International Journal of Public Health Science (IJPHS) Vol. 8, No. 2, June 2019, pp. 143~150 ISSN: 2252-8806, DOI: 10.11591/ijphs.v8i2.20061  143 Journal homepage: https://www.iaescore.com/journals/index.php/IJPHS Integrating palliative care and hospice services in long term care: an eightfold path health policy analysis Amil Kusain Tan Jr. Department of Nursing Science, The Graduate Center, City University of New York, United States of America Article Info ABSTRACT Article history: Received Mar 15, 2019 Revised Apr 17, 2019 Accepted May 28, 2019 It is evident in the literature that as near end of life approaches, health expenditure increases. The re-hospitalization and underutilization of palliative and hospice services add to the burgeoning health cost. There is a lack of support for patients with advanced illness in long-term care facilities. This paper aims to provide a comprehensive review of the problem and assess alternatives to reduce readmission among patients with advanced disease and those who are at the end of life. This paper adapted Bardach’s Eightfold Path analysis as a guide to analyzing the problem using a case study approach. The article discussed the issues, reviewed the literature for evidence, provided the alternatives, identified criteria, evaluated projected outcomes, discussed the trade-offs of adopting the policy, and provided a recommendation. In conclusion, integration of palliative and hospice care services across the continuum of long-term care is a viable alternative policy to address the problem. Keywords: Eightfold path Health policy Long term care Palliative/hospice care Policy analysis Copyright © 2019 Institute of Advanced Engineering and Science. All rights reserved. Corresponding Author: Amil Kusain Tan Jr, Department of Nursing Science, The Graduate Center, City University of New York, 365 5th Ave, New York, NY 10016, United States of America. Email: amilkusainjr.tan@yahoo.com 1. INTRODUCTION According to Healthy People 2020, an estimated 50 million individuals are 65 years old and above in 2014. Sixty percent of those have one or more chronic diseases such as heart disease, cancer, chronic obstructive pulmonary disease (COPD), stroke, diabetes, and Alzheimer's disease [a] With the increase in life expectancy, there is an increasing demand for long-term care services. Such services accounted for $300 billion in health expenditures in 2010 as reported by the Centers for Medicare and Medicaid Services (CMS). [b] Long-term care facilities include skilled nursing facilities and sub-acute rehabilitation centers. Skilled Nursing Facility Case A is a 520-bed capacity skilled nursing facility (SNF) that accepts two types of population. The chronic long-term patients who are both Medicare and Medicaid, and sub-acute patients who are primarily Medicare A beneficiaries. Sub-acute patients have an average length of stay of 30 to 100 days. The type of sub-acute patients admitted are: patients admitted requiring post-operative rehabilitation mostly orthopedics cases; patients who are acutely ill such as complex chronic heart failure and COPD cases; patients with tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube; patients requiring 1-3 months intravenous (IV) antibiotic administrations; advanced cases of cancer patients; patients who are suffering from dementia and other psychiatric disorders; and patients requiring end-of-life care. The acuity of patient’s needs has been dramatically increased in recent years. More and more complex patients are admitted requiring a high level of nursing care. Readmission issues become highly contentious between hospital and SNF because hospital gets penalized by CMS for 30-day readmission. Instead of establishing a partnership and care coordination. The SNF most often are blamed for poor care management when patients get re-admitted.