Legislative Mandate

The 1979 Virginia General Assembly directed the Virginia Department of Health to conduct a two-year evaluative study of hospice and to make "recommendations regarding standards for the quality of care and criteria for licensure and reimbursement of both the home care and inpatient components of hospice programs provided in a variety of health-care settings and geographic areas of the state." To conduct this study, the Department of Health appointed a Hospice Advisory Committee in order to draw on relevant expertise of various individuals across the State.

Hospice Concept

Hospice programs of care have evolved in recognition of the unique needs of the dying patient for comfort, contact with family and friends, freedom from pain, and a preference for care at home. The hospice movement attempts to offer an alternative to the 20th century emphasis upon the institution rather than the home as the principal place for dying. The term "hospice" refers to a philosophy and concept of care for terminally ill patients and families, and not to a building or site from which hospice care is delivered. A hospice program provides palliative and supportive care for terminally ill patients and their families in both home and inpatient settings, depending on the individual needs of the patient and family. Hospice care may not be appropriate for all terminal patients and families, and should be viewed as an alternative care system which should be available as an option for those patients and families who choose palliative treatment modalities. Hospice utilizes an interdisciplinary team approach to care. In addition to health professionals, the team includes two groups unique to hospice, the patient and his family, and trained volunteers. The hospice concept emphasizes care at home with inpatient backup, continuity of care and caregivers, control of symptoms, and bereavement services.

Contents of Report

This report contains an introduction to the hospice concept, a description of hospice program development in Virginia, a description of the legislative history of hospice, an overview of the evaluative study design, a discussion of significant accomplishments, and a listing of conclusions and recommendations requiring legislative action.

Conclusions and Legislative Recommendation

A. Continuation of the evaluative study is recommended, with particular efforts directed to data collection and analysis for an additional one- to two-year period in order to track the continuing evolution of the hospice concept and how it is being applied in Virginia. The continued monitoring of cost, utilization, and reimbursement experience will assure that any changes in the statutes or policies of the Commonwealth of Virginia related to hospice will be based on valid, comprehensive information.

B. The Department of Health in conjunction with the Hospice Advisory Committee has concluded that licensure of hospice programs is necessary to insure consumer protection, to preserve the integrity of the hospice concept, and to assure quality hospice program development.