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The purpose of this statement is to describe the role of occupational therapists and occupational therapy assistants in providing services to clients who are living with chronic or terminal conditions and are at the end of life. It also serves as a resource for occupational therapy practitioners,1 hospice and palliative care programs, policymakers, funding sources, and clients and caregivers who receive hospice and palliative care services. Occupational therapy practitioners provide skilled intervention to improve quality of life by facilitating engagement in daily life occupations throughout the entire life course. Participation in meaningful life occupations continues to be as important at the end of life as it is at earlier stages. The term end-of life care has replaced the term terminal care and encompasses both hospice and palliative care that can occur during the final stages of life.
Hospice
The contemporary definition of hospice encompasses a philosophy of care for individuals of any age with life-limiting illnesses for whom further curative measures are no longer desired or appropriate. Hospice referrals require that the client have a life expectancy of 6 months or less with the usual course of the diagnosis (Centers for Medicare and Medicaid Services, 2010). Hospice care focuses on symptom control and meeting the emotional, social, spiritual, and functional needs of the client and family. As an example, the Medicare Benefit Policy Manual states that "physical therapy, occupational therapy, and speech-language pathology services may be provided for purposes of symptom control or to enable the individual to maintain activities of daily living and basic functional skills."
Reimbursement for hospice care may be provided by a variety of medical insurers, including Medicare, Medicaid, and private insurance. Some hospice organizations receive funds from grants and private donations that are used to cover services. Local civic, charitable, or religious organizations also may provide funding to help patients and their families with hospice expenses.
The basic philosophy of hospice is described in the Standards of Practice for Hospice Programs (National Hospice and Palliative Care Organization, 2002):
Hospice provides support and care for persons in the last phases of incurable disease so that they may live as fully and as comfortably as possible. Hospice recognizes that the dying process is a part of the normal process of living and...