The Cleveland Clinic Foundation and Northwestern Memorial Hospital – Nursing Homes Example

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"The Cleveland Clinic Foundation and Northwestern Memorial Hospital" is a great example of a paper on nursing homes.   Palliative care involves a commitment by clinicians to give the best care to patients to enable them to live throughout the stages of illness without much suffering and die peacefully (Walsh & Miller, 1991). This review seeks to compare and contrast palliative care offered at the Northwestern Memorial Hospital and at the Cleveland Clinic Foundation.   Foundation and Development The hospice program at Northwestern was started in 1980 by the hospital’ s nurses as an initiative to give supportive care to patients at home.

In the initial stages, a team of palliative caregivers would visit people suffering from terminal mental illnesses at home. In 1987, a 10-bed division of the home hospice program was opened at the hospital to address “ quality-of-life issues” (Cassel et al. , 2000). By 1997, Northwestern had been providing quality palliative care to a large part of Chicago.                       The Cleveland Clinic started its palliative care program in 1987. Contrary to Northwestern, Cleveland’ s palliative care stemmed from its inpatient units for acute care and hospice facility respectively.

The realization that these patients needed more care led to the establishment of Palliative Medicine. This is the only program for palliative care in the greater part of Cleveland. Today, the palliative care program has four physicians on a full-time basis, two nurses, and volunteers. Aims of Palliative Care At Northwestern, clinicians strive to offer the best care in local settings for the patients and their families. The hospitals emphasize home hospice over inpatient services. This is done to ensure that patient contentment and physician independence are upheld. At Cleveland, the aim of the palliative facility is to offer high-quality care to patients with acute cancer throughout the stages.

Such patients should be treated with dignity right through illness till bereavement. The major difference between Cleveland and Northwestern is that the former attaches prime importance to inpatient services over home care. Aspects of Palliative Care One of the services offered at Northwestern is consultations with regard to recommendations and help on the best care for the patient. The consultation team works for 24 hours on weekdays. On weekends, rotating fellows work with a physician to provide consultations.

The inpatient unit caters to patients who are too ill to be cared for in any other setting. The majority of these patients come from other units in the hospital, although a number of patients come from home. Clinicians are required not to resuscitate a patient at the inpatient unit. The home hospice program provides services for patients in their homes, sometimes in collaboration with a local health care agency. Philanthropy helps pay caregivers for lone patients. There is a bereavement program for patients who die either at the unit or at home. The major difference between Northwestern and Cleveland is that in the latter, palliative care is a five-phase program.

The first phase is consultation, which is followed up by an outpatient clinic located within the hospital, at the cancer center. The third element is an acute care unit for inpatients which deals with medical complications and acute symptoms. Cleveland has its own home and hospice care and therefore, does not rely on local home hospice care programs to attend to released patients. Lastly, there is an inpatient hospice unit to enable patients to stay longer.

The bereavement program conducts a biannual memorial service and has a music therapy group that visits patients at home and in the hospital. One similarity between the two hospitals is that education and research are an integral part of palliative care. The education has given and research conducted at both institutions focus on the patient, thus enabling clinicians to give the best and updated care to patients (Walsh, Krech, & Miller, 1991). Financing The program at Northwestern is able to finance itself through hospice benefits, reimbursement, and professional billing.

Revenue collected from patients goes into direct expenses, while money from charity is used to support home-based care only. For the home hospice services, the hospital funds the program using money collected from drugs and analytic tests at the hospital. The hospice service also receives Medicaid from Illinois State, in addition to payments by commercial insurance companies. Similarly, the palliative program at Cleveland is fiscally self-sufficient. Most of the funds come from patient revenue; therefore, palliative medicine has never submitted an application for grants.

Small donations from philanthropists are used to fund staff education. At the inpatient unit for acute care, health insurance funds the services provided there. Challenges in Offering Palliative Care   In its initial stages, other staff members at the hospital opposed the idea of the program being named “ hospice program” (Cassel et al. , 2000). This is because palliative care was seen as a means of gaining reimbursement rather than being guided by the codes of high-quality practice. Secondly, it is not a guarantee that a physician will always be punctually available for consultations.

Nurses have also complained of a lack of reimbursement for their palliative services. At the inpatient unit, the staff is susceptible to stress due to the high number of deaths; thus their work may be affected. Insurance companies also become problematic in payment for inpatients, citing no justification for skilled care. Concerning home hospice, it is difficult for the program to attend to patients living in inaccessible or high crime areas. When Cleveland’ s Palliative Medicine was being set up, it did not have a hospice facility meaning that patients had to be taken home.

The problem with this model was that the hospital was unable to coordinate its activities with those at the homes. Secondly, the kind of care provided at homes was not of good quality and was inconsistent. Thirdly, a lot of revenue that would have helped the hospital operate better was being lost with the patients’ stay at home. The hospital, thus, had to come up with its own hospice unit. Of late, Cleveland has been dealing with issues affecting proper communication, decision making, and management of patient illnesses at the hospital.   Summary Palliative care at Northwestern and at Cleveland differs in as many aspects as it is similar.

Among the similarities is that both hospitals are non-profit organizations providing palliative care. Secondly, both programs are financially self-sufficient and do not depend on grants to operate the palliative care services. The importance of education and research is a common phenomenon between the two programs. Among the differences between Cleveland and Northwestern is that palliative care in the latter was initiated by nurses. At Cleveland, the realization that hospice inpatients needed more care led to the program (Goldstein, Walsh, & Horvitz, 1996).

Secondly, Cleveland offers five services including consultations, outpatient clinics, acute care inpatients, home hospice, and hospice inpatient facilities. On the other hand, Northwestern offers consultation, acute inpatient care, and home hospice services only. Lastly, Cleveland prefers inpatient to home hospice, while Northwestern emphasizes home hospice over inpatient care.


Cassel, C. et al. (2000). Pioneer programs in palliative care: Nine case studies. New York: Milbank Memorial Fund.

Goldstein, P., Walsh, D., and Horvitz, L. (1996). The Cleveland Clinic Foundation Harry R. Horvitz Palliative Care Center. Support Care in Cancer, 4, 329-33.

Walsh, T., & Miller, R. (1991). Psychosocial aspects of palliative care in advanced cancer. Journal of Pain and Symptom Management, 6(1), 24-9.

Walsh, T., Krech, R., & Miller, R. (1991). The role of a palliative care service family conference in the management of the patient with advanced cancer. Palliative Medicine, 5, 34-9.

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