Cutler Institute for Health and Social Policy

Population Health and Health Policy

Barriers to Medicare Hospice Utilization

Abstract: 

This report, prepared for the Maine Hospice Council and funded by the Carpenter Foundation, presents findings of a qualitative study of barriers to hospice utilization. This study includes the perspectives of all 26 Medicare certified hospice providers in Maine. Significant findings of the qualitative study include <li> A continuing need to educate the general public about hospice and the Medicare benefit. <li> Maine health care providers have low referral rates to the hospice programs and often misunderstand the regulations and guidelines of the hospice benefit. <li> The referral process to hospice programs is based on fragile systems of communication, fraught with potential miscues, misunderstandings, and missed opportunities. <li> Providers indicate a strong interest in coming to the table to collectively address the underutilization of the Medicare hospice benefit in Maine. <li> Active consumerism may be an important key to increased dialogue and acceptance of end-of-life care--demand for hospice services may not increase until the consumer is engaged in the conversation. <li> Certain components in the Medicare hospice benefit appear open to varying interpretation and application, causing confusion for consumers and referring physicians, and may be a potential source of tension between certified agencies. <li> Significant workforce issues impact the ability of Maine hospice programs to meet even the current demand for services. <li> Provision of hospice in long-term care facilities is both an opportunity and a challenge.</li>

Publication Type: 
Report
Publish Date: 
December 13, 2007
Author: 
URL: 
http://muskie.usm.maine.edu/Publications/ihp/HospiceBarriers.pdf

Cutler Institute awarded $600,000 to help youth raised in foster system

Marty Zanghi

USM's Cutler Institute for Health and Social Policy has been awarded a $600,000 grant to help young people raised in Maine's foster system to prepare for college and the workforce.

The money comes from the Annie E. Casey Foundation as part of a $5.4 million national effort aimed at youth who are homeless or in either the foster care or juvenile justice systems.

"Many of these young people have suffered abuse or trauma and were raised in poverty and neglect," said Marty Zanghi, the Cutler Center's youth development director.

The money -- including an expected $400,000 more in matching funds -- will pay for contracted work with agencies in the target areas, starting with the greater Portland area and Penobscot, Kennebec and Somerset counties.

Nationally and in Maine, only about 3 percent of people who grow up in the foster care system achieve a college degree, he said.

"It's dramatically lower than the rate for the general population," Zanghi said. "It's a horrible outcome."

It doesn't have to be that way, though.

"There are young people that overcome these circumstances," he said. "I know people who have master's degrees and Ph.Ds."

The Casey Foundation's national effort is being called the "Learn and Earn to Achieve Potential" (LEAP) initiative.

The initiative is working on partnerships in Maine and nine other areas: Alaska, Arizona, California, Massachusetts, Michigan, Minnesota, Nebraska and New York. In each case, people will adapt two evidence-based models to meet the needs of these youth, including support to address the trauma they may have experienced in their lives.

In Maine, the work will include a pair of successful programs, Jobs for Maine Graduates (JMG) and Jobs for the Future. Results will be carefully tracked, Zanghi said.

After the first year, the program is expected to grow.

"Eventually, the additional help will be available to all children, 14 and over, in the foster care system in the state of Maine," Zanghi said.

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