Hospice development in a subacute care setting.

In developing inpatient and home hospice services in a subacute care setting, Villa Mercy chose to forego traditional hospice models in favor of a strong medical model. It confronted six basic issues in its pioneering effects. 1. Goal formulation. Villa Mercy provides for inpatient admissions whenever appropriate, but also aims to enable patients to stay at home as long as possible and to educate health professionals and the community on hospice care and the dying process. 2. Medical model functions. A hospice core team--composed of a hospice medical director, a chaplain, a social worker, a pharmacist, and registered nurses--meets weekly and assesses each patient's progress. Each core team member follows a specific role in meeting the patient's physical, psychological, social, and spiritual needs. 3. Pain and symptom management. Specific guidelines are followed in observing and listening to the patient, administering pain medication and controlling dose increases, working with patients who are in chemotherapy or drug therapy, and dealing with symptoms caused by the drug regimen. 4. Inpatient versus home care issues. the staffs of both components must coordinate their efforts and feel comfortable with moving patients from one component to the other. 5. Reimbursement channels. Title 18, Blue Cross, and other commercial third party payers have provided coverage at Villa Mercy. Tightening Health Care Financing Administration (HCFA) regulations, however, will make funding more difficult for providers operating under HCFA guidelines. 6. Volunteers. Volunteers are an essential part of the facility's hospice services and receive 20 hours of intensive classwork over a 10-week period before working with a patient and family.