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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 and came into the United States in the 1970s in response to the work of Cicely Saunders in the United Kingdom. Since its first establishment, the industry has rapidly expanded. In the United States, it is distinguished by more extensive volunteerism and a greater emphasis on the patient's psychological needs in coming to terms with dying. 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 utilized by 1.4 million people in the United States. More than one-third of dying Americans utilize the service. However, 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, care may extend beyond six months so long as a patient's condition continues to merit such medical outlook. 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. 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. Outside the United States there may not be the same distinctions made between care of those with terminal illnesses as against 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; and specific end-of-life care is more likely to be included in the general term "palliative care". ==History and statistics== The first hospices are believed to have originated in the 11th century when for the first time the incurably ill were permitted into places dedicated to treatment by Crusaders.〔 〕 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.〔Connor, 5.〕 But 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.〔 It was there in the 1950s that Cicely Saunders, who later founded St Christopher's Hospice in London, developed many of the foundational principles of modern hospice care.〔 In 1971, Hospice, Inc. was founded in the United States, first bringing the principles of modern hospice care to that country.〔Connor, 6.〕 Throughout the 1970s, the philosophies of hospice were being implemented throughout the United States. The hospice movement in the United States soon distinguished itself 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".〔Connor, 5–6.〕 Medicare, a social insurance program in the United States, added hospice services to its coverage in 1982.〔 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. Since then, the hospice industry has rapidly expanded. 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. In that year, 72% of hospice providers were non-profit.〔 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).〔 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. In 2007, 1.4 million people in the United States utilized hospice, with more than one-third of dying Americans utilizing the service, approximately 39%.〔 〕〔 〕 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.〔 As the hospice industry has expanded, so, too, has the concept of hospice care. 2003 saw the opening of the first US children's hospice facility, the George Mark Children's House Hospice in San Francisco. 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."〔 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Hospice care in the United States」の詳細全文を読む スポンサード リンク
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