of end-of-life care in the United States is evaluated, focusing on statistics of disparities in access to and type of care provided across the country.

* Although only a few portions of the Patient Protection and Affordable Care Act deal with end-of-life care reform, the multiple innovative efforts occurring at state and local levels are proving very effective in improving end-of-life care.

* Possible improvements and obstacles to those improvements, and the involvement of the profession of nursing are highlighted.

* The focus of this investigation is to determine if the evidence supports the following imperative: that the money spent for end-of-life care be spent in a manner that benefits the patient and complements his or her wishes.

"Improving end-of-life care should be a national priority, not just from a cost perspective, but from a quality perspective, be - cause we can do much better" (Carlson, 2010, p.17).

CARING FOR INDIVIDUALS AT THE end of their life has been a topic of conversation for decades, from political, health policy, and quality perspectives. Issues exist in multiple welldefined areas that include access to and disparities in provision of end-of-life care, problems and confusion with financing the care, inadequacies when it comes to professionals' educational preparation related to end-of-life conversations, and the quality of endof- life care. Additionally, conversations about end-of-life care would not be complete without acknowledging the ethical and legal issues and debate that surround this topic. The purpose of this article is to examine the current reality of end-of-life care and determine what portions of current health care reform will affect end-of-life care practices and policy in the United States. Addit - ionally, hospice, palliative care, and nursing's involvement in endof endof- life care and reform are discussed. Research of current literature was conducted and concludes with a discussion of findings to support the author's personal viewpoint that current health care policy fails to recognize and endorse effective reform for end-of-life care.

Hospice and Palliative Care

One solution to end-of-life care, the hospice movement, has seen incredible growth in the United States over the past several decades. It has been over 40 years since hospice care began in the United States. Since that time, "hospice has grown into a business that served over 1 million Medicare beneficiaries, from more than 3,300 providers in 2008, accor - ding to the Medicare Payment Ad - visory Commission" (Zigmond, 2010, p. 6). The history of hospice in the United States dates back to 1963, when Florence Wald, then the dean of the school of nursing at Yale University, invited Dr. Cicely Saunders from London to give a series of lectures on hospice care. "Dr. Cicely Saunders, the matriarch of the worldwide hospice movement, clearly had an impact as shortly after her visit and lecture series, the first hospice in the United States opened in Branford, Connecticut, in 1973" (Connor, 2007, p. 90). Today, hospice focuses on, "caring, not curing and, in most cases: care is provided in a patient's home. Care can also be provided in freestanding hospice centers, hospitals, and nursing homes or other long-term care facilities. Hospice services, which include care management for all aspects of the patient, include family support as well" (National Hospice and Palliative Care Organization [NHPCO], 2011a, ¶ 2)

Palliative care is defined by the World Health Organization (WHO) as, "an approach that im - proves quality of life for patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of problems, including physical, psy - chosocial, and spiritual" (WHO, 2011). …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

End-of-Life Care in the United States: Current Reality and Future Promise - A Policy Review
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.