that was what the patient most wished to do. All Hospice volunteers have a strong commitment to helping other people. An initial screening and orientation program, conducted by the Hospice director of volunteer services, is the first step in a training process which included formal orientation sessions and "on the job" training experience in which prospective volunteers visit patients with experienced members of the team. Once accepted into the program, each volunteer functions in A tangible indication of the success of the Hospice program of care has been the increasing percentage of patients enabled to die in their own homes. the way best suited to that volunteer. At any point Hospice in New Haven is likely to have about 40 active home care volunteers and at least 50 on the waiting list. Service Costs Previous mention has been made of a contract with the National Cancer Institute which funded the operation of the home care program as a demonstration project during the first three years of its operation. When the contract expired Hospice began to make a regular charge for visits from the home care team staff. The stated charge is $29.00 per visit. Much of this cost is borne by third party payers. As a Certified Home Health agency under Medicare, Hospice receives Medicare reimbursement. It also receives payment through Medicaid, Blue Cross of Connecticut, and private insurance companies which are required by Connecticut. law to include home health care in insurance coverage. Hospice also has grants from Title XX and Title III which help to pay for patient care costs. If a patient is not covered by third party payers a sliding scale is applied. No patient is turned away from this or any other Hospice program for lack of ability to pay. Ultimately, changes will be needed in laws and regulations governing reimbursement for Hospice services for patients and their families. Inpatient Care Though the major thrust of the Hospice movement in the nation is geared to medically directed home care, inpatient care is also impor tant. The first Hospice inpatient building in the country, specifically designed for care of the terminally ill and their families, will be opened by Hospice, Inc. in Branford, Connecticut in October 1979. At present, inpatient facilities are encompassed within existing health care facilities. Whatever form the facility takes, it is important that it and the home care program are operated autonomously under the same administration so that there is continuity of care for patients as they move back and forth between home and facility. A major characteristic of a Hospice facility should be its homelike and non-institutional atmosphere. Provisions must be made for the participation of family members in the care of patients. The Hospice facility in Branford will provide large windows looking out upon an area which includes a school, church, and residential areas, thus avoiding a sense of isolation and abandonment which often affects the terminally ill patient. There will be small kitchenettes so that family members may prepare special foods. A chapel will provide a center for spiritual emphasis. Beds may be moved outdoors when weather permits. The $3.5 million cost of the Branford building has been paid for through a $1.5 million grant from the State of Connecticut, a $1 million grant from the U.S. Department of Health, Education and Welfare, and $1 million in contributions from foundations, corporations, individuals and organizations. The Results of the Hospice Program A tangible indication of the success of the Hospice program of care has been the increasing percentage of patients enabled to die in their own homes. The figure has climbed from somewhere in the vicinity of 50 percent when the program first opened to 76 percent during the past 10 months. Family members indicate their sense of satisfaction with the results of the family support system engendered by Hospice. Studies indicate positive personal results in the lives of patients and family members. One Hospice patient summed it up saying "I want to live until I die, if you know what I mean." Hospice is hard at work helping people young and old to live as fully and completely as possible during whatever time they have left. Emphasizing life, its fullness and quality, rather than death, Hospice is bringing new hope to those who once thought that nothing more could be done, and found that such was not the case. |