Hello, I need help in creating a power point slide for my project. Thank you so much for your assistance.

• Length: 15-17 slides; answers must thoroughly address the questions in a clear, concise manner
• Structure:
  • Title slide and reference slides in APA style. (at least 2 slides)
  • Project Description (1 slide)
  • Project Rationale (2 slides)
  • Personal/Professional Expectations (2 slides)
  • Project Goals (1 slide)
  • Analysis of the Literature (4 slides)
  • Procedure Findings (5 slides)
  • Additionally, because a good presentation has few words on the slides include a script with the verbiage you would say when presenting; script should be a minimum of 50 words per slide.

My Project below:

Title: Hospice Patients on Extended Length of Stay

Abstract

This project focuses on analyzing hospice patients who have been receiving hospice care for more than six months, with care provided in their homes. The ideal hospice stay is typically around 90 days, so this extended duration presents unique challenges and implications. The project examines the impact on the healthcare agency in terms of financial and regulatory concerns, as well as the expectations and experiences of the families, patients, and staff involved. It also investigates the provision of questionable interventions and evaluates any grounds for disenrollment from hospice care.

Hospice care is designed to provide comfort and support to patients with terminal illnesses and their families, usually during the last phases of an incurable disease. The goal is to enhance the quality of life, manage pain and symptoms, and offer emotional and spiritual support. However, when patients remain in hospice care for extended periods beyond the typical 90-day stay, it creates a set of complex challenges. These challenges include increased financial strain on hospice providers, potential regulatory scrutiny, and varying expectations from patients and families regarding the care provided.

The project setting involves home-based hospice care, which is preferred by many patients and families due to the comfort and familiarity of the home environment. However, this setting also presents logistical and operational challenges for hospice providers, such as coordinating care, managing resources, and ensuring consistent quality of service over extended periods. The project aims to shed light on these issues and provide insights into improving the management of hospice patients with extended lengths of stay.

Contents

Chapter 1: Introduction and Purpose............................................................................. 6

Chapter 2: Literature Review........................................................................................ 9

Chapter 3:Method......................................................................................................... 27

Chapter 4: Discussion of the Findings and Recommendations...................................... 31

Chapter 5:Conclusion.................................................................................................... 38

References....................................................................................................................... 41

Appendix A..................................................................................................................... 46

Introduction and Purpose

Hospice care is designed to provide comfort and support to patients with terminal illnesses and their families, usually during the last phases of an incurable disease. The goal is to enhance the quality of life, manage pain and symptoms, and offer emotional and spiritual support. However, when patients remain in hospice care for extended periods beyond the typical 90-day stay, it creates a set of complex challenges. These challenges include increased financial strain on hospice providers, potential regulatory scrutiny, and varying expectations from patients and families regarding the care provided.

Background

The rising number of hospice patients experiencing an extended length of stay (LOS) at home presents unique challenges for healthcare providers, families, and the patients themselves. This study examines 50 hospice patients who have been on service at home for more than six months. The focus will be on understanding the multifaceted issues related to the financial strain on hospice agencies, psychosocial dynamics within families, challenges faced by clinicians, unnecessary interventions, regulatory compliance, and the expectations placed on the care team. By exploring these challenges, the study aims to contribute valuable insights to the field of nursing, particularly in the area of end-of-lifecare.

Significance

By examining the financial challenges, the study aims to shed light on how extended LOS affects the sustainability of hospice agencies. This is particularly important as hospice care is often funded by a combination of private pay, insurance, and government programs, making it vulnerable to financial strain when patients require care for longer periods than initially anticipated. The psychosocial challenges explored in this study include the emotional and psychological impact on families who must cope with prolonged caregiving responsibilities. These challenges can lead to increased stress, burnout, and conflict within families, which can impact the quality of care provided to the patient.

The clinical challenges addressed in the study involve the difficulties healthcare providers face when managing patients with extended LOS. This includes the risk of unnecessary interventions, which can arise when clinicians feel pressured to continue aggressive treatments despite the patient's declining health. The study also examines the importance of compliance with regulations, particularly in ensuring that the care provided aligns with established standards and guidelines.

Purpose

The purpose of this project is to explore and analyze the complexities associated with the extended length of stay (LOS) of hospice patients at home. Specifically, the study will identify the financial, psychosocial, familial, and clinical challenges encountered by hospice agencies, patients, and their families. By examining these factors, the project seeks to provide evidence-based recommendations for improving the management of hospice care, enhancing communication among healthcare professionals, and ensuring compliance with regulatory standards. This research will offer a comprehensive understanding of how prolonged hospice care impacts all stakeholders involved.

To address the questions posed for the capstone project, a systematic approach was utilized, focusing on the primary objectives of the study: the exploration of challenges faced by hospice patients with an extended length of stay (LOS) at home. This involved clearly defining the project's purpose, significance, and contribution to the nursing field. The approach began with a comprehensive literature review to understand the current state of knowledge regarding extended hospice care, followed by identifying the gaps and areas that require further investigation. This foundation allowed for the formulation of a research question that aligns with the overall goals of the project. By focusing on specific aspects such as financial, psychosocial, and clinical challenges, the study was narrowed down to ensure it remained manageable and focused.

The purpose of the project is to explore the challenges associated with extended LOS in hospice care, specifically focusing on patients who have been on service at home for more than six months. These challenges include financial strain on hospice agencies, psychosocial stressors for families, difficulties faced by clinicians, unnecessary interventions, compliance with regulations, and the expectations placed on care providers. The project's significance lies in its potential to contribute valuable insights to nursing's body of knowledge and improve communication among healthcare professionals involved in hospice care.

Literature Review

This literature review aims to explore the body of knowledge related to extended lengths of stay (LOS) in hospice care, particularly focusing on patients receiving care at home for more than six months. The primary databases searched for relevant literature included PubMed, CINAHL, MEDLINE, and Google Scholar. The search terms used were "hospice care," "length of stay," "extended hospice care," "financial impact of hospice," "regulatory issues in hospice care," "home hospice care," "patient expectations hospice," "family expectations hospice," "staff experiences hospice care," "disenrollment from hospice," and "questionable interventions in hospice care." To refine the search, Boolean operators such as AND and OR were employed to combine keywords. Filters were applied to focus on peer-reviewed articles published within the last ten years. This strategy yielded a range of studies that provide a foundation for understanding the multifaceted aspects of extended hospice care, which this review will analyze.

Hospice care is designed to provide comfort and support to patients nearing the end of life, with the goal of enhancing the quality of life rather than prolonging it. Ideally, hospice care is short-term, with an average length of stay (LOS) of around 90 days. However, some patients remain in hospice care for extended periods, exceeding six months. This extended LOS presents unique challenges for hospice agencies, patients, families, and healthcare providers. This literature review aims to explore the financial, regulatory, and ethical implications of extended hospice care and the impact it has on the involved stakeholders.

Extended LOS in hospice care has been a subject of extensive research, with studies examining various factors that contribute to patients remaining in hospice care beyond the typical 90-day period. Research by Smith et al. (2018) indicates that extended LOS can be attributed to factors such as delayed referrals, prognostic uncertainty, and the complex needs of patients with chronic and progressive conditions. Moreover, Thompson and Allen (2019) highlight that while hospice care aims to provide comfort in the last days of life, some patients stabilize or even improve, resulting in longer stays. This section will discuss how these factors interplay to influence extended hospice stays and the implications for patient care and resource allocation.

Search Strategy and Methodology

A comprehensive search of relevant literature was conducted using the primary databases PubMed, CINAHL, MEDLINE, and Google Scholar. The search terms employed included "hospice care," "length of stay," "extended hospice care," "financial impact of hospice," "regulatory issues in hospice care," "home hospice care," "patient expectations hospice," "family expectations hospice," "staff experiences hospice care," "disenrollment from hospice," and "questionable interventions in hospice care." Boolean operators (AND, OR) were used to combine keywords, and filters were applied to focus on peer-reviewed articles published within the last ten years. This search strategy yielded a diverse array of studies, which form the foundation for the analysis presented in this review.

Financial Implications of Extended Hospice Length of Stay

1 Financial Burden on Hospice Agencies

Extended LOS in hospice care significantly impacts the financial stability of hospice agencies. Hospice care is reimbursed by Medicare, Medicaid, and private insurers, with payments structured around an expected 90-day period. When patients exceed this period, agencies often face a financial strain as the cost of care increases without a proportional increase in reimbursement. A study by Carlson et al. (2015) found that hospice agencies with a higher percentage of patients experiencing extended LOS tend to report lower profit margins, highlighting the financial burden imposed by prolonged care.

Furthermore, the cost of maintaining an interdisciplinary team to provide comprehensive care to patients over an extended period further exacerbates the financial challenges faced by hospice agencies. The literature indicates that agencies must often make difficult decisions regarding the allocation of resources, which can impact the overall quality of care provided to patients.

The financial ramifications of extended LOS in hospice care are significant for healthcare providers. According to a study by Johnson et al. (2020), extended stays often lead to increased costs for hospice agencies due to the provision of prolonged care without corresponding increases in reimbursement rates. The Centers for Medicare & Medicaid Services (CMS) provide a fixed per diem rate for hospice services, which does not adjust based on the length of care provided (CMS, 2021). Consequently, hospice agencies may face financial strain, especially if a significant proportion of their patients have extended LOS. Research by Patel and Nguyen (2017) also suggests that this financial strain can lead to ethical dilemmas regarding care decisions, particularly when resources are limited. This section will further explore the financial impacts and consider how different models of reimbursement might better support hospice agencies managing patients with extended LOS.

One of the most significant impacts of an extended LOS in hospice care is on the agency's finances. Hospice care is typically designed for a short-term duration, with an average expected stay of 90 days. When patients exceed this duration, the costs can accumulate, creating a strain on the resources available to hospice organizations. This section will explore how extended stays can impact operational budgets, reimbursement structures, and overall financial health.

Multiple studies indicate that Medicare reimbursementthe primary source of funding for hospice care in the United Statesrelies on a per diem payment model, which assumes that most patients will not remain in hospice for extended periods. For example, research by Smith et al. (2018) found that the per diem rate does not adequately cover the costs for patients with extended LOS, especially as their care needs often increase with time. This discrepancy between care needs and payment structures can create a financial burden on hospice organizations. Similarly, Jones et al. (2019) highlighted that agencies may face significant losses when patients remain in hospice for longer than the expected duration, as the cost of providing nursing care, medications, and equipment increases while reimbursement rates remain static.

Additionally, some studies have pointed out the potential for financial penalties or audits if agencies are found to be enrolling patients who do not meet the strict criteria for hospice care, particularly when these patients remain in hospice for longer than expected. Johnson et al. (2020) argue that extended LOS patients are often flagged for review by regulatory bodies, further complicating the financial stability of hospice organizations.

2 Cost Management Strategies

In response to the financial burden of extended hospice LOS, agencies have developed various strategies to manage costs effectively. One approach is the optimization of care delivery through the efficient use of interdisciplinary teams. According to a study by Kelley et al. (2013), the integration of specialized care teams can lead to more targeted interventions, reducing unnecessary costs while still maintaining high standards of care.

Another strategy involves early discharge planning, where hospice teams begin discussing potential discharge options with patients and families as soon as it becomes clear that the patient may exceed the expected 90-day LOS. This proactive approach allows for better resource allocation and ensures that patients receive appropriate care without unnecessary financial strain on the agency (Gomes et al., 2013).

Additionally, some hospice agencies explore alternative funding sources, such as grants or private donations, to supplement the revenue received from insurance reimbursements. These funds can help cover the costs associated with extended care and ensure that agencies can continue providing high-quality services to all patients, regardless of their LOS (Connor, 2017).

Regulatory Challenges in Extended Hospice Care

1 Compliance with Medicare and Medicaid

Extended LOS in hospice care can create regulatory challenges, particularly in maintaining compliance with Medicare and Medicaid requirements. These programs have specific guidelines regarding the documentation and justification of continued hospice care beyond the initial 90-day period. Hospice agencies must provide clear evidence that extended care is medically necessary, which can be challenging in cases where patients do not show significant deterioration (Centers for Medicare & Medicaid Services [CMS], 2021).

The literature emphasizes the importance of rigorous documentation to support claims for extended hospice care. According to a study by Lorenz et al. (2014), agencies that fail to provide adequate documentation risk facing denied claims or even penalties from regulatory bodies. This issue is further complicated by the subjective nature of some criteria used to determine the necessity of continued hospice care, such as the patient's quality of life or the likelihood of imminent death.

Regulatory compliance in hospice care, particularly concerning extended LOS, presents several challenges. Studies have shown that hospice agencies must navigate complex regulations to remain compliant, especially when patients exceed the typical LOS thresholds. For instance, Nguyen and Patel (2019) discuss how agencies are often subjected to increased scrutiny and audits from CMS when a significant number of their patients exceed the expected LOS. These audits can result in financial penalties if it is determined that the extended care was not medically necessary. Moreover, Jones (2018) points out that the criteria for patient eligibility and disenrollment from hospice care are often ambiguous, leading to potential regulatory non-compliance and increased administrative burdens. This section will examine these challenges in detail and discuss how regulatory frameworks can be adapted to better account for patients with extended care needs.

From a regulatory standpoint, extended hospice stays raise questions about eligibility, compliance, and potential disenrollment. Hospice care is intended for patients with a prognosis of six months or less, as determined by their physician. When patients surpass this threshold, regulatory scrutiny increases, with both Medicare and other insurers closely monitoring for signs of fraud or abuse. This section will address the regulatory challenges that arise when patients exceed the expected LOS and the potential consequences for hospice providers.

Regulations governing hospice care are strict, particularly those set by Medicare and Medicaid. These agencies require that hospice patients have a certified terminal illness with a life expectancy of six months or less. However, as noted by Green et al. (2017), predicting life expectancy can be inherently difficult, especially in patients with chronic or non-cancer diagnoses. For example, patients with conditions like heart failure or dementia may experience a more prolonged decline, making it harder for physicians to determine when hospice care is appropriate.

According to Thompson et al. (2018), hospice providers may face penalties if they are found to be keeping patients on hospice care without proper re-certification or if there is evidence of questionable interventions that suggest patients no longer meet the criteria for hospice. As a result, many agencies have implemented stricter screening and re-evaluation processes to ensure compliance with these regulations. Wilson et al. (2019) stress that while these practices are necessary for regulatory compliance, they can also create an additional administrative burden for hospice staff.

2 Documentation and Justification of Care

Proper documentation is crucial for compliance with regulatory requirements. Hospice agencies must ensure that their records accurately reflect the patient's condition and the need for continued care. This involves regular assessments and updates to the patient's care plan, which should be thoroughly documented and justified (CMS, 2021).

Studies have shown that the quality of documentation can vary significantly between hospice agencies, with some agencies demonstrating more thorough and consistent practices than others (Morrison et al., 2015). Agencies that prioritize detailed and accurate documentation are more likely to successfully navigate regulatory challenges and secure reimbursement for extended hospice care.

Expectations of Patients and Families

1 Patient Expectations and Quality of Life

Patients entering hospice care typically expect a focus on comfort and quality of life. However, when care extends beyond the anticipated timeframe, these expectations may change. Patients may begin to experience frustration or anxiety as their condition remains stable, leading to questions about the purpose and goals of continued hospice care.

Research indicates that prolonged hospice care can lead to a decline in patient satisfaction, particularly if patients feel that their care is no longer aligned with their personal goals and values (Teno et al., 2013). It is essential for hospice teams to engage in ongoing communication with patients to reassess their goals and adjust the care plan accordingly.

From the perspective of patients, extended hospice stays can create feelings of uncertainty about their prognosis and future care needs. Some patients may begin to question their eligibility for hospice care, particularly if they feel they are no longer actively dying. According to Morris et al. (2018), patients who remain in hospice for extended periods may struggle with the psychological and emotional aspects of their care, as the initial expectation of a short life expectancy changes over time.

2 Family Expectations and Satisfaction with Care

Families play a critical role in the hospice care experience, and their expectations can significantly impact their satisfaction with the care provided. Extended hospice care can lead to increased stress and uncertainty for families, particularly if they are unsure of what to expect (Kelley & Morrison, 2015). Studies have shown that clear communication and setting realistic expectations are essential for maintaining family satisfaction throughout the hospice experience (Waldrop & Meeker, 2012).

Hospice teams must work closely with families to ensure they understand the care plan and the reasons for continued hospice care. This includes providing regular updates on the patient's condition and discussing potential outcomes and transitions in care. By fostering open communication and addressing any concerns or questions, hospice teams can help alleviate some of the stress and uncertainty that families may experience during extended hospice care.

The experiences and expectations of families, patients, and hospice staff can be profoundly affected by extended LOS in hospice care. A qualitative study by Lewis et al. (2017) found that family members often have evolving expectations regarding the care provided, especially when the patient remains in hospice care longer than anticipated. Families may experience emotional and financial stress, compounded by uncertainty about the patient's prognosis and the appropriateness of continuing hospice care. Similarly, staff may face moral distress when providing care to patients who no longer meet the standard criteria for hospice, as highlighted by Thompson and Wright (2016). Additionally, research by Brown and Miller (2018) suggests that patients themselves may experience a range of emotions, from relief at receiving continued care to anxiety about their prolonged illness. This section will explore these dynamics and their implications for patient-centered care.

Families of hospice patients may expect that their loved one will continue to receive high-quality care, even if their condition stabilizes or improves temporarily. However, as Davies et al. (2020) point out, the goals of hospice care are focused on comfort rather than curative treatments. This distinction can create tension when family members request interventions that may not align with the palliative nature of hospice. For example, Richards et al. (2021) found that families often request continued aggressive treatments, even when these interventions do not improve the patient's quality of life.

Staff Experiences and Ethical Considerations

1 Staff Burnout and Compassion Fatigue

Healthcare providers working in hospice care are at risk of burnout and compassion fatigue, particularly when caring for patients with extended LOS. The emotional toll of providing end-of-life care for an extended period can lead to decreased job satisfaction, increased turnover, and reduced quality of care. Research by Sinclair et al. (2017) highlights the prevalence of burnout among hospice care providers, with those caring for patients with extended LOS being particularly vulnerable.

To mitigate the risk of burnout, hospice agencies must prioritize the well-being of their staff. This can include providing access to mental health resources, offering regular training on coping strategies, and fostering a supportive work environment (Sinclair et al., 2017). Agencies that invest in their staff's well-being are more likely to retain experienced caregivers and maintain high-quality care for patients.

Staff experiences with extended hospice stays can also vary. Hospice workers, including nurses, social workers, and volunteers, may find it challenging to provide care for patients whose needs evolve beyond the typical 90-day timeframe. As noted by Hill et al. (2020), staff members often experience burnout when caring for patients with extended stays, particularly when they feel the care being provided is no longer aligned with the patient's prognosis or care goals.

2 Ethical Dilemmas in Questionable Interventions

Extended hospice care can give rise to ethical dilemmas, particularly when it comes to questionable interventions. In some cases, patients may receive treatments or interventions that are not consistent with the goals of hospice care, raising concerns about the appropriateness of continued care (Quill et al., 2018). These situations require careful ethical consideration and often involve difficult conversations with patients, families, and healthcare providers.

The literature emphasizes the importance of adhering to the core principles of hospice care, which focus on providing comfort and dignity to patients at the end of life (Quill et al., 2018). When faced with ethical dilemmas, hospice teams must carefully weigh the potential benefits and risks of continued interventions and ensure that their decisions align with the patient's goals and values.

When patients exceed the typical LOS in hospice, questions often arise about the appropriateness of continuing hospice services. In some cases, patients may receive interventions that are not traditionally associated with palliative care, raising concerns about whether they should be disenrolled from hospice. This section will examine the ethical and regulatory implications of providing questionable interventions and explore the grounds for disenrollment.

Hospice care is designed to prioritize comfort and quality of life, rather than curative treatments. However, as noted by Reynolds et al. (2019), there are instances where patients receive treatments that are more aggressive or invasive than what is typically offered in a hospice setting. For example, some patients may receive intravenous antibiotics or blood transfusions, which can be seen as contradictory to the goals of hospice. In these cases, providers may need to reassess the patient's eligibility for hospice care.

Disenrollment from Hospice Care

1 Criteria for Disenrollment

The topic of questionable interventions and the grounds for patient disenrollment from hospice care is a complex and often contentious area of study. Literature on this subject, such as the work of Miller and Cooper (2019), emphasizes the ethical dilemmas hospice staff face when interventions that might not align with palliative care principles are used. This could include treatments that prolong life without improving quality, leading to questions about their appropriateness in a hospice setting. Furthermore, Smith et al. (2020) discuss the regulatory criteria for disenrollment, noting that patients must be discharged from hospice if they no longer meet the criteria of terminal illness with a prognosis of six months or less. However, as Jones (2018) points out, determining this can be challenging, particularly for non-cancer diagnoses where the disease trajectory is less predictable. This section will delve into these issues, examining the ethical, clinical, and regulatory aspects of disenrollment from hospice care.

Disenrollment from hospice care is a complex and sensitive issue, particularly when it involves patients with extended LOS. Criteria for disenrollment typically include the patient's improved condition, a change in the care plan, or the patient's choice to seek curative treatment (CMS, 2021). However, the decision to disenroll can be fraught with challenges, particularly when patients and families are emotionally attached to the hospice care team.

A study by Teno et al. (2013) found that disenrollment from hospice care can lead to feelings of abandonment among patients and families, particularly if the reasons for disenrollment are not clearly communicated. To minimize these negative impacts, hospice teams must engage in thorough discussions with patients and families about the criteria for disenrollment and the potential next steps in care.

2 Impacts on Patients and Families

Disenrollment from hospice care can have significant emotional and psychological impacts on patients and families. For patients, it may represent a loss of the comfort and support they have come to rely on, leading to feelings of abandonment or uncertainty. For families, disenrollment can be a source of stress and anxiety as they navigate the transition to other forms of care (Gomes et al., 2013).

To support patients and families during this transition, hospice teams should provide clear information about the reasons for disenrollment and offer guidance on the next steps in care. This may include referrals to other healthcare providers, assistance with care planning, and emotional support to help patients and families adjust to the change.

Discussion

The extended LOS in hospice care presents a multifaceted challenge that impacts patients, families, healthcare providers, and hospice agencies. Financially, extended care strains hospice agencies' resources, requiring them to implement cost management strategies while maintaining the quality of care. Regulatory compliance adds another layer of complexity, with agencies needing to provide thorough documentation to justify continued care.

From the perspective of patients and families, extended hospice care can lead to evolving expectations and emotional challenges. Patients may struggle with the prolonged nature of their care, while families may experience increased stress and uncertainty. Healthcare providers, in turn, face the risk of burnout and must navigate ethical dilemmas related to questionable interventions.

Disenrollment from hospice care, while sometimes necessary, can be a difficult process for all involved. Ensuring that patients and families understand the criteria for disenrollment and providing support during the transition is crucial for maintaining their well-being.

Conclusion

In conclusion, the existing literature provides a comprehensive overview of the multifaceted issues related to extended LOS in hospice care, including financial, regulatory, ethical, and personal dimensions. However, there remain significant gaps in the research, particularly regarding the best practices for managing extended LOS and the long-term impacts on all stakeholders involved. This literature review lays the groundwork for further investigation into these gaps and offers a basis for understanding the broader context in which extended hospice care operates. The insights gained from this review will inform the development of strategies and recommendations in the subsequent sections of this capstone project.

Extended LOS in hospice care presents significant challenges that require careful consideration and management. Hospice agencies must balance the financial, regulatory, and ethical aspects of care while addressing the needs and expectations of patients and families. By developing strategies to manage these challenges, agencies can continue to provide high-quality care to patients with extended hospice stays, ensuring their comfort and dignity at the end of life.

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Method

Approach to the Project

The approach selected for this project involved analyzing hospice patients who have been receiving care for more than six months. This approach was chosen due to the unique challenges associated with extended hospice stays, which typically last around 90 days. By examining extended hospice care, the project addresses a significant gap in understanding related to long-term care and its implications. This approach was deemed most appropriate as it directly addresses the financial, regulatory, and operational impacts on healthcare agencies, as well as the experiences of patients, families, and staff. The project specifically explored the financial, regulatory, and operational impacts on healthcare agencies, as well as the experiences of patients, families, and staff. This approach was chosen for its relevance in addressing these complex issues and providing a comprehensive view of the implications of prolonged hospice care.

Description of the Process

Selection of Activity Type

For this project, a PowerPoint presentation was selected as the primary activity type for presenting findings and soliciting feedback. The PowerPoint presentation was chosen due to its ability to organize and present complex data clearly, using visual aids such as charts and graphs. This format also supports interactive discussions during feedback sessions, which is crucial for obtaining actionable insights. The use of PowerPoint ensured that the data was presented in an accessible manner and supported the collection of actionable insights.

Content Selection and Rationale

Content Included:

Introduction and Background: Provides an overview of hospice care and the importance of examining extended stays.

Research Findings: Includes data on the financial impacts, regulatory challenges, and patient and family experiences associated with extended hospice care.

Case Studies: Presents examples of extended hospice stays and their outcomes.

Recommendations: Offers suggestions for improving the management of extended hospice stays.

Content Excluded:

Detailed Literature Review: As this chapter focuses on project implementation, detailed citations and literature reviews were omitted.

External Scholarly Work: The chapter excludes discussions of other scholars' work to focus solely on the project's findings and methods.

The content was selected to ensure a comprehensive presentation of the challenges and implications of extended hospice care, while being concise and focused. By focusing on practical findings and recommendations, the chapter aimed to provide a clear and actionable analysis.

Selection of Reviewers

Reviewers Chosen:

Hospice Care Managers: Experts with extensive experience in managing hospice care and addressing regulatory and financial issues.

Healthcare Administrators: Stakeholders involved in the financial and operational aspects of hospice care.

Family Members of Patients: Individuals who have personal experience with extended hospice care.

Rationale for Selection:

Expertise: Hospice care managers and healthcare administrators were selected for their in-depth knowledge of operational and financial aspects.

Stakeholder Perspective: Family members were chosen to provide insights into the personal impact and experiences of extended hospice stays.

Development of Feedback Tools

Instrument Created:

Survey: A survey was developed to gather feedback from reviewers regarding the clarity, relevance, and impact of the presentation. Developed to collect feedback on the PowerPoint presentation. The survey included both quantitative and qualitative questions to capture a comprehensive range of feedback.

Tool Components:

Quantitative Questions: Likert scale questions to assess the clarity and usefulness of the presentation.

Qualitative Questions: Open-ended questions to obtain detailed feedback and suggestions for improvement.

Rationale:The survey was designed to collect structured feedback that would help refine the presentation and improve the overall project. Quantitative questions provided measurable insights, while qualitative questions offered detailed, actionable suggestions.

Identification of Themes and Categories

Themes Identified:

Financial Impact: Insights into how extended hospice stays affect financial resources and budgeting.

Regulatory Concerns:Feedback on regulatory challenges and compliance issues.

Patient and Family Experience: Common concerns and experiences reported by patients and their families.

Operational Challenges: Difficulties faced by healthcare providers in managing extended care.

Categories Developed:

Challenges: Specific issues related to financial, regulatory, and operational aspects.

Recommendations: Suggested improvements and strategies for managing extended hospice stays.

Conclusion

This chapter has detailed the approach, process, and tools used to implement and evaluate the project on extended hospice care. By selecting a PowerPoint presentation and gathering feedback from a diverse group of reviewers, the project aimed to provide a thorough analysis of the challenges and implications associated with prolonged hospice care. The feedback collected will be used to refine the findings and develop actionable recommendations for enhancing hospice care management.

Findings and Recommendations

Discussion of Findings

This chapter presents the results and analysis of the feedback obtained from the evaluation tool used to assess the project on "Hospice Patients on Extended Length of Stay." The feedback was collected from various stakeholders, including hospice care managers, healthcare administrators, and family members of patients, to gather a comprehensive understanding of the challenges and potential improvements related to extended hospice care. The feedback is analyzed to identify key themes, discuss limitations of the project approach, and draw conclusions based on the reviewers' perspectives.

Feedback Analysis

The feedback from the reviewers was gathered through a structured survey that included both quantitative and qualitative components. Quantitative feedback was obtained using a Likert scale to assess the clarity, relevance, and impact of the presentation, while qualitative feedback was collected through open-ended questions that provided deeper insights into the reviewers' perspectives. The findings from the feedback were organized into four primary themes: financial impact, regulatory concerns, patient and family experience, and operational challenges.

Financial Impact

One of the main themes identified in the feedback was the financial strain on hospice agencies due to extended lengths of stay (LOS). Reviewers noted that the costs associated with prolonged hospice care often exceed the reimbursement provided by Medicare, Medicaid, and private insurers, leading to significant financial challenges. For instance, a hospice care manager commented, "Extended stays strain our resources significantly, especially since we do not receive additional reimbursement after the initial 90 days." This feedback aligns with previous research indicating that the financial burden of extended hospice care can impact the sustainability of hospice agencies (Johnson et al., 2020).

Regulatory Concerns

Another prominent theme in the feedback was the regulatory challenges associated with extended hospice care. Reviewers expressed concerns about maintaining compliance with Medicare and Medicaid guidelines, particularly in cases where patients exceed the typical 90-day LOS. A healthcare administrator stated, "We face increased scrutiny and audits when patients remain in hospice care for longer periods, which adds to our administrative burden." This feedback suggests that regulatory compliance is a significant challenge for hospice agencies, as supported by previous studies (Nguyen & Patel, 2019).

Patient and Family Experience

The feedback also highlighted the experiences and expectations of patients and families during extended hospice care. Several reviewers noted that families often feel uncertain about the care provided when the patient's condition stabilizes or improves temporarily. One family member shared, "We were unsure if continuing hospice care was the right choice when my father seemed to improve, and this led to a lot of anxiety and stress for our family." This sentiment reflects the complex emotional dynamics experienced by families during extended hospice care, as discussed in the literature (Lewis et al., 2017).

Operational Challenges

The final theme identified in the feedback was the operational challenges faced by hospice providers in managing extended hospice care. Reviewers highlighted difficulties in coordinating care, managing resources, and ensuring consistent quality of service over extended periods. A hospice care manager noted, "It's challenging to maintain the same level of care for patients who remain in hospice for extended periods, especially with limited staff and resources." This feedback underscores the operational complexities of providing long-term hospice care, which are consistent with previous findings in the literature (Hill et al., 2020).

Limitations of Project Approach

Several limitations were identified in the project approach based on the feedback received. One significant concern was the number of participants involved in the evaluation. The sample size was relatively small, which may limit the generalizability of the findings. Additionally, some reviewers expressed concerns about the selection of reviewers, suggesting that including more diverse perspectives, such as those of frontline caregivers, could provide a more comprehensive understanding of the challenges associated with extended hospice care.

Another limitation was the reliance on a single method (PowerPoint presentation) for disseminating information and gathering feedback. Some reviewers suggested that a more interactive approach, such as focus groups or workshops, could have facilitated deeper discussions and more nuanced feedback. As one reviewer mentioned, "While the presentation was informative, a more interactive format might have allowed us to explore the issues in greater depth and provide more targeted feedback."

Conclusions Drawn from Feedback

The feedback provided by the reviewers offers valuable insights into the challenges associated with extended hospice care and highlights areas for improvement. The findings confirm many of the issues identified in the literature, such as the financial burden on hospice agencies, the regulatory challenges, and the emotional complexities faced by patients and families. However, the feedback also suggests that more attention is needed to address the operational challenges faced by hospice providers and to explore innovative strategies for managing extended care.

Overall, the feedback underscores the need for a multifaceted approach to improving hospice care for patients with extended LOS. This approach should include financial planning, regulatory compliance, patient and family support, and operational management. While the feedback aligns with many of the findings from previous research, it also highlights areas where further investigation is needed, particularly regarding the development of cost-effective care models and the use of alternative funding sources to support extended hospice care.

Recommendations for Improvement

Based on the feedback received, several recommendations can be made to enhance the management of hospice patients with extended LOS:

Develop Cost Management Strategies

To address the financial challenges associated with extended hospice care, hospice agencies should consider implementing cost management strategies such as optimizing care delivery through interdisciplinary teams and exploring alternative funding sources. Additionally, early discharge planning and proactive discussions with patients and families about potential discharge options can help manage costs effectively while ensuring appropriate care.

Enhance Regulatory Compliance

To mitigate regulatory challenges, hospice agencies should prioritize rigorous documentation and regular reassessment of patients' eligibility for hospice care. Providing staff with training on regulatory requirements and developing standardized protocols for documentation can help ensure compliance and reduce the risk of audits and penalties.

Improve Communication with Patients and Families

To address the emotional and psychological impacts of extended hospice care, hospice teams should engage in ongoing communication with patients and families. Regular updates on the patient's condition, discussions about care goals, and education about the hospice care model can help manage expectations and reduce anxiety.

Support Staff Well-Being

To prevent burnout and compassion fatigue among hospice care providers, agencies should invest in staff support programs that include access to mental health resources, regular training on coping strategies, and opportunities for professional development. Creating a supportive work environment can help retain experienced staff and maintain high-quality care.

Explore Innovative Care Models

Hospice agencies should consider exploring innovative care models that better support patients with extended LOS. This could include partnerships with community organizations, the use of telehealth to provide remote support, and the development of specialized programs for patients with complex needs. By adopting a more flexible approach to care delivery, hospice agencies can better meet the diverse needs of their patients.

Increase Dissemination of Findings

To further disseminate the findings of this project, several strategies can be employed, such as creating a Doctor of Nursing Practice (DNP) project, presenting the findings at professional conferences through poster or podium presentations, or conducting in-service training sessions for hospice care providers. These efforts can help raise awareness of the challenges associated with extended hospice care and promote best practices for managing patients with extended LOS.

Future Directions for the Project

Now that the project has been completed, there are several potential directions for future work:

Developing a DNP Project

The findings from this project could serve as the basis for a DNP project focused on developing evidence-based interventions to address the challenges of extended hospice care. This project could involve designing a comprehensive care model that integrates financial planning, regulatory compliance, patient and family support, and staff well-being strategies.

Conducting Further Research

Future research could explore specific aspects of extended hospice care in more detail, such as the impact of different reimbursement models on hospice agency sustainability, the effectiveness of alternative care models, or the experiences of specific patient populations. Additional studies could also examine the long-term outcomes of patients with extended LOS and identify best practices for managing their care.

Expanding Dissemination Efforts

To increase the impact of the project, further dissemination efforts should be made, such as submitting the findings to peer-reviewed journals, presenting at national and international conferences, or collaborating with professional organizations to develop guidelines for best practices in managing extended hospice care.

Implementing Pilot Programs

Based on the findings and recommendations, hospice agencies could consider implementing pilot programs to test new care models or strategies for managing extended hospice care. These programs could be evaluated for their effectiveness in improving patient outcomes, reducing costs, and enhancing staff satisfaction.

Conclusion

The project on "Hospice Patients on Extended Length of Stay" has provided valuable insights into the financial, regulatory, and operational challenges associated with extended hospice care. The feedback from the reviewers highlights the importance of a comprehensive approach that addresses the needs of patients, families, and healthcare providers. By implementing the recommendations outlined in this chapter and pursuing future directions for research and practice, hospice agencies can improve the management of extended hospice care and enhance the quality of life for patients at the end of life.

References

Centers for Medicare & Medicaid Services. (2021). Hospice care coverage. Retrieved fromhttps://www.cms.gov/medicare/hospice-benefit

Connor, S. R. (2017). Hospice and palliative care: The essential guide. Taylor & Francis.

Hill, A. M., Murphy, L. J., & Roberts, S. A. (2020). Burnout in hospice care: Staff experiences with long-term patients. Journal of Palliative Medicine, 23(5), 578-586.https://doi.org/10.1089/jpm.2020.0032

Johnson, T. P., Smith, L. J., & Walker, D. R. (2020). Financial challenges in providing extended hospice care: A cost analysis. Health Economics Review, 10(2),

Conclusion

The phenomenon of extended lengths of stay (LOS) in hospice care presents a multifaceted set of challenges for all stakeholders involved, including hospice agencies, patients, families, and healthcare providers. Hospice care, traditionally designed for patients with a life expectancy of six months or less, becomes complex when patients remain in care beyond the anticipated period. The project delves into the financial, regulatory, clinical, and emotional challenges associated with patients who stay in hospice care for more than six months.

One of the primary concerns identified is the financial burden placed on hospice agencies. Hospice care is typically reimbursed by Medicare and other insurance providers based on a per diem model, which assumes a short duration of care. When patients exceed this typical 90-day period, the reimbursement model does not adjust to account for the increased costs associated with providing long-term care. For instance, research by Carlson et al. (2015) emphasizes that hospice agencies with a significant proportion of patients experiencing extended LOS report lower profit margins. This financial strain forces agencies to allocate resources carefully, often leading to difficult decisions that impact both the quality and the scope of care provided (Johnson et al., 2020). Hospice care, particularly when delivered in a home setting, requires coordination of interdisciplinary teams, the provision of medical equipment, and the management of medications, all of which contribute to rising costs over time.

From a regulatory perspective, extended hospice care invites increased scrutiny from organizations such as Medicare and Medicaid. These entities require clear and ongoing documentation to justify continued hospice services, especially when patients exceed the six-month threshold (Centers for Medicare & Medicaid Services [CMS], 2021). Hospice agencies face the challenge of balancing care for patients who may not be visibly deteriorating, with the need to comply with regulatory standards that necessitate evidence of ongoing decline. As noted by Carson et al. (2018), failure to maintain proper documentation can lead to audits, denied claims, and even penalties. This regulatory burden adds another layer of complexity for hospice providers who are already stretched thin due to the financial and operational challenges of long-term care.

Patients and families are another group profoundly impacted by extended hospice stays. Hospice care is initially intended to provide comfort and support during the final phase of life, but when patients remain stable or improve, families often experience confusion and anxiety about the next steps in care. As highlighted by Greene et al. (2018), families may question the continued need for hospice services, especially if the patient no longer appears to be actively dying. This uncertainty can lead to emotional distress and difficult conversations with healthcare providers about the goals of care. For example, a study by Davies et al. (2020) found that families often struggle to understand the distinction between palliative and curative care, particularly when faced with a prolonged hospice experience.

Healthcare providers, including nurses, social workers, and physicians, also face significant challenges when caring for patients with extended hospice stays. Burnout and compassion fatigue are common, as providers are tasked with managing the emotional toll of end-of-life care over a longer-than-expected period (Hill et al., 2020). Providers may also face ethical dilemmas when patients receive treatments that seem inconsistent with the goals of hospice care. For instance, Lee et al. (2019) discuss the ethical challenges of providing interventions such as intravenous antibiotics or blood transfusions, which may prolong life without necessarily improving the patient's quality of life. These dilemmas require careful consideration of the patient's values and goals, as well as ongoing communication with family members who may have differing expectations about the care being provided.

The issue of disenrollment from hospice care also becomes relevant when patients experience prolonged stability. Medicare guidelines require that patients meet specific criteria for continued hospice care, including a life expectancy of six months or less. When patients stabilize or improve, hospice agencies may be required to discharge them, even if their long-term prognosis remains uncertain. As noted by Carson et al. (2018), this process of disenrollment can be emotionally challenging for patients and families, who may feel abandoned or confused about the transition to other forms of care. Hospice providers must navigate these difficult conversations with sensitivity, ensuring that patients and families understand the reasons for disenrollment and have a clear plan for the future.

In conclusion, the challenges associated with extended lengths of stay in hospice care are complex and multifaceted, impacting financial stability, regulatory compliance, patient and family experiences, and provider well-being. Hospice agencies must implement strategies to manage these challenges, such as optimizing care delivery, enhancing documentation practices, and improving communication with patients and families. Additionally, further research is needed to explore innovative care models that can better support patients with extended LOS, ensuring that hospice care continues to provide comfort and dignity to all patients at the end of life.

References

Bradley, E. H., Carlson, M. D. A., Holford, T. R., & Morrison, R. S. (2015). Hospice care: What

services do patients and their families receive? Health Services Research, 40(1), 393-413.https://doi.org/10.1111/j.1475-6773.2005.00364.x

Carlson, M. D. A., Morrison, R. S., & Bradley, E. H. (2015). Understanding the financial impact

of hospice care: A review of reimbursement models. Journal of Palliative Care, 30(1), 1-12.

Centers for Medicare & Medicaid Services. (2021). Hospice care coverage. Retrieved from

https://www.cms.gov/medicare/hospice-benefit

Carson, B. D., Thompson, M. A., & Wood, R. H. (2018). Medicare audits and extended hospice

stays: A regulatory perspective. Journal of Health Care Compliance, 30(6), 45-52.

Connor, S. R. (2017). Hospice and palliative care: The essential guide. Taylor & Francis.

Davies, M., Miller, R., & Thompson, H. (2020). Family expectations and experiences of

extended hospice care. Journal of Palliative Care, 36(2), 130-145.https://doi.org/10.1177/0825859720914693

Greene, S. R., Langford, M. D., & Morris, P. A. (2018). Patient perceptions of prolonged hospice