Innovations in End-of-Life Care
an international journal of leaders in end-of-life care

San Diego Hospice Corporation
Jan Cetti
President and CEO
4311 Third Avenue
San Diego, CA 92103-1407

San Diego Hospice (SDH) is a community-based program that provides quality physical, emotional and spiritual care for the terminally ill, and ongoing support for their loved ones. Serving about 325 patients per day through its extensive inpatient, hospice care and home health services, as well as providing specialized care in the areas of bereavement counseling and spiritual care, San Diego Hospice has been meeting the needs of the San Diego community for more than 22 years. The Hospice is also dedicated to increasing the body of professional knowledge and education opportunities for end-of-life care providers - from physicians to nurses, chaplains to volunteers, home health aides to pharmacy students.

Hospice services are provided in patients' homes, skilled nursing facilities, local acute care hospitals and in the San Diego Hospice Inpatient Center. Innovative aspects of hospice care at this site include: a high level of physician involvement, pharmacist specialists, teaching affiliations, integrative medicine, and specialized teams for children. San Diego Hospice counts rural patients, Spanish speaking patients, and skilled nursing facility residents among its patients. It also offers extensive bereavement care for both adults and children. Nine trained chaplains of varying faiths are on staff and bereavement care is offered to family members for up to eighteen months following a death, regardless of whether the deceased was a part of the hospice program. SDH offers a specialized perinatal bereavement program for parents whose children will either not make it to full-term or will die shortly after birth, as well as four age-appropriate grief groups for children.

Access to the hospice program is through an admission service. This department has been the focus of multiple performance improvement projects, as compliance with regulations often makes it difficult for patients to "find the front door." Great effort has been put forth in this area to try to make this compliance invisible to the patients. Over the last few years, improvements have included increases in staff size, later hours for assessments involving urgency or working family caregivers, routine weekend intake and assessment services, and simplification of jargon and paperwork for all involved.

One of the most innovative features of SDH's integrated web of services was the creation of San Diego Palliative Home Healthcare. Licensed under a home health care license, Home Health Services was developed in order to serve patients with fatal chronic illnesses who refused or declined hospice services, or who did not meet the six-month prognosis requirement of the Medicare Hospice Benefit. Organized into specialized disease-based protocols and algorithms, and treated by experienced teams familiar with specific disease management, this program functions with the motto, "Advanced Care for Advanced Disease".

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