Important Questions for Hospice in the Next Century

This report contains six main sections. The first focuses on hospice coverage policies and reviews the history of the Medicare hospice benefit, its current structure, and its influence on care of the dying. Also included is a description of hospice care covered by other insurers including state Medicaid programs and private employers. The second section provides a literature review of the issues surrounding access to hospice and the provision of hospice care in nursing facilities. This is followed by a brief description of current end of life initiatives to improve care of the terminally ill. The next section summarizes discussions with hospice and nursing facility providers, federal and state certification surveyors, and state Medicaid officials regarding overlapping areas in caring for the terminally ill. The final section summarizes the issues and provides a framework for the four subsequent reports in this study. [191 PDF pages]