Caring for grieving family members: results from a national hospice survey.
BACKGROUND
A founding principle of hospice is that the patient and family is the unit of care; however, we lack national information on services to family members. Although Medicare certification requires bereavement services be provided, reimbursement rates are not tied to the level or quality of care; therefore, limited financial incentives exist for hospice to provide more than a minimal benefit.


OBJECTIVE
To assess the scope and intensity of services provided to family members by hospice.


METHODS
We fielded a national survey of hospices between September 2008 and November 2009.


METHODS
A national sample of US hospices with an 84% response rate (N=591).


METHODS
Bereavement services to the family, bereavement services to the community, labor-intensive family services, and comprehensive family services.


RESULTS
Most hospices provided bereavement services to the family (78%) and to the community (76%), but only a minority of hospices provided labor-intensive (23%) or comprehensive (27%) services to grieving family members. Larger hospice size was positively and significantly associated with each of the 4 measures of family services. We found no significant difference in provision of bereavement services to the family, labor-intensive services, or comprehensive services by ownership type; however, nonprofit hospices were more likely than for-profit hospices to provide bereavement services to the community.


CONCLUSIONS
Our results show substantial diversity in the scope and intensity of services provided to families of patients with terminal illnesses, suggesting a need for clearer guidance on what hospices should provide to exemplify best practices. Consensus within the field on more precise guidelines in this area is essential.
Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA. cbarry@jhsph.edu
Colleen L
CL
Barry
Melissa D A
MD
Carlson
Jennifer W
JW
Thompson
Mark
M
Schlesinger
Ruth
R
McCorkle
Stanislav V
SV
Kasl
Elizabeth H
EH
Bradley
D001601:Bereavement; D003430:Cross-Sectional Studies; D005190:Family; D006117:Grief; D017051:Hospice Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D006801:Humans; D006278:Medicare / Q000706:statistics & numerical data; D010067:Ownership / Q000706:statistics & numerical data; D012067:Religion; D012111:Residence Characteristics / Q000706:statistics & numerical data; D014481:United States