Hospices as providers of total care in one western state.

This article presents results from a study of all hospice programs in a western state. Personal interviews and questionnaires were utilized to collect data about hospice programs, their directors, nurses, social workers, and chaplains. Results from this study indicate the hospice programs in one state do not uniformly deliver "total care," services designed to address physical, emotional, social, and spiritual needs. Caseloads for nurses were consistent at 9-12 patients per one Full Time Equivalent (FTE) while caseloads for social workers and chaplains varied widely from less than twenty patients per FTE to more than one hundred for some chaplains. Social workers and chaplains identified lack of time as a significant challenge, while nurses were challenged by the emotional needs of patients and families. Social workers and chaplains were significantly more likely than nurses to view the medical needs of patients as the primary focus of their hospice programs. Further, results indicate that characteristics of programs and directors were related to the availability of services and staff perceptions of hospice practices.