Brooklyn New York is one of the poorest boroughs of the New York City. According to US Census the population of Brooklyn has increased to almost 2.5 million in 2005, and consist almost 900,000 households. More than 33 percent of the households have children living below the age of 18, 23 % of the household in the area have single mom household and more importantly 10% of the household have a person above the age of 65 living alone. (NYC Health, 2006)
To understand the need of palliative healthcare provider in Brooklyn we have referred to the data of one of the 11 areas of Brooklyn – Greenpoint. The other areas are – Northwest Brooklyn, Central Brooklyn, East New York and New Lots, Sunset Park, Borough Park, Flatbush, Canarsie and Flatlands, Southwest Brooklyn, Southern Brooklyn, and Bushwick and Williamsburg. (NYC Health, 2006)
The statistics of Greenpoint are reflection of the state of affairs in the whole Brooklyn region. The below chart presents the deadly impact of life taking diseases in Greenpoint and it also reflects on the loss of potential life due to these severe diseases. Loss of potential years is counted after taking 75 as mean.
As shown by the chart above most potential life is being lost to Cancer, followed by Heart diseases. Palliative care is paramount in case of cancer as patient as the end of life treatment is pretty expensive.
What really makes the situation grim is the amount of poverty in the region and falling income level due to the present financial crisis. Almost 25 percent of the area’s population lives in poverty and average household income of the region is just above $32000 per annum. The per capita income is around $16000. According to New York State statistics more than 31 percent of the New Yorkers needed care but don’t receive it and secondly almost 61 percent of people not covered by insurance don’t have a permanent doctor. (NYC Health, 2006)
Legal and Regulatory Compliance
Hospice care in United States was first emerged as the response to numerous concerns coming from terminally ill patients. Most of them preferred to die at home but were dying in the hospital acute care centers. The prevalent solution was not an answer to both the concerns. The family was spending too much money in hospital bills while the person is deprived of the family affection which he/she carves for at close to the end of his/her life.
The main objective of the hospice service was to keep the patient in the familiar surrounding as long as possible and provide him/her care then and there. There are four level of care under the Medicare hospice regulations and requirement for each one is different (Marianne Matzo & Deborah Witt Sherman, 2005) —
Routine Home Care – It’s the most common level of home care and requires very few physician visits. The physician often visit the patient at home and along with providing medical solution he/she helps the family in specific problems like – relieving pain, explaining symptoms of disease and course of preliminary action, evaluating the need of resources required to provide care at center.
Continuous Healthcare – It is increased level of healthcare where a skilled nurse provides service 24 hours a day to ease patient’s pain and smoothen the period of crisis to prevent patient’s hospitalization. This is the most preferred option where the burden of financial resources to take care of the patient is far greater than the resources a family can afford. The care is provided by a registered nurse, even though hours may not be consecutive.
Respite Care – It is third level of care and provided by the local hospital or care providing institute. Number of times providing care to ill family member either takes too much toll on one care provider or the patient health severely goes down. Under such a condition respite care can be provided by moving the ill member to a professional healthcare organization or a respite camp.
Regular Inpatient Care – In the severely ill cases regular attention to patient is required and professional hospice institute are required to provide not only regular health care but also emergency life support system to prolong the life of the patient. Emergency medication and care is essential at this stage.
To Provide Quality Services a Hospice Center Needs to Have
- Care Planning Mechanism – Addressing the symptoms and various side effects of the disease a patient is going to encounter.
- Patient and Family understanding of the stage of disease and relative hopes.
- Care settings in terms of space for families, attention and privacy.
Hospital and Hospice care collaboration is the key in providing better services as hospital can not only monitor the condition of the patient but with timely intervention can prolong the life of the patient.
In United States Hospice care is provided under Medicare and a patient can also get it from private insurer through regulated benefits and type of service required.
Under the present Medicare and Medicaid arrangement –
- Hospice or palliative care is covered for beneficiary who is certified by the physicians as likely to die with in six months.
- Secondly patient can avail cover by insuring medical treatment of terminal illness that purely focuses on prolongation of life.
- A number of private players do provide hospice care but these benefits more often than not are either amount capped or day capped.
Hospice institute or palliative care providing program can avail reimbursement from all the above mentioned arrangements. (Marianne Matzo & Deborah Witt Sherman, 2005)
Expected Outpatients Visits and Impatient Admissions
As Brooklyn is one of the poorest areas of New York with a very low rate of insurance coverage, hospice services can be profitable not only from balance sheet perspective but also from the perspective of helping people. As shown by the statistics the Brooklyn area has low per capita income with high either single parent home or single person household. With more than 10 percent population living alone with nobody to care, hospice home is not only a better option for people to get better care but also cheaper care option compare to a regular hospital.
In a neighborhood of 20,000 people and as a single hospice service provider, the company can expect patients close to 200 at anytime. This number can include 10 percent of the elderly population, members of the 25 percent population living below poverty line and 34 percent of the single parent household.
Staffing Policies in Healthcare Organization
Healthcare organizations are one of the most integrated organizations in the corporate world. The number of stakeholders and their influence is far greater in healthcare industry than any other. According to US Department of Labor estimates by 2010 healthcare sector will be among the top ten fastest employment providing sector and it will grow by 25 percent and adding 13.3 million jobs in the process (Louise Kursmark, 2005).
According to Johnson and Scholes (1997) “Organizations can successfully manage change if they able to integrate their human resource management policies and strategies with strategic change process of training, employee relations, compensations packages and other personnel department aspects.
Key for Hospice Home
Most of the palliative care is provided at home so the organization needs multi-tasking and inter disciplinary competent employees. They should not only able to assess, evaluate and treat but also help the family members to join in and contribute. The success of any palliative care institute is the support of family members. (Marianne Matzo & Deborah Witt Sherman, 2005)
Step 1 – Human Resource Policy
If the hospice home is trying to focus on providing home based healthcare then it has to hire different sort of people but if it needs to provide services in a respite camp model then it has to hire different sort of people. The organization has to choose its strategy and hire people accordingly.
Step 2 – Integration of Hospice Homes and Family
Palliative care success depends upon family contribution and awareness in terms of pain and issues a patient will face. A trained nurse and health care provider not only have to manage patient but also train family members in doing the basic things right.
Christina Faull, Yvonne Carter, Richard Woof (1998) Handbook of palliative care. 1998
Marianne Matzo & Deborah Witt Sherman (2005) Palliative care nursing: quality care to the end of life.
NYC Health (2006) Brooklyn and New York City Health and Mental Hygine. Retrieved on 17th June from http://www.nyc.gov/html/doh/html/survey/survey01.shtml