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Welcome Volunteer Coordinators!

This format is being offered to the hospices utilizing the hospice volunteer training online program.

Feel free to post your ads, events, and any announcements related to your agency here.

The social sites that I use will have your information posted on them - increasing your audience exposure exponentially.

For instance, if you are recruiting new volunteers it can posted here.  The ad will autopost to Twitter, FaceBook, Digg, Blogger and many RSS feeds.

This is also a good place to look for frequently asked questions about the course sites you manage. 

You can also post an article or announcement of events.

Please do not post non-related advertising.  Anything health care / hospice related is acceptable.

 

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Hospice and Handling a End of Life Illness – Info Barrel | Senior Home Care Information

Hospice and Handling a End of Life Illness – Info Barrel

Tagged with: hospice team    ill patient    medications    nurses    referral

Some people get scared and frightened even thinking aboutdeath or dying. But I had to live it; it’s something I never thought I’d haveto face when I had to care for my terminally ill husband. It’s not an easysubject for me, but everyone has to face the subject of dying at some point intheir life. This is where my life changed, after being a wife for 33 years, Inow had to become a caretaker and it wasn’t always the easiest. But when we had to have hospice, they were ofgreat help and were there when we needed them most.

Hospice isprofessionally trained, they helped with pain management a lot, and as thiswas something he dealt with greatly trying new and different medications alongthe way. They are also there for spiritual as well as social support. They arethere to help the whole family deal with issues. He was also able to getwhatever medications he needed for his care without any concerns, the focus wason caring, not curing, making the patient comfortable.

Hospice is availableto anyone regardless of finances, illness, culture, age, and gender. Theprognosis is 6 months or less, and not seeking out a cure. The patient has tohave a referral, and then they bring in a hospice team to evaluate the needs ofthe patient and treatment. They workedwith me as a caretaker learning what to do. From the beginning, when enteringhospice caseload for the critically ill patient, there is nothing that you haveto buy as everything is fully supplied. They were always on call anytime day ornight even for the simplest questions even to check medication at unusualhours.

What was so convenient to us is the fact we never had to go anywhere?It was a blessing because it was hard to move him. He received care at home with nurses comingto our home daily, and the doctor even made a home visit too. Hospice servicesare available everywhere, just talk to your medical professionals aboutit. Most insurance will pay for Hospicecare. We are very thankful for the help we received when we needed it; theyalways knew what to do.

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Tagged with: hospice team    ill patient    medications    nurses    referral

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Hospice Volunteer Training Online - Choosing the Path of Service

Training designed for hospice volunteers. Online courses cover basic concepts and do not replace on site training. These courses enhance the volunteer experience by providing infection control, ethics and privacy, and communication techniques. Other courses suitable for enhancing the volunteer experience are posted and updated regularly.

via volunteertrainingonline.com

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Preserving their voices - Salt Lake Tribune

The life of Hershell Pruitt was remembered in bits.

His five children each hold a piece. This week, they gathered at the hospice to say goodbye to their 86-year-old father, a World War II veteran of the Pacific campaign, who passed away Friday after a bout with Alzheimer's disease.

But before he died, his family began putting those stories together to form the arc of a spectacularly full life.

There to preserve Pruitt's story on a digital recording was a volunteer from Salt Lake County's Silverado Hospice who interviewed the family, part of a new program to capture the details of terminal patients' lives. The recordings are then pressed onto CDs and given to surviving family members.

"Getting us all together, we each added a little piece to the story," said son Charles Pruitt, 46, Salt Lake City. "Each of us in turn told a story, and we were engaged and just sitting on the edge of our seats. It was a different perspective on my father's life."

Since the Memory Catcher program started earlier this year at Silverado, a handful of volunteers have recorded the stories of terminal patients for about 15 families, said volunteer Eileen Allen, who interviewed the Pruitts for their father's history. It's a free service offered by Silverado, which houses the hospice center for Alzheimer's patients.

"We did not do that with my father, and we should have done it," Allen said. Her father was a veteran of World War II, the Korean

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and Vietnam wars. "That's why this program appealed to me when I was looking for an avenue to volunteer."

The Memory Catcher program was inspired by University of Utah English professor Meg Brady, who initiated an audio history program for terminal patients at the Huntsman Cancer Institute.

Brady helped train hospice volunteers in interviewing techniques. Preserving a loved's one voice is significant, said David Pascoe, the hospice center's chaplain. "And when they pass away, you've got this record -- not a written history, but Mom or Dad's voice."

"We've been doing this for the last several months, and some of these stories are just amazing," Pascoe said. "Some are World War II vets who haven't told these stories before, and they tell these amazing tales of marching across Europe or through the beaches on D-Day."

Hershell Pruitt was reluctant to talk to his family about his war days. "He told us it was not something that he thought was pleasant conversation," Charles Pruitt said. "In fact, he had a very hard time watching any movie or television show that looked at war in any sort of light way. I remember watching 'M*A*S*H,' and he said, 'War is not funny, there was nothing funny about it.' "

But Pruitt, who served on a naval destroyer that once escorted Gen. Douglas MacArthur, occasionally would recount certain stories to his children.

"We all know sort of a few anecdotes," Charles Pruitt said. "He would mention someone he met in basic training in Hawaii, and he would tell small stories about people, and a little bit about places."

The siblings' two-hour recording session at the Alzheimer's center proved to be emotional and exhausting. "At the end, we were just tired, but in a pleasant way," Charles Pruitt said. "It was in a way sort of cathartic."

And very much worth it, the son noted, because he and each of his siblings now have a CD that captures the essence and details of their father's incredible life that they can pass on to their children.

"This is something that's going to be in our family forever and will be very important to us," Charles Pruitt said. "I can imagine my daughter listening to it. I hope she'll treasure it and listen to it as often as she likes."

vince@sltrib.com

Preserving their voices -->

Catching memories

For information about the Silverado Hospice, call chaplain David Pascoe at 801-827-3671.

via sltrib.com

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Saul Friedman: A Little known Life-saving Medicare Benefit

This issue of my Gray Matters column is personal. But it needs to be said for Huffington Post, a marvelous service of modern journalism, pays too little attention to the issues facing older Americans, many of whom, like me, are online and eager to be part of the onine community. So, here goes..

My cancer doctor told me in writing, that I had six months to live. But he acknowledged he could not be sure and that the six months could be extended indefinitely.

That made me eligible to take advantage of a little understood, free Medicare program that has been enhanced by the new health insurance reforms, and could be available to anyone with a prolonged, chronic life-threatening illness. I'm talking about the Medicare/Medicaid hospice program.

Until recently entering a hospice program was frightening because it meant you understood you were dying and you voluntarily agreed to forgo chemotherapy or any other curative treatment, and were given only palliatives, painkillers and bedside help from professional whose job it was to make you comfortable.

All that has changed. As Dylan Thomas told us, we should "not go gentle into that good night." So hospice should no longer be feared and avoided like the "dying of the light." Rather it should be embraced as a fine, comprehensive home health care program.

A little background: In 1995, Medicare was under assault from the Republican congress led by Newt Gingrich. Specifically, Medicare's funds were cut to pay for private Medicare HMOs. And Medicare was criticized for the amount of money it was spending on the care of beneficiaries in the last year of their lives. Indeed it accounted for a third of Medicare spending.

Medicare responded with its pioneer hospice program to care for the dying. Hundreds of hospices were founded around the country, most of them funded by Medicare which included nurses, social workers and devoted volunteers, who became the providers of palliative care for the dying. Private insurers followed with coverage of hospice services, but private insurance carried heavy premiums; Medicare covered 100 percent of hospice costs.

I watched how it worked for a close relative who was dying of lung cancer and his family. Hospice supplied the hospital bed set up in the home. Hospice supplied the drugs he needed for pain as well as the care to keep him clean and comfortable. And hospice helped with bereavement counseling for his wife and son.

Then, as now, he was admitted to hospice because his doctor attested that he had less than six months to live. He died three months after his diagnosis. But remember the columnist Art Buchwald who cheated death and remained in hospice care for much longer than six months years? Because such predictions are more and more uncertain as treatment options have become available, the courts forced a change in Medicare regulations. A person could not be discharged from hospice because he lived longer than six months; the six months could be renewed indefinitely.

Since 2007 Congress and Medicare have realized that, with medical advances such as the CT-Scan, PET-Scan, open heart and by-pass surgery, radiation and chemotherapy that Medicare could not insist that hospice patients cannot take advantage of these possibilities, while fighting his or her disease. Medicare and private insurers adopted an "open access" policy, admitting into hospice-for curative and/or palliative treatment, as long as a doctor said they had no more than six months to live.

Thus hospice has become a comprehensive health care program for the seriously ill, who may or may not be close to death. Indeed, as I have learned, it is not at all rare that a beneficiary can get well enough to graduate from hospice. My hospice expects me to be one of those beneficiaries.

In the meantime, hospice assigns to a beneficiary a nurse who comes by your home regularly to check your vital signs, see how you're doing and help with chronic or even acute medical problems. Even more important the assigned nurse, or another nurse is on call 24/7. That means that if there is an emergency, such as a urinary problems, or the side effects of the chemotherapy, you need not go to the emergency room. I've learned that the hospice nurse on call is equipped and trained to deal with such problems. No longer do I need to call 911 on a weekend and go to an emergency room. Besides being traumatic and tiring, it would cost Medicare hundreds, even thousand of dollars.

Similarly, while a hospice beneficiary may keep routine appointments with doctors, hospice nurses are equipped to deal with colds, the flu and other ailments that would ordinarily send you to a physician, at Medicare' expense. And hospice will help a patient's oncologist by drawing blood often to keep track of possible problems such as a drop in the red or white cell counts or potassium and iron levels.

Thus hospice becomes your care giver in fighting the disease as well as preparing for the worst. Medicare hospice, for example, supplies beneficiaries with kits that include morphine and other powerful painkillers; I've put my kit away and have almost forgotten about it. The best option is to avid hospitalization for your illness, for Medicare requires that hospital patients forgo curative treatment.

In addition, Medicare hospice assigns to beneficiaries a licensed, professional social worker to help family care givers with advice, counseling and resources to help patients and families cope with the stresses of life-threatening and debilitating illness. Hospice may supply a hospital-style bed, with linens, or oxygen, or an IV to prevent dehydration

The recently passed health reforms expanded curative and palliative hospice care for children in Medicaid or the Children's Health Insurance Program (CHIP). It allows children enrolled in either program to receive hospice services without forgoing curative treatment. The Centers for Medicare and Medicaid Services (CMS) are expected to require states to comply with the changes, which are to take effect in 2013.

Finally, as of next January 1, the reforms will require that a nurse practitioner or doctor must have a face-to-face encounter with the patient at the end of the six month period to recertify his/her eligibility.

Here is where you can read or download and print Medicare's 16-page booklet on its hospice services, including where to find a hospice near you: http://www.medicare.gov/Publications/Pubs/pdf/02154.pdf

Write to saulfriedman@comcast.net Friedman also writes for www.timegoesby.net

Follow Saul Friedman on Twitter: www.twitter.com/saulfriedman

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Hospice Industry Outlook – 2010 Report

According to leading financial analysts, the United States has endured yet another recession and is continuing to recover. Yet the health care industry, and in particular various hospice care services, continue to feel little impact from the economic recession.

In the first year of the recession, mild global decoupling created slight alarm but little real action. In the second year, a synchronized global recession caused economies to plummet, reaching the lowest point in decades. And, while the financial outlook for 2010 is uncertain overall, the hospice industry is slated for remarkable growth.

Likewise, the most recent edition of the National Home and Hospice Care Survey (NHHCS) indicates that the job turn-over rate is lower in the hospice industry than in any other health care related venue. Representing a continual thermostat of current trends in hospice and home health agencies, it includes all facilities which are certified or licensed for reimbursement through the Medicaid or Medicare programs. This is good news for hiring managers, who may feel a bit pessimistic about taking on new employees.

Financial Outlook

A recent report published by the Department of Health and Human Services indicates that reimbursement rates for Medicare and Medicaid hospice patients will increase, beginning January 1, 2010. And, while reimbursement rates for physician services will not enjoy these increases, corporations who serve this distinctive segment of the population will find maintaining their operational budget is less difficult with the additional revenue. Terry Pratt, acting director of the agency, indicated to all state agencies nationwide that the new rates will increase by 2.1 percent, despite provisions in Section 1814 of the Social Security Act, which allow for a decrease in rates in cases of economic recession or national emergencies.

These increases provide a certain degree of financial security to hospice corporations, as budget cuts, which seem to be an issue of concern for other government agencies, will not apply to Medicare and Medicaid reimbursements for end-of-life care. Those who are employed in the field can be assured of job security, while those who are seeking employment will find the door wide open for new positions.

Hiring Trends for 2010

According to several Hospice Employers that utilize the NSLPN.com Career Network for posting open positions, hiring trends in the hospice and home health industry will continue to increase throughout the first part of 2010. Since April 2009, the demand for professionals in the hospice industry has increased by 314%, despite the current economic recession. In addition, while other careers lost tremendous ground in overall economic growth and financial stability, the hospice care and related health fields remained strong, with remarkable, positive change.

The hospice industry is a venue which can provide a wide variety of jobs like no other. Because hospice care provides a different level of medical treatment than the traditional health services, virtually anyone can be hired for available positions. While a working knowledge of general health care and sanitary practices are necessary for the hands-on health care worker, others who provide services such as cleaning or emotional support to the family or patient are not required to obtain the same level of training. During the first quarter of 2010, it is anticipated that hospice care corporations will continue to hire new employees to meet these and other needs. These trends can be credited for new job creation as well.

Post-fellowship employment opportunities for individuals in the medical field are expected to increase during the first quarter of 2010 as well. According to positive increases in the number of new medical students coming out of doctoral or other training programs, more individuals will be seeking professional employment venues. It is anticipated that hospice industries nationwide will increase their staff by as much as 5.7%, with 1.4% of these jobs being executive level positions. These new positions will further increase the viability of hospice care and ensure adequate operations.

Administrative positions in hospice are expected to decrease in 2010, primarily due to new efficiencies in office equipment and technology. Speech-to-text software decreases the need for skilled typists, while high-speed Internet services, mobile communication devices, and cell phone browser applications allow current administrative assistants to work more efficiently. And while it is not expected that the administrative sector will lose jobs, new ones are less likely to be created or filled. Hospice nurses and care providers will continue to utilize mobile devices for administrative purposes, further reducing the need for in-office administrative assistants.

New Trends in Hospice Care for 2010

While profit margins continue to decline or stabilize and businesses tighten their belts, home health care corporations are revamping their expenditure-to-profit ratios in unique ways. Recognizing current changes in demographics, many agencies are creating new markets for the urbanizing and aging populations by opening new campus facilities. Building and operating environmentally-friendly businesses and hospice facilities have resulted in massive financial savings while maximizing profit margins. Finally, finding unique ways to cut costs, such as offering internships to nursing or medical students, utilizing time management strategies, and gaining cooperation from civil and community service organizations continue to bolster the hospice industry.
New Hospice Facilities in 2010

Innovative expansions in the hospice and home health industry is anticipated to boost the overall financial outlook in the first quarter of 2010. While some companies continue to provide traditional in-home services, others are adding hospice wings to existing facilities.

The Cedars, an assisted living and nursing home facility in Monroeville, PA for example, recognizes the need for hospice services in the city and surrounding area. An $8 million addition to the existing campus is slated for grand opening in the early part of 2010. John Silvestri, a board member of the Monroeville Christian / Judea Foundation and manager of the facility, is thrilled to be a part of the expansion.

“We are opening an all-new, standalone facility, devoting an equal amount of space to patients and their families. Our mission is to provide health care at all stages of life. With the new addition, we will be able to continue this mission.”

Other live-in hospice centers are scheduled to open nationwide. A new addition to the Elwyn Medical Center of Philadelphia will open 36 new beds and rooms to disabled patients who cannot be adequately served by nursing homes, traditional group homes, or in-home care. Go-Ye Village, an assisted living apartment complex and nursing care center located in Tahlequah, Oklahoma, is adding four more buildings to their property, each dedicated to hospice care for various conditions. While one building may serve cancer patients, another may be dedicated to the victims of Alzheimer’s and their families.

Thousands of patients will benefit from these and other new facilities, which will provide these patients with comfortable living arrangements for the same or comparable price of nursing home services.
Green Hospice Corporations

Thanks to extensive public education efforts, scientific research, breaking glaciers, and obvious environmental damage, the average citizen can no longer deny the effects of “modern” consumption. The hospice industry recognizes that something must be done to stop the continual erosion of the environment. In order to meet these goals, numerous hospice corporations are turning their attention toward greener facilities, environmentally friendly business practices, and reducing carbon emissions. Likewise, with the undeniable consequences that will ensue if action is not taken, the trend toward greener, environmentally-friendly practices is expected to increase in 2010.

While including green products or services is nothing new, building entire new facilities that support the environment is a recent endeavor. The hospice industry is blazing a trail among conscientious businesses by including such items as low consumption water facilities, solar panels, wind turbines, organic and locally grown produce, recycled building materials, recyclable supplies, as well as installing energy-saving windows and appliances. As the going-green initiative stretches worldwide and into all sectors of the economy, more hospice and home health care corporations are jumping on the band wagon. And, while the price to construct such a facility costs about 2% more than the standard location, the financial savings can be as much as $100,000 in return, not to mention the reduced environmental impact.

Hospice of Northeastern Illinois is slated to open an all-new green hospice facility in Spring 2010. The new facility, which was architecturally designed to create a minimal carbon footprint in the surrounding woodland area, will include solar lighting, renewable energy sources, lush organic gardens, and numerous items made of recycled products. It is one of only a few all-green hospices around the nation.

“We recognize the need in caring for the whole person, and especially in the case of hospice patients,” says Carla Andrews, director of the new facility. “By providing opportunities to enjoy the crisp, clean air, engage in gardening, or simply basking in the sun, our patients can enjoy their final moments of life to the fullest, while doing something to save our planet.”

Other hospice companies have committed themselves to doing their part to support the environment in smaller ways. Safe Harbor Hospice of Fredericktown, MO has taken the carbon footprint issue to a higher level by including environmental awareness and recycling practices in every aspect of their business day. From energy conservation inside every office to recycling all recyclable products, the corporation sets the standard for doing business in an environmentally-friendly way. The old, gas-guzzling company cars have now been replaced with newer, higher MPG models. New appliances and water conservation facilities have been installed in all office locations. In addition, instead of traveling to various homes at random, hospice care service routes are now streamlined for optimal gasoline efficiency.

Amy Keller, director of clinical services and patient care, states, “I feel good about giving back to the environment and the community. Being active in this way is very important.”

Safe Harbor Hospice has made it their mission to reduce their carbon footprint while educating themselves and others about additional green behaviors.
Final Thought

An obvious shift toward traditional markets is apparent, in part due to uncertainty in the economic outlook for the coming year, and the hospice industry will continue to blaze a trail for new and innovative business venues throughout the first quarter of 2010. Subsequently, professionals, administrators, and executives in the and hospice and related home health sector should avoid unnecessary lay-offs, as finding good, reliable employees may prove difficult in the near future.

Sources:
http://pittsburgh.bizjournals.com/pittsburgh/stories/2009/11/23/story10.html
http://www.philly.com/philly/business/75605332.html
http://todaysfacilitymanager.com/facilityblog/labels/real_estate
http://www.thefreelibrary.com/Fitch+Rates+Resurrection+Health+Care+(IL)+2009+...&…-a0212860434
www.aei.org/docLib/20081107_2.pdf
http://www.cms.hhs.gov/Hospice/downloads/hospicerates10correction.pdf
http://www.cms.hhs.gov/transmittals/downloads/R1796CP.pdf
http://www3.cancer.gov/prevention/pob/catalog/placements.html
http://www.cdc.gov/nchs/nhcs/nhcs_surveys.htm
http://www.greenbeanchicago.com/green-hospice-sets-trend-health-care/?utm_sou...
http://www.toledoonthemove.com/news/news_story.aspx?id=197023
http://www.dailyjournalonline.com/articles/2009/10/19/news/doc4adc8be411fdc86...
http://www.highbeam.com/doc/1G1-187643794.html
Department of Health and Human Services, Pub. 100-04, Medicare Claims Processing Manual, Chapter 11, Processing Hospice Claims, § 30.2.
Section 1814(i)(1)(C)(ii) of the Social Security Act, Payment Rates for Hospice Care

via nslpn.com

Posted via web from Hospice Volunteer Training Online

The Caregiver's Path to Compassionate Decision Making

The Caregiver’s Path to Compassionate Decision Making: Making Choices for Those Who Can’t.

(www.thecaregiverspath.com and/or www.kindethics.com )

 ISBN: 978-1-60832-041-7

The book helps families dealing with Alzheimer’s (and other dementias), strokes, brain injuries, mental illnesses, developmental delays and other mental limitations who have lost their ability to make their own decisions. Their caregivers struggle with the constant angst of, “Am I doing the right thing? Have I made the right decision?”

The Caregiver’s Path helps these caregivers make ethical, heartfelt decisions that honor and respect the patient’s wishes, and to relieve their stress and angst. The book also addresses many end-of-life issues as well, and the other issues such as “When to take the car keys away?” and “Breaking your promise to not place a loved one in a nursing home.”

The info is practical and easy to apply—which is why the book is so helpful!

Posted via web from Hospice Volunteer Training Online

Oceanside Home Hospice seeking Caring Volunteers

Check out this website I found at classifiedads.com

Help the folks at Oceanside Home Hospice build their volunteer force. Good folks to work with and now is the right time to be of service!

Posted via web from Hospice Volunteer Training Online

amednews: Medicare to test allowing more than palliative care in hospice :: May 24, 2010 ... American Medical News

Medicare to test allowing more than palliative care in hospice

The new health reform law also orders Medicaid and CHIP plans to cover "concurrent care" for terminally ill children.

By Kevin B. O'Reilly, amednews staff. Posted May 24, 2010.

New changes to Medicare and Medicaid payment could address the emotionally wrenching dilemma faced by physicians and terminally ill patients forced to choose between continuing curative treatments and taking advantage of hospice care programs' in-home palliative, psychological and spiritual services.

The health reform law enacted in March directs state Children's Health Insurance Programs and Medicaid plans to immediately cover "concurrent care" -- a combination of curative efforts and hospice care -- for children with terminal illnesses. The Congressional Budget Office estimates that the expanded coverage will cost $200 million over 10 years.

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The law also calls on the Health and Human Services secretary to conduct a three-year, budget-neutral demonstration project of concurrent care for Medicare patients at 15 hospice-care sites.

The use of hospice and palliative care has grown steadily in recent years. Nearly 1.5 million patients received hospice care in 2008, up 36% from 2004, according to the National Hospice and Palliative Care Organization, which represents 80% of the country's hospices. Yet physicians offering this alternative to patients often receive hostile responses from patients and families who view it as the final step through death's door.

The median length of stay in hospice is less than three weeks.

"There are people who, when talking about hospice, they'll say, 'Don't say that word in front of my loved one,' " said Christian Sinclair, MD, associate medical director of Kansas City Hospice & Palliative Care in Missouri. "We get such a visceral reaction to changing toward a palliative care goal."

Choosing hospice care can be especially scary for patients on Medicare, said Diane E. Meier, MD, director of the nonprofit Center to Advance Palliative Care. Some private health plans cover concurrent care, but for Medicare patients -- and, until recently, children covered by Medicaid -- choosing hospice has meant giving up aggressive treatment efforts.

"The Medicare hospice benefit is the jewel in the crown of Medicare in that it's truly interdisciplinary care," said Dr. Meier, director of the Hertzberg Palliative Care Institute at New York's Mount Sinai Medical Center. "But in order to get this wonderful benefit that is hospice, you must, on the flip side, sign a form giving up the right to regular Medicare. People feel, quite rightly, that it's like signing a death certificate."

Smoother transitions

Dr. Meier notes that it takes only a day to process the paperwork for leaving hospice and re-entering regular Medicare. But the idea of enrolling in hospice in the first place and "giving up" on life still frightens patients and families, leading them to delay use of hospice.

The median length of stay in hospice is less than three weeks, and one-third of hospice patients die within a week of being admitted, said J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization. He said that Medicare paying for concurrent care could make it easier for patients and families to move from aggressive treatment to palliative care.

"You go from one phase to the next phase with something to hold on to as you make that transition," Schumacher said. "Many people say, 'I wish I'd come to hospice sooner.' "

Getting patients into hospice earlier gives them access to expert advice to help decide whether curative efforts are worth pursuing further, Schumacher said. "We believe involving hospice sooner will help people forgo nonproductive treatment."

The demonstration project will test whether paying for concurrent care helps patients and saves Medicare money. Then the HHS secretary will recommend to Congress whether to change the hospice-care payment policy. A Centers for Medicare & Medicaid Services innovation center created in the health reform law also may be able to act on the recommendations. Hospice care cost Medicare $11.2 billion in 2008, according to the Medicare Payment Advisory Commission.

In the meantime, children with terminal illnesses and their families should benefit from Medicaid's coverage of concurrent care efforts, Dr. Sinclair said.

"In pediatrics, the prognosis for patients can be a lot harder to define," he said. "Having a concurrent care model is helpful, because those families need a lot of help, especially from psychosocial and the other resources that hospice can provide."

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Copyright 2010 American Medical Association. All rights reserved.

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