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Planet of the Apes (1968 film)
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Planet of the Apes
Theatrical release poster
Directed by
Franklin J. Schaffner
Produced by
Arthur P. Jacobs
Screenplay by
Michael Wilson
Rod Serling
Based on
Planet of the Apes
by Pierre Boulle
Starring
Charlton Heston
Roddy McDowall
Maurice Evans
Kim Hunter
James Whitmore
James Daly
Linda Harrison
Music by
Jerry Goldsmith
Cinematography
Leon Shamroy
Edited by
Hugh S. Fowler
Production
company
APJAC Productions
Distributed by
20th Century Fox
Release date
February 8, 1968 (1968-02-08) (Capitol Theatre)
April 3, 1968 (1968-04-03) (United States)
Running time
112 minutes[1]
Country
United States
Language
English
Budget
$5.8 million[2]
Box office
$33.4 million (North America)[2]
Planet of the Apes is a 1968 American science fiction film directed by Franklin J. Schaffner. It stars Charlton Heston, Roddy McDowall, Kim Hunter, Maurice Evans, James Whitmore, James Daly and Linda Harrison. The screenplay by Michael Wilson and Rod Serling was loosely based on the 1963 French novel La Planète des Singes by Pierre Boulle. Jerry Goldsmith composed the groundbreaking avant-garde score. It was the first in a series of five films made between 1968 and 1973, all produced by Arthur P. Jacobs and released by 20th Century Fox.[3]
The film tells the story of an astronaut crew who crash-lands on a strange planet in the distant future. Although the planet appears desolate at first, the surviving crew members stumble upon a society in which apes have evolved into creatures with human-like intelligence and speech. The apes have assumed the role of the dominant species and humans are mute creatures wearing animal skins.
The script was originally written by Rod Serling, but underwent many rewrites before filming eventually began.[4] Directors J. Lee Thompson and Blake Edwards were approached, but the film's producer Arthur P. Jacobs, upon the recommendation of Charlton Heston, chose Franklin J. Schaffner to direct the film. Schaffner's changes included an ape society less advanced—and therefore less expensive to depict—than that of the original novel.[3] Filming took place between May 21 and August 10, 1967, in California, Utah and Arizona, with desert sequences shot in and around Lake Powell, Glen Canyon National Recreation Area. The film's final "closed" cost was $5.8 million.
The film was released on February 8, 1968, in the United States and was a commercial success, earning a lifetime domestic gross of $32.6 million.[5] The film was groundbreaking for its prosthetic makeup techniques by artist John Chambers[6] and was well received by critics and audiences, launching a film franchise,[7] including four sequels, as well as a short-lived television show, animated series, comic books, and various merchandising. In particular, Roddy McDowall had a long-running relationship with the Apes series, appearing in four of the original five films (absent, apart from a brief voiceover, from the second film of the series, Beneath the Planet of the Apes, in which he was replaced by David Watson in the role of Cornelius), and also in the television series.
The original series was followed by Tim Burton's remake Planet of the Apes in 2001 and the reboot Rise of the Planet of the Apes in 2011.[8] Also in 2001, Planet of the Apes was selected for preservation in the United States National Film Registry by the Library of Congress as being "culturally, historically, or aesthetically significant".
Contents
[hide]
1 Plot
2 Cast
3 Production
3.1 Origins
3.2 Filming
3.3 Taylor's spacecraft
4 Reception
4.1 Critical response
4.2 Accolades
5 Legacy
5.1 Original series sequels
5.2 Television series
5.3 Remake
5.4 Reboot series
5.5 Comics
5.6 In popular culture
6 Gallery
7 See also
8 References
9 External links
Plot[edit]
Play media
Teaser, Planet of the Apes (1968)
Astronauts Taylor (Charlton Heston), Landon (Robert Gunner) and Dodge (Jeff Burton) are in deep hibernation when their spaceship crashes in a lake on an unknown planet after a long near-light speed voyage, during which they aged 18 months due to time dilation while their fourth crewmate Stewart died and decayed due to a malfunction. The three survivors abandon ship when it immediately starts sinking, Taylor remaining on long enough to see the date is November 25, 3978, approximately two millennia after their departure in 1972. Once ashore, Dodge performs a soil test and pronounces the soil incapable of sustaining life.
After abandoning their raft, the astronauts set off through a desolate wasteland in hopes of finding food and water before their provisions run out. They encounter plant life and go swimming at an oasis at the edge of the desert, ignoring eerie scarecrow-like figures around the edge. While they are swimming, their clothes are stolen. The astronauts pursue the thieves, finding their clothes torn to shreds and their supplies pillaged as the perpetrators, a group of mute primitive humans, raid a cornfield. The primitive humans are then set upon by armed gorillas on horseback who capture some of them while killing the rest, Dodge being killed in the chaos while Landon is rendered unconscious. Talyor is shot in the throat and captured alongside the primitive humans, taken to Ape City where his life is saved after a blood transfusion administered by two chimpanzees: animal psychologist Zira (Kim Hunter) and surgeon Galen (Wright King).
While unable to speak as his throat wound is healing, called "Bright Eyes" by Zira and placed with one of the captive primitive humans he later names "Nova", Taylor observes the enhanced society of talking apes and in a strict caste system: the gorillas being the military police, hunters and workers; the orangutans overseeing the affairs of government, science, and religion; and intellectual chimpanzees being mostly scientists. While their society is a theocracy similar to the beginnings of the human Industrial Era, the apes consider the primitive humans as vermin that are hunted, either killed outright, enslaved, or used in scientific experiments.
Taylor eventually gets Zira's attention, convincing her of his intelligence as she and her fiancé Cornelius (Roddy McDowall), an archaeologist, take an interest in him. But the couple's orangutan superior Dr. Zaius (Maurice Evans) learns of this and arranges for Taylor to be castrated. But Taylor escapes before the castration can occur, passing through a museum during his desperate flight through Ape City where he finds Dodge's stuffed and eyeless corpse on display. When Taylor is recaptured by gorillas, he overcomes his throat injury while roaring: "Take your stinking paws off me, you damn dirty ape!"
A hearing to determine Taylor's origins is convened by the president of the Assembly (James Whitmore), Dr. Zaius, and Maximus (Woodrow Parfrey). Dr. Honorious (James Daly) is the prosecutor. Taylor mentions his two comrades at this time, learning that Landon was subjected to a lobotomy that has rendered him catatonic and unable to speak. After the tribunal, believing Taylor to be of a human tribe from beyond their borders, Zaius privately threatens to castrate and lobotomize Taylor for the truth about where he came from. With help from Zira's socially rebellious nephew Lucius (Lou Wagner), Zira and Cornelius free Taylor and Nova and take them to the Forbidden Zone, a taboo region outside Ape City that has been ruled out of bounds for centuries by Ape Law where Taylor's ship crashed. While Cornelius and Zira are intent to gather proof of an earlier non-simian civilization which the former came upon a year prior to be cleared of heresy, Taylor is more focused on the evolution of the ape world and to prove he is not of that world.
Arriving at the cave, Cornelius is intercepted by Zaius and his soldiers, with Taylor holding them off while threatening to shoot if he has to. Zaius agrees to enter the cave to disprove their theories and to avoid physical harm to Cornelius and Zira. Inside, Cornelius displays the remnants of a technologically advanced human society pre-dating simian history. Taylor identifies artifacts such as dentures, eyeglasses, a heart valve and, to the apes' astonishment, a talking children's doll. More soldiers appear and Lucius is overpowered, but Taylor holds Zaius hostage so he can arrange his escape. But Zaius admits to Taylor that he always knew of the ancient human civilization, revealing that "the Forbidden Zone was once a paradise, your breed made a desert of it... ages ago!" Taylor nonetheless thinks it best to search for answers, despite being warned that he may not like what he finds. Once Taylor and Nova have ridden off, Dr. Zaius has the gorillas lay explosives to seal off the cave and destroy the evidence while charging Zira, Cornelius and Lucius with heresy.
Taylor and Nova, at last free, follow the shoreline and discover the remains of the Statue of Liberty, revealing that this "alien" planet is actually Earth long after a nuclear war. Realizing what Zaius meant earlier, Taylor falls to his knees in despair and anger while condemning humanity for destroying the world.
Cast[edit]
Charlton Heston as George Taylor
Roddy McDowall as Cornelius
Kim Hunter as Zira
Maurice Evans as Dr. Zaius
James Whitmore as President of the Assembly
James Daly as Honorious
Linda Harrison as Nova
Robert Gunner as Landon
Lou Wagner as Lucius
Woodrow Parfrey as Maximus
Jeff Burton as Dodge
Buck Kartalian as Julius
Norman Burton as Hunt Leader
Wright King as Dr. Galen
Paul Lambert as Minister
Production[edit]
Origins[edit]
Producer Arthur P. Jacobs bought the rights for the Pierre Boulle novel before its publication in 1963. Jacobs pitched the production to many studios, but was passed over. After Jacobs made a successful debut as a producer doing 1964's What a Way to Go! (1964) for 20th Century Fox and begun pre-production of another movie for the studio, Doctor Dolittle, he managed to convince Fox vice-president Richard D. Zanuck to greenlight Planet of the Apes.[9]
One script that came close to being made was written by The Twilight Zone creator Rod Serling, though it was finally rejected for a number of reasons. A prime concern was cost, as the technologically advanced ape society portrayed by Serling's script would have involved expensive sets, props, and special effects. The previously blacklisted screenwriter Michael Wilson was brought in to rewrite Serling's script and, as suggested by director Franklin J. Schaffner, the ape society was made more primitive as a way of reducing costs. Serling's stylized twist ending was retained, and became one of the most famous movie endings of all time. The exact location and state of decay of the Statue of Liberty changed over several storyboards. One version depicted the statue buried up to its nose in the middle of a jungle while another depicted the statue in pieces.[9]
To convince the Fox Studio that a Planet of the Apes film could be made, the producers shot a brief test scene from a Rod Serling draft of the script, using early versions of the ape makeup. Charlton Heston appeared as an early version of Taylor (named Thomas, as he was in the Serling-penned drafts), Edward G. Robinson appeared as Zaius, while two then-unknown Fox contract actors, James Brolin and Linda Harrison, played Cornelius and Zira. This test footage is included on several DVD releases of the film, as well as the documentary Behind the Planet of the Apes. Linda Harrison, at the time the girlfriend of studio chief Richard Zanuck, went on to play Nova in the 1968 film and its first sequel, and had a cameo in Tim Burton's Planet of the Apes more than 30 years later, which was also produced by Zanuck. Although Harrison often opined that the producers had always had her in mind for the role of Nova, they had, in fact, considered first Ursula Andress, then Raquel Welch, and Angelique Pettyjohn. When these three women proved unavailable or uninterested, Zanuck gave the part to Harrison. Dr. Zaius was originally to have been played by Robinson, but he backed out due to the heavy makeup and long sessions required to apply it.[10] Robinson later made his final film, Soylent Green (1973), opposite his one-time Ten Commandments (1956) co-star Heston.
Michael Wilson's rewrite kept the basic structure of Serling's screenplay but rewrote all the dialogue and set the script in a more primitive society. According to associate producer Mort Abrahams an additional uncredited writer (his only recollection was that the writer's last name was Kelly) polished the script, rewrote some of the dialogue and included some of the more heavy-handed tongue-in-cheek dialogue ("I never met an ape I didn't like") which wasn't in either Serling or Wilson's drafts. According to Abraham some scenes, such as the one where the judges imitate the "See no evil, speak no evil and hear no evil" monkeys, were improvised on the set by director Franklin J. Schaffner and kept in the final film because of the audience reaction during test screenings prior to release.[11][page needed] During filming John Chambers, who designed prosthetic make up in the film,[6] held training sessions at 20th Century-Fox studios, where he mentored other make-up artists of the film.[12]
Filming[edit]
The astronauts' journey from their downed ship was filmed along the Colorado River in Glen Canyon.
Filming began on May 21, 1967, and ended on August 10, 1967. Most of the early scenes of a desert-like terrain were shot in northern Arizona near the Grand Canyon, the Colorado River, Lake Powell,[11]:61 Glen Canyon[11]:61 and other locations near Page, Arizona[11]:59 Most scenes of the ape village, interiors and exteriors, were filmed on the Fox Ranch[11]:68 in Malibu Creek State Park, northwest of Los Angeles, essentially the backlot of 20th Century Fox. The concluding beach scenes were filmed on a stretch of California seacoast between Malibu and Oxnard with cliffs that towered 130 feet above the shore. Reaching the beach on foot was virtually impossible, so cast, crew, film equipment, and even horses had to be lowered in by helicopter.[11]:79 The home movies of Roddy McDowall (on YouTube) show makeup, the Ape Village set and the beach site/set - a wooden ramp was built around the point from Westward Beach to Pirates Cove for access to the beach set. The remains of the Statue of Liberty were shot in a secluded cove on the far eastern end of Westward Beach, between Zuma Beach and Point Dume in Malibu.[13] As noted in the documentary Behind the Planet of the Apes,[9] the special effect shot of the half-buried statue was achieved by seamlessly blending a matte painting with existing cliffs. The shot looking down at Taylor was done from a 70-foot scaffold, angled over a 1/2-scale papier-mache model of the Statue. The actors in Planet of the Apes were so affected by their roles and wardrobe that, when not shooting, they automatically segregated themselves with the species they were portraying.[14]
Taylor's spacecraft[edit]
The spacecraft onscreen is never actually named in the film. But for the 40th anniversary release of the Blu-ray edition of the film, in the short-film created for the release called A Public Service Announcement from ANSA, the ship is called "Liberty 1".[15] The ship had originally been called "Immigrant One" in an early draft of the script, and then called "Air Force One" in a test set of Topps Collectible cards, and dubbed "Icarus" by a fan; that name gained popularity among Ape fandom.[15][16]
Reception[edit]
Critical response[edit]
Planet of the Apes was well received by critics and is widely regarded as a classic film and one of the best films of 1968, applauded for its imagination and its commentary on a possible world gone upside down.[17][18] As of April 2012, the film held a 90% "Certified Fresh" rating on the review aggregate website Rotten Tomatoes, based on 50 reviews.[19] In 2008, the film was selected by Empire magazine as one of The 500 Greatest Movies of All Time.[20]
Accolades[edit]
The film won an honorary Academy Award for John Chambers for his outstanding make-up achievement. The film was nominated for Best Costume Design (Morton Haack) and Best Original Score for a Motion Picture (not a Musical) (Jerry Goldsmith).[21] The score is known for its avant-garde compositional techniques, as well as the use of unusual percussion instruments and extended performance techniques, as well as his 12-note music (the violin part using all 12 chromatic notes) to give an eerie, unsettled feel to the planet, mirroring the sense of placelessness.
American Film Institute Lists
AFI's 100 Years...100 Movies—Nominated[22]
AFI's 100 Years...100 Thrills—#59
AFI's 100 Years...100 Heroes and Villains:
Colonel George Taylor—Nominated Hero[23]
AFI's 100 Years...100 Movie Quotes:
"Take your stinking paws off me, you damned dirty ape!"—#66
AFI's 100 Years of Film Scores—#18
AFI's 100 Years...100 Movies (10th Anniversary Edition)—Nominated[24]
AFI's 10 Top 10—Nominated Science Fiction Film[25]
Legacy[edit]
Main article: Planet of the Apes
Original series sequels[edit]
Writer Rod Serling was brought back to work on an outline for a sequel. Serling's outline was ultimately discarded in favor of a story by associate producer Mort Abrahams and writer Paul Dehn, which became the basis for Beneath the Planet of the Apes.[11][page needed] The original film series had four sequels:
Beneath the Planet of the Apes (1970)
Escape from the Planet of the Apes (1971)
Conquest of the Planet of the Apes (1972)
Battle for the Planet of the Apes (1973)
Television series[edit]
Planet of the Apes (1974)
Return to the Planet of the Apes (animated) (1975)
Remake[edit]
Planet of the Apes (2001): The film was a re-imagining of the original film, directed by Tim Burton.
Reboot series[edit]
Rise of the Planet of the Apes (2011): A series reboot, directed by Rupert Wyatt, was released in August 5, 2011 to critical and commercial success. It is the first installment in the new series of films.[8]
Dawn of the Planet of the Apes (2014): The second entry in the Planet of the Apes reboot series, directed by Matt Reeves, was released in July 11, 2014.[26][27]
War for the Planet of the Apes (2017): The third film in the reboot series, directed by Matt Reeves, was released on July 14, 2017.[28][29][30]
Comics[edit]
Comic book adaptations of the films were published by Gold Key (1970) and Marvel Comics (b/w magazine 1974-77,[31] color comic book 1975-76[32]). Malibu Comics reprinted the Marvel adaptations when they had the license in the early 1980s. Dark Horse Comics published an adaptation for the 2001 Tim Burton film. Currently Boom! Studios has the licensing rights to Planet of the Apes. Their stories tell the tale of Ape City and its inhabitants before Taylor arrived. However, in July 2014, it was announced that Boom! Studios and IDW Publishing will do a crossover between Planet of the Apes and Star Trek the original series.
In popular culture[edit]
A parody of the film series titled "The Milking of the Planet That Went Ape" was published in Mad Magazine. It was illustrated by Mort Drucker and written by Arnie Kogen in regular issue #157, March 1973.[33]
Numerous parodies and references have appeared in films and other media, including Spaceballs, The Simpsons, Futurama, Family Guy, South Park, Jay and Silent Bob Strike Back, Mad Men, The Big Bang Theory and the Madagascar films.[citation needed]
The film is also alluded to in literature, most notably in Junot Díaz's Pulitzer-winning novel The Brief Wondrous Life of Oscar Wao (2007).[citation needed]
Gallery[edit]
The crash of the astronauts' spacecraft was partially filmed in and around Lake Powell.
Horseshoe Bend on the Colorado River, near Page, Arizona, was a part of the Forbidden Zone, through which Taylor, Zira, and Cornelius fled Ape City.
Malibu Creek State Park, part of which was formerly the 20th Century Fox Movie Ranch, was the location of the astronauts' initial encounter with primitive humans and superior apes, and of Cornelius, Zira and Taylor's escape from Ape City.
The final scene was filmed at Point Dume's Westward Beach on the Malibu coast.
The cliff face of Point Dume is obscured by the matte painting of the Statue of Liberty.
See also[edit]
1960s portal
Film in the United States portal
Speculative fiction portal
Primates portal
List of American films of 1968
Apocalyptic and post-apocalyptic fiction, about the film genre, with a list of related films
Survival film, about the film genre, with a list of related films
References[edit]
Jump up ^ "Planet of the Apes". British Board of Film Classification. Retrieved December 21, 2014.
^ Jump up to: a b "The Planet of the Apes (1968) - Financial Information". The Numbers. Retrieved December 21, 2014.
^ Jump up to: a b "Those Damned Dirty Apes!". www.mediacircus.net. Retrieved June 13, 2011.
Jump up ^ "30 Years Later: Rod Serling's Settling the Debate over Who Wrote What, and When". www.rodserling.com. Retrieved August 4, 2007.
Jump up ^ "Planet of the Apes (1968)". Box Office Mojo. January 1, 1982. Retrieved August 18, 2016.
^ Jump up to: a b Brian Pendreigh (September 7, 2001). "Obituary:John Chambers: Make-up master responsible for Hollywood's finest space-age creatures". The Guardian. Retrieved February 27, 2013.
Jump up ^ "Planet of the Apes (1968) A Film Review by James Berardinelli". www.reelviews.net. Retrieved August 4, 2007.
^ Jump up to: a b Lussier, Germain (April 14, 2011). "RISE OF THE PLANET OF THE APES Set Visit and Video Blog". Collider. Retrieved August 18, 2016.
^ Jump up to: a b c American Movie Classics (1998). Behind the Planet of the Apes. Planet of the Apes Blu-Ray: 20th Century Fox Home Entertainment.
Jump up ^ Pulver, Andrew (June 24, 2005). "Monkey business". The Guardian. Retrieved May 13, 2015.
^ Jump up to: a b c d e f g Russo, Joe; Landsman, Larry; Gross, Edward (2001). Planet of the Apes Revisited: The Behind-The Scenes Story of the Classic Science Fiction Saga (1st ed.). New York: Thomas Dunne Books/St. Martin's Griffin. ISBN 0312252390.
Jump up ^ Tom Weaver (2010). Sci-Fi Swarm and Horror Horde: Interviews with 62 Filmmakers. McFarland. p. 314. ISBN 0786458313.
Jump up ^ "Film locations for Planet of the Apes (1968)". Movie-locations.com. Retrieved August 18, 2016.
Jump up ^ "Apes Trivia". Theforbidden-zone.com. Retrieved August 18, 2016.
^ Jump up to: a b Handley, Rich (2009). Timeline of the Planet of the Apes: The Definitive Chronology. Hasslein Books. p. 11. ISBN 9780615253923.
Jump up ^ Key, Jim (January 1, 1999). "The Flight of the Icarus". Sci-Fi & Fantasy Models International. Next Millennium Publishing Ltd (38): 14.
Jump up ^ "The Greatest Films of 1968". AMC Filmsite.org. Retrieved May 21, 2010.
Jump up ^ "The Best Movies of 1968 by Rank". Films101.com. Retrieved May 21, 2010.
Jump up ^ "Planet of the Apes Movie Reviews, Pictures". Rotten Tomatoes. Retrieved April 16, 2012.
Jump up ^ "Empire's The 500 Greatest Movies of All Time". Empire Magazine. Retrieved May 21, 2010.
Jump up ^ Wiley, Mason; Bona, Damien (1986). MacColl, Gail, ed. Inside Oscar: The Unofficial History of the Academy Awards. New York: Ballantine Books. p. 768.
Jump up ^ "America's Greatest Movies" (PDF). AFI. 2002. Retrieved August 18, 2016.
Jump up ^ "AFI'S 100 Years 100 Heroes & Villains" (PDF). AFI. Retrieved August 18, 2016.
Jump up ^ "AFI 100 Years 100 Movies" (PDF). Retrieved August 18, 2016.
Jump up ^ "AFI Ballot" (PDF). Archived from the original (PDF) on October 17, 2011. Retrieved August 18, 2016.
Jump up ^ Lussier, Germain. "Matt Reeves Confirmed to Helm 'Dawn of the Planet of the Apes'". Slashfilm.com.
Jump up ^ "Dawn of the Planet of the Apes Moves Up One Week". ComingSoon.net. Retrieved December 10, 2013.
Jump up ^ McNary, Dave (January 5, 2015). "Channing Tatum's X-Men Spinoff to Hit Theaters in 2016". Variety. Retrieved January 7, 2015.
Jump up ^ Sneider, Jeff (January 5, 2015). "Channing Tatum's 'Gambit' Gets 2016 Release Date, 'Fantastic Four' Sequel Moves Up". Retrieved January 6, 2015.
Jump up ^ "New Planet of the Apes Movie Title Revealed". Collider. Retrieved May 14, 2015.
Jump up ^ Planet of the Apes at the Grand Comics Database
Jump up ^ Adventures on the Planet of the Apes at the Grand Comics Database
Jump up ^ "Doug Gilford's Mad Cover Site - Mad #157". Madcoversite.com. Retrieved August 18, 2016.
External links[edit]
Wikiquote has quotations related to: Planet of the Apes
Wikimedia Commons has media related to Planet of the Apes.
Official website
Planet of the Apes on IMDb
Planet of the Apes at AllMovie
Planet of the Apes at Rotten Tomatoes
Planet of the Apes at Box Office Mojo
Planet of the Apes Script
Planet of the Apes Media Archive An interactive celebration of the Planet of the Apes franchise in sight, sound and motion
Review and analysis of the Apes series
Dale Winogura (Summer 1972). "Special Planet of the Apes Series Issue - Interviews & Set Visit" (PDF). Cinefantastique.
[show]
v
t
e
Planet of the Apes
Films
Original series
Planet of the Apes (1968)
Beneath the Planet of the Apes (1970)
Escape from the Planet of the Apes (1971)
Conquest of the Planet of the Apes (1972)
Battle for the Planet of the Apes (1973)
Remake
Planet of the Apes (2001)
Reboot series
Rise of the Planet of the Apes (2011)
Dawn of the Planet of the Apes (2014)
War for the Planet of the Apes (2017)
Television
Planet of the Apes (1974)
Return to the Planet of the Apes (1975)
Behind the Planet of the Apes (1998)
Video games
Planet of the Apes (2001)
Revenge of the Apes (2003)
Planet of the Apes: Last Frontier (2017)
Other
La Planète des singes
Characters
Comics
Star Trek/Planet of the Apes: The Primate Directive
Tarzan on the Planet of the Apes
Planet of the Apes/Green Lantern
[show]
v
t
e
Films directed by Franklin J. Schaffner
Features
The Stripper (1963)
The Best Man (1964)
The War Lord (1965)
The Double Man (1967)
Planet of the Apes (1968)
Patton (1970)
Nicholas and Alexandra (1971)
Papillon (1973)
Islands in the Stream (1977)
The Boys from Brazil (1978)
Sphinx (1981)
Yes, Giorgio (1982)
Lionheart (1987)
Welcome Home (1989)
TV
Twelve Angry Men (1954)
Seven Against the Wall (1958)
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values: كوكب القردة (فيلم 1968) – Arabic

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Hospice care in the United States
From Wikipedia, the free encyclopedia
Jump to: navigation, search
Exterior of an inpatient hospice unit
Hospice care in the United States is a type and philosophy of end-of-life care which focuses on the palliation of a terminally ill patient's symptoms. These symptoms can be physical, emotional, spiritual or social in nature. The concept of hospice as a place to treat the incurably ill has been evolving since the 11th century. Hospice care was introduced to the United States in the 1970s in response to the work of Cicely Saunders in the United Kingdom. This part of health care has expanded as people face a variety of issues with terminal illness. In the United States, it is distinguished by extensive use of volunteers and a greater emphasis on the patient's psychological needs in coming to terms with dying.
Under hospice, medical and social services are supplied to patients and their families by an interdisciplinary team of professional providers and volunteers, who take a patient-directed approach to managing illness. Generally, treatment is not diagnostic or curative, although the patient may choose some treatment options intended to prolong life, such as CPR. Most hospice services are covered by Medicare or other providers, and many hospices can provide access to charitable resources for patients lacking such coverage.
With practices largely defined by the Medicare system, a social insurance program in the United States, and other health insurance providers, hospice care is made available in the United States to patients of any age with any terminal prognosis who are medically certified to have less than six months to live. In 2007, hospice treatment was used by 1.4 million people in the United States. More than one-third of dying Americans use the service. Common misperceptions regarding the length of time a patient may receive hospice care and the kinds of illnesses covered may result in hospice being underutilized. Although most hospice patients are in treatment for less than thirty days and many for less than one week. But hospice care may be authorized for more than six months given a patient's condition.
Care may be provided in a patient's home or in a designated facility, such as a nursing home, hospital unit or freestanding hospice, with level of care and sometimes location based upon frequent evaluation of the patient's needs. The four primary levels of care provided by hospice are routine home care, continuous care, general inpatient, and respite care. Patients undergoing hospice treatment may be discharged for a number of reasons, including improvement of their condition and refusal to cooperate with providers, but may return to hospice care as their circumstances change. Providers are required by Medicare to provide to patients notice of pending discharge, which they may appeal.
In other countries, there may not be the same distinctions made between care of those with terminal illnesses and palliative care in a more general setting. In such countries, the term hospice is more likely to refer to a particular type of institution, rather than specifically to care in the final months or weeks of life. End-of-life care is more likely to be included in the general term "palliative care".
Contents
[hide]
1 History and statistics
2 Philosophy and practices
3 Hospice demographic
3.1 Re-certification
3.2 Pediatric hospice care
4 Expense
5 Providers
6 Levels of care
6.1 Routine home care
6.2 Continuous care
6.3 General inpatient care
6.4 Respite
7 Hospice interdisciplinary team
7.1 Team members
8 Discharge from hospice
9 Barriers to Access
9.1 Reimbursement
9.2 Stigma
10 See also
11 References
12 External links
History and statistics[edit]
The first hospices are believed to have originated in the 11th century, when for the first time the terminally ill were permitted into places dedicated to treatment by Crusaders.[1] In the early 14th century, the order of the Knights Hospitaller of St. John of Jerusalem opened the first hospice in Rhodes, meant to provide refuge for travelers and care for the ill and dying.[2] The hospice practice languished until revived in the 17th century in France by the Daughters of Charity of Saint Vincent de Paul and, later, by the Irish Sisters of Charity, who opened St Joseph's Hospice in London, England in 1902.[2] In the 1950s at St. Joseph's, Cicely Saunders developed many of the foundational principles of modern hospice care. She later founded St Christopher's Hospice in London.[2]
In 1971, Hospice, Inc. was founded in the United States, the first organization to introduce the principles of modern hospice care to that country, where medical care had focused on fighting illness through hospital stays.[3] Throughout the 1970s, the philosophies of hospice were being implemented throughout the United States. The hospice movement in the United States became distinguished from that in Britain, according to Stephen Connor's Hospice: Practice, Pitfalls and Promise, by "a greater emphasis on use of volunteers and more focus on psychological preparation for death".[4] In 1982 Medicare, a social insurance program in the United States, added hospice services to its coverage.[3] On September 13, 1982, by request of the senate, US President Ronald Reagan proclaimed the week of November 7 through November 14, 1982, as National Hospice Week.[5]
Since then, the hospice industry has rapidly expanded. This growth has accompanied the AIDS epidemic and the aging of the population, with related illnesses. By 1995, hospices were a $2.8 billion industry, with $1.9 billion from Medicare alone funding patients in 1,857 hospice programs with Medicare certification.[6] In that year, 72% of hospice providers were non-profit.[6] By 1998, there were 3,200 hospices either in operation or under development throughout the United States and Puerto Rico, according to the National Hospice and Palliative Care Organization (NHPCO).[6] According to 2007's Last Rights: Rescuing the End of Life from the Medical System, hospice sites are expanding at a national rate of about 3.5% per year.[7] In 2007, 1.4 million people in the United States used hospice, with more than one-third of dying Americans using the service, approximately 39%.[8][9] In 2008, Medicare alone, which pays for 80% of hospice treatment, paid $10 billion to the 4,000 Medicare-certified providers in the United States.[8][10]
As the hospice industry has expanded, so, too, has the concept of hospice care. In 2003 the first US children's hospice facility, the George Mark Children's House Hospice, opened in San Francisco.[11] In February 2009, Buffalo News reported that the balance of non-profit and for-profit hospices was shifting, with the latter as "the fastest-growing slice of the industry."[8]
Philosophy and practices[edit]
The goal of hospice agencies in the United States is to provide comfort to the patient and heighten quality of life.[12] How comfort is defined is up to the patient or, if the patient is incapacitated, the patient's family. This can mean freedom from physical, emotional, spiritual and/or social pain. Hospices typically do not perform treatments that are meant to diagnose or cure an illness,[13] and they do not seek to hasten death or, primarily or unduly, to extend life.[14][15][16][17] While it is generally not required that patients sign "Do not resuscitate" (DNR) orders to be on hospice, some hospices require them as a condition of acceptance.[18][19]
Many hospice patients, though not all,[20] have made decisions against receiving CPR should their heart or breathing stop. If a patient does decide to request CPR, that service may not be provided by the hospice; the family may need to contact Emergency Medical Services to provide CPR.[21] The principle of not extending life and withdrawing diagnostic or curative treatments is often the greatest barrier for patients in accepting hospice care. In some cases, medical professionals may feel conflict in attempting to provide it.[22]
Some confusion still exists as to what treatments a patient may receive in hospice care. Hospices may provide treatments that have been traditionally regarded as curative, including radiation therapy or antibiotics, if these are administered to improve quality of life.[23][24] Determination of appropriate treatment is made by medical personnel on an individual basis.
Another aspect of the hospice philosophy is that the care is patient-centered, to treat the whole patient. Many healthcare agencies in the US market themselves as patient-centered; for hospice, this patient-directed care is integral and interwoven throughout the care which is provided.[25] Related Medicare regulations reflect this philosophy.
Hospice demographic[edit]
In order to qualify for hospice care, a patient must have certification from two physicians that he or she has less than six months to live if his or her disease runs its natural course; usually the patient's primary physician and the Hospice Medical Director will provide this certification.[26] Patients can and do stay on hospice longer than six months, and as long as the hospice team continues to certify with supporting evidence that the patient is terminal, insurance companies will usually continue to pay for hospice care.[27]
Many physicians are slow to refer to hospice care, waiting until they are absolutely certain of a terminal prognosis. Some physicians believe that the patient must have a six-month prognosis or less to receive hospice care, while others are overly optimistic in their assessment of prognosis, presuming treatment will be more effective than it is.[27][28] As a result, the majority of patients are referred to hospice in the very end-stages of their diseases, or choose that time to seek hospice care. The average length of stay in hospice before a patient dies was 26 days in 1994 and 19 days in 1998.[29] Although the length of average stays has since increased, the term of care continues to be underused. In 2004 the average stay was 57 days and the median length was 22 days.[30] 33% of hospice patients admitted in 2004 died within seven days of admission.[31]
Such late admission is inconsistent with the process of hospice, which is to alleviate patient distress over a period of time, based on time for patients and family members to develop relationships with the hospice team.[32]
Some people believe that only individuals suffering from cancer or AIDS can receive hospice care. Hospice in the United States developed around the model of cancer care, with a relatively predictable pattern of deterioration.[33] According to 2002's The Case Against Assisted Suicide: For the Right to End-of-life Care, "60% of hospice patients have cancer."[34] But, patients can be on hospice for numerous other illnesses, such as end-stage heart and lung diseases, stroke, renal failure, Alzheimers, or many other conditions. Any diagnosis that would be an acceptable cause of death on a death certificate is, if expected to be terminal, an acceptable diagnosis for hospice care.[35]
Re-certification[edit]
In order to qualify for hospice, a patient has to be certified as having a prognosis of less than six months to live. Sometimes patients live longer. Medicare patients who receive the hospice benefit must waive other Medicare benefits that could prolong life.[36] Under the Medicare provisions, the hospice benefit through the first six months is broken up into two 90-day benefit periods. At the end of these two benefit periods, the hospice team will evaluate whether or not the patient continues to have a prognosis of less than six months to live.[37] Following these two 90-day benefit periods, the hospice is required to evaluate more closely and review the case every 60 days. Commercial insurers, managed care program providers, and Medicaid often have their own regulations regarding re-certification. When the hospice re-certifies a six-month or less prognosis, this is based on the patient's current condition.
Pediatric hospice care[edit]
See also: Children's hospice
Patients in hospice have primarily been elderly; according to the 2006 Handbook of Social Work in Health and Aging, more than 80% of hospice patients in the United States are over 65.[38] But hospice care is available to all age groups, including those under 21. Not all hospices are able to serve every population.
In 1983, less than 1% of hospice providers offered pediatric care; by 2001, that number had grown to 15%.[39] The first pediatric hospice facility in the United States, the George Mark Children's House Hospice of San Francisco, opened in 2003. While pediatric hospice options are expanding, as of 2006 many adult-oriented hospice programs remained ill-prepared to handle younger populations.[40]
The primary diagnosis for children in hospice treatment is cancer, but, like the adult population, children may enter hospice for a variety of conditions, including AIDS, prematurity, congenital disorder, cerebral palsy, cystic fibrosis, or "death-inducing trauma", such as automobile accidents.[40] Hospice care, which is intended to treat the whole family, may also be made available to families expecting a child who is not anticipated to survive long after delivery.[40]
The recommended model of hospice for children differs from that of adults. In 2000, the committees on Bioethics and Hospital Care for the American Academy of Pediatrics jointly released a recommendation that palliative care for children should be provided for any life-threatening condition from the point of diagnosis, whether death is the prognosis or not, as the benefits of palliative care can be offered concurrently with curative treatment.[41] The Virginia-based Children's Hospice International also recommends hospice services for all children with life-threatening conditions, even if seeking "hopeful" treatment, "to enhance the quality of life for the child and family".[42] However, the federal standards set by Medicaid require the six-months terminal prognosis. Insurance providers may restrict access to hospice care to pediatric patients undergoing life-extending treatment.[43]
Expense[edit]
The cost of hospice care may be met by health insurance providers, including Medicare or Medicaid for eligible Americans. Hospice is covered 100% with no co-pay or deductible by Medicare Part A except that patients are responsible for a copay for outpatient drugs and respite care, if needed.[44] (Respite care may be necessary, for instance, if a family member who is providing home hospice care is briefly unable to perform his or her duties and an alternative care provider becomes necessary.)[44] As of 2008, Medicare was responsible for around 80% of hospice payments, reimbursing providers differently from county to county with a higher rate for inpatient hospice care. A lower rate is paid for home care, with a higher rate paid for round-the-clock nursing care in order to get a patient's symptoms under control.[8][45]
Most commercial health insurances and Medicaid have a hospice benefit as well.[46] These typically are similar to the Medicare benefit. There may be a co-pay required by commercial health insurance providers depending on individual plans.[47] According to a 2008 article by Lauren Tara LaCapra on TheStreet.com, Medicare and Medicaid paid 78% of home-based hospice charges in 2008, with 12% being supplied by private insurance providers and 10% "out of pocket", paid by the patient.[48] Most non-profit hospice agencies have contingencies for patients who lack insurance coverage and will provide care to the patient free of charge or at reduced rates.[46] LaCapra said that out-of-pocket expenses for home-based hospice services were $758 a year in 2008 for the average hospice patient.[48]
Once a patient is enrolled in hospice, the hospice becomes the insurance payor for that patient for any hospice-related illnesses.[47] In other words, if a patient is on hospice for end-stage congestive heart failure, the hospice is responsible for all care related to the heart failure. However, if the patient were to see a podiatrist, this would be billed through their regular insurance.
Providers[edit]
Hospice is a competitive business.[49] In any given service area, there may be hundreds of different non-profit and commercial providers.[50] Hospices can be small community-based operations, part of regional and national corporations, or part of a hospital or other health system. Data from the National Hospice and Palliative Care Organization indicated that in 2008 58.3% of hospice agencies were independent, with 20.8% based in hospitals, 19.7% geared for home health care and 1.3% in conjunction with nursing homes.[51] In 2007, the mean number of patients being treated in hospice facilities on any given day was 90.2.[citation needed] 79.4% of hospice providers admitted fewer than 500 patients per year.[52] The number of for-profit and non-profit providers has become more balanced as the for-profit sector has grown. In 2007, 47.1% of agencies were for-profit, with 48.6% non-profit. The remaining 4.3% were government-owned providers.[52]
In order to receive payments for hospice patients under Medicare or Medicaid, a hospice must be certified by the Centers for Medicare and Medicaid Services, and in 2007 93.1% were.[53] Among those that were not certified, some were in the process of seeking certification. However, some agencies do not seek certification or voluntarily relinquish it. For one example, an agency that is entirely supported through donations or relies on volunteer staff might not choose to seek certification. The NHPCO estimated in 2008 that at least 200 "all-volunteer" programs were in operation in the United States.[53]
Levels of care[edit]
There are four primary levels of care; routine home care, continuous care, general inpatient and respite/respite inpatient.[54] All hospices in the United States certified by Medicare are required to offer each of these levels of care.[55]
Routine home care[edit]
Routine home care is the most common level of care provided.[55] In spite of its title, routine home care does not indicate a location of care, but a level (or intensity) of care provided. Routine care may be provided at a nursing home or assisted living facility,[54] although the majority of hospice patients are treated at home.[14] Interdisciplinary team members supply a variety of services during routine home care, including offering necessary supplies, such as durable medical equipment, medications related to the hospice diagnosis and incidentals like diapers, bed pads, gloves, and skin protectants.[56] Twenty-four-hour on-call services must be available as needed.[57] Typically this is provided after normal business hours by a registered nurse prepared to address urgent patient concerns.[57]
Continuous care[edit]
Continuous Care is a service provided in the patient's home.[55] It is for patients who are experiencing severe symptoms and need temporary extra support.[55] Once a patient is on continuous care, the hospice provides services in the home a minimum of eight hours a day.[54] Because the criteria for continuous care is similar to general inpatient care, and due to the challenges a hospice can face with staffing extended day care in the home, continuous care is intended to be used for short periods of time.[58]
General inpatient care[edit]
General inpatient care is an intensive level of care which may be provided in a nursing home, a specially contracted hospice bed or unit in a hospital, or in a free-standing hospice unit.[59] General inpatient criteria is for patients who are experiencing severe symptoms which require daily interventions from the hospice team to manage.[54] Often, patients on this level of care have begun the "active phase" of dying, when their prognosis is measured in days as opposed to weeks or months. Although there is a limit to how long Medicare will cover this level of care, it is usually provided for brief periods of time, with five to seven days being the average.[45]
Respite[edit]
Respite Care (sometimes referred to as respite inpatient) is a brief and periodic level of care a patient may receive. Respite is a unique benefit in that the care is provided for the needs of the family, not the patient. Should a family member need a "break" from caregiving, or if a vacation is planned, then this level of care may be provided. During respite, the patient is transferred from the home to an institutional setting; this can be a nursing home, assisted living, hospital or an inpatient hospice unit.[55] Should a patient be transferred to an assisted living facility, nursing home, or hospital, the hospice would continue to provide care to the patient which is on par with the services provided under the routine home care benefit. In this way, the only difference between respite and routine care is that the hospice pays the room and board charges of the facility. Should a patient receive respite in an inpatient hospice unit the care would be similar to what other patients of the hospice unit receive. Respite is provided for a maximum of five days every benefit period.[59]
Hospice interdisciplinary team[edit]
The hospice interdisciplinary team is the core service which every hospice provides to patients and families.[60] Hospice differs from other forms of care in that the core members of the hospice team function as an interdisciplinary, rather than a multidisciplinary, team.[61] Multidisciplinary teams involve several professionals who independently treat various issues a patient may have. The problems that are being treated may or may not relate to other issues being addressed by individual team members. Interdisciplinary team approach involves all members of the team working together towards the same goal, which in this case is to afford patients a comfortable dying experience and families the support they need in coping with this. In an interdisciplinary team approach, there can often be role blending by members of the core team, who may take on tasks usually filled by other team members.[61]
The hospice team is required by Medicare to meet every 14 days. During this team meeting, patient needs are discussed and planned for the next two weeks.[62] Additionally, the team reviews the patient's medical condition to ensure that the patient still meets criteria for hospice care.
Team members[edit]
Team members include hospice medical directors, physicians, pharmacists, registered nurses, social workers, counselors, home health aides, and volunteers.[63]
Hospice Medical Director: The hospice medical director, a physician, often provides the most support to the clinical staff providing care to the patient and family. The medical director may also provide medical care if the primary physician is unavailable or if the patient does not have a primary care provider. The hospice medical director is also required under Medicare to recertify patients.[64]
Physician: Physicians involved in patient care may include the primary physician, who can provide valuable information about patient medical history, and physicians connected to the hospice team. These primarily provide support to other hospice team members, but may also treat the patient directly.[65] The physician subspecialty of Hospice and Palliative Medicine was established in 2006,[66] to provide expertise in the care of patients with life-limiting, advanced disease and catastrophic injury; the relief of distressing symptoms; the coordination of interdisciplinary patient and family-centered care in diverse settings; the use of specialized care systems including hospice; the management of the imminently dying patient; and legal and ethical decision making in end-of-life care.[67]
Registered Nurses: Registered nurses are responsible for coordinating all aspects of the patient's care and insuring symptoms (physical or otherwise) are being addressed and managed. The primary care nurse visits a minimum of twice weekly, and the content of the visit can vary greatly. When patients are experiencing few symptoms and/or are early in their diseases, the RN visit may just be a short check up. If a patient's symptoms worsen, the nurse will visit more often, make recommendations for increasing or changing the medication intervention and provide support and education regarding the disease/dying process. Many patients on hospice may require complex treatments: respiratory care, wound care or even IV therapy at home. In most cases, the hospice nurse is trained to handle these unique needs as well.[68]
Social Worker: Every patient is assigned a social worker who visits at the time of admission to hospice. The social worker function can vary from providing superficial support to patients and families to intensive crisis-oriented counseling. Additionally, with a terminal illness often comes more complicated financial stressors; the social worker can be instrumental in connecting the patient and family with community resources including services such as Meals on Wheels.[69] Lastly, if a patient is unable to be cared for at home, the social worker will work to find a safer place for the patient to receive hospice care.[70]
Counselor: Counselors are required as part of the core team by Medicare regulations. Typically, the role is filled by a Chaplain or Spiritual Counselor, but social workers or other persons, sometimes specially trained, may also serve.[71] While not every patient will see a Chaplain on hospice, all hospices have to be able to provide regular and consistent Chaplain services. The Chaplain is available to provide spiritually supportive counseling, life review and may connect a patient with clergy they are comfortable with. At times the hospice Chaplain will officiate at a patient's funeral.[72]
Home Health Aide: The home health, or hospice, aide is not a core service for a hospice patient; this means it is not required that every patient on hospice receive an aide. However, most patients do receive this service, and it is often the one most depended on by the patient and family. The hospice aide typically visits anywhere from 3–7 days a week for approximately 1–2 hours at each visit. His or her functions include providing respite to the primary caregiver and physical support to the patient, including bathing, dressing, or feeding. Many times it is the hospice aide who develops the closest relationship with the patient, due to the frequency of visits. The hospice aide is not a licensed nurse and therefore can not administer medications, treat wounds, handle IV's or similar treatments.[73]
Pharmacist: Pharmacists oversee the patient's drug therapy, which includes filling prescriptions, monitoring for drug interactions and adverse effects, anticipating problems, and assessing the appropriateness of drug therapies in the context of patient-oriented goals.[74][75]
Volunteers: Volunteers form a major part of hospice care in the United States and may provide a variety of physical or emotional comforts to patients and family, including providing housework, health care, spiritual counseling and companionship. Hospice volunteers also provide administrative assistance to hospices.[76]
Discharge from hospice[edit]
The majority of discharges from hospice are due to the death of the patient, although hospice treatment may not end then as care also provides for a period of bereavement counseling for the family afterward.[77] However, there are several other scenarios when a patient may be discharged from hospice.
De-certification:
If it is determined at the time of review that a patient's prognosis may be greater than six months, the patient is de-certified (discharged) from hospice.[78] The hospice is required by law to give advance notification to the patient, and the patient can appeal the hospice's decision to Medicare.[79] Usually the hospice plans these discharges weeks in advance to make the transition off hospice, which can be traumatic for patients who have been preparing to die, as smooth as possible. Should the patient's condition worsen once discharged from hospice they can be readmitted to hospice.
Revocation:
A patient may be discharged by revocation if he or she chooses to relinquish the hospice benefit.[80] Revocation could be due to hospitalization, if the patient chooses to pursue some type of curative treatment or experiences dissatisfaction with hospice care. However, not all hospitalizations of patients require revocation; should the admitting diagnosis to the hospital be unrelated to the condition for which they are in hospice, the patient may remain on hospice while undergoing treatment for it.
Transfer of hospice:
Transfer of hospice does not involve a discharge from hospice in general, but a discharge from the current hospice provider to another one.[81]
Discharge for cause:
Occasionally a hospice will be unable to provide care to a patient, either due to philosophical differences with the patient or due to a safety issue. Such causes could include disruptive or abusive behavior from the patient or other persons in the patient's home or refusal to cooperate with the hospice program.[82] Patients may, after being discharged from hospice for any reason, re-enroll in hospice at a later date as necessary.
Barriers to Access[edit]
As indicated, hospice is frequently under-utilized and often not taken advantage of until very late in a patient's illness. The reasons for this have as much to do with financial considerations as with the psycho-social difficulty in choosing hospice. A 2009 study found that with proper case management hospice access could be liberalized without additional costs to insurers.[83]
Reimbursement[edit]
Physicians: There are multiple aspects as to why, financially, hospice care may be difficult to access. The first would relate to physician reluctance. As stated previously, when enrolled in hospice, the patient transitions from their primary insurance to having most of their care managed directly by the hospice. As hospices typically have a limited budget, expensive care may not be permitted by the hospice.[84] Additionally, reimbursement for physician visits can be complicated and result in non-payment to physicians.[85][86] Therefore, difficulty in authorizing expensive treatments and lack of payment for visits can be reasons for non-referral from a physician.
Nursing Homes: A second aspect to reimbursement pertains to the nursing home. In many cases, patients who are transferred to a nursing home from a hospital will have a portion of their nursing home stay reimbursed by Medicare. In these cases, Medicare is paying for some kind of rehabilitative care. Medicare will not reimburse any room and board coverage in the nursing home for patients on hospice. Occasionally, patients who would be better served receiving hospice care will be "rehabilitated" in the nursing home so as to defray the costs of the room and board.[87]
Hospices: While late referral to hospice is a much more prevalent problem than early referral, some hospice providers will hesitate to admit patients to hospice (or they may de-certify them from hospice too early) due to scrutiny from Medicare for patients deemed to be on hospice too long. After a patient has been on hospice for six months, Medicare is more aggressive in auditing the hospice for inappropriate payment of services. For some hospices this is simply not worth the trouble, and patients are screened very carefully prior to admission.[88]
Stigma[edit]
Physicians: Medical care is traditionally focused on curing and healing the patient. For many, hospice care is not seen as the true practice of medicine.[8] Physicians face a persistent social stigma in that hospice is mistaken as giving up on a patient, rather than committing to palliation.[89] Additionally, and although this perception has been changing, when thinking of hospice the doctor is often focused on patients with cancer and not many of the other terminal diseases which qualify for hospice care.
Patients: Many patients and families simply do not want to receive hospice care. The most common reason is an unwillingness to recognize when comfort rather than cure is a more realistic goal. When hospice is framed as care for when "there is nothing left to do" instead of a different kind of treatment, patients may believe that choosing hospice is the equivalent of doing nothing.[90][91]
See also[edit]
Stephen Connor (psychologist)
References[edit]
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Jump up ^ Rose, Susannah (2004). 100 Questions & Answers about Caring for Family Or Friends with Cancer. Jones & Bartlett Publishers. p. 169. ISBN 0-7637-2361-4. Hospice is a type of care focusing on improving or maintaining quality of life, as opposed to extending life....
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Jump up ^ This is an approach historically taken by hospice providers in England. Cf. Gormally, Luke (1992). The Dependent Elderly: Autonomy, Justice, and Quality of Care. Cambridge University Press. p. 167. ISBN 0-521-41531-4. The work of a hospice is aimed not primarily at extending life but at making it more comfortable by palliative care.
Jump up ^ Wilbur, Jason K.; Mark Graber (2008). Family Medicine Examination and Board Review (2 ed.). McGraw Hill Professional. p. 849. ISBN 0-07-149608-4. Despite popular belief, a hospice patient need not agree to a DNR status upon receiving the hospice benefit; however, hospice agencies are permitted to have different admission criteria and some require a DNR status for admission.
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Jump up ^ Spettell, C. M.; Rawlins, W.; Krakauer, R.; Fernandes, J.; Breton, M.; Gowdy, W.; Brodeur, S.; MacCoy, M.; Brennan, T. (2009). "A comprehensive case management program to improve palliative care". Journal of palliative medicine. 12 (9): 827–832. PMID 19719372. doi:10.1089/jpm.2009.0089.
Jump up ^ Mezey, Mathy Doval (2002). Ethical patient care: a casebook for geriatric health care teams. JHU Press. p. 308. ISBN 0-8018-6770-3. Resource allocation questions often raise difficult ethical issues.... In this case, the hospice administration set limits on the amount of care it could reasonably provide [the patient], given its financial considerations, which put its team of care providers in direct conflict with Dr. Richards, the home nurse, and [the patient's wife].
Jump up ^ Committee on Palliative and End-of-Life Care for Children and Their Families (2002). Field, Marilyn Jane; Richard E. Behrman, eds. When children die: improving palliative and end-of-life care for children and their families. National Academies Press. pp. 279–280. ISBN 0-309-08437-7. Procedures for documenting and filing claims for physician care are often complicated and burdensome. For example, for hospice patients, Medicare allows direct billing only by the physician of record. If another physician provides care related to the patient's terminal condition, the hospice must bill Medicare and pay the physician. Some physicians and hospices are unaware of this requirement and, thus, experience claims denials (Huskamp, et al., 2001). Such denials may contribute to physician reluctance to care for hospice patients.
Jump up ^ See "Physician reimbursement: hospice" (PDF). National Hospice and Palliative Care Organization. Archived from the original (PDF) on 2008-11-27. Retrieved 2009-03-22.
Jump up ^ "Paying for Hospice". National Hospice and Palliative Care Organization. Archived from the original on May 9, 2008. Retrieved 2009-02-16.
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Jump up ^ Simpson, Elizabeth (2008-11-15). "What really matters at the end". The Virginian-Pilot. Retrieved 2009-03-22. There's a stigma that comes with palliative care that this is hospice. But it's living with a disease. Living to the fullest. The worst thing a doctor can say is, 'There's nothing more I can do for you.' We can make the pain go away.
Jump up ^ Russell, Mitchell; Susan LeGrand (June 2006). "I'm not that sick, overcoming barriers to the hospice discussion" (PDF). Cleveland Clinic Journal of Pallliative Medicine. 73 (6): 3, 4. doi:10.3949/ccjm.73.6.517.
Jump up ^ Jennings, et al., 26,27,28
External links[edit]
Family Caregiver's Guide to Hospice and Palliative Care
Medicare and Medicaid Programs: Hospice Conditions of Participation; Final Rule, June 5, 2008. United States Department of Health and Human Services.
Home Care & Hospice News
The Medicare Hospice Benefit, Center for Medicare Advocacy.
Children's Hospice International
CDC National Home and Hospice Care Data
Question and Answers about hospice care needs provided free
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