Personal reflections.

A hospice pioneer and veteran of 23 years reflects on the early days of the hospice movement in the United States. The political, social and economic forces, which shaped the industry, are addressed from a local state and national perspective. Current challenges are briefly referenced with a call for hospice leaders to recognize the need for and identify where hospice fits into the broad end of life discussions.

The cost of caring for patients with HIV infection in hospice.

This article explores the organizational barriers that have limited the number of persons with AIDS cared for by hospice programs throughout the United States. The financial implications of caring for persons with AIDS are discussed and data from a survey of 15 hospice providers is presented. Examples of creative and cooperative coalitions among hospice programs and other community organizations that maximize scarce resources and share the financial burden of caring for those infected with HIV are presented as models. The diverse funding sources and individual hospice program decisions about palliative treatments and drugs and admission criteria highlight the difficulty of generalizing from the survey.

Patients without a primary caregiver. A model for caring for persons with AIDS.

The hospice program of Hospital Home Health Care Agency of California provides hospice care to persons with AIDS in residential group homes in collaboration with other community-based organizations. As a model, it is applicable to other geographic areas and/or situations where the absence of a primary caregiver prevents access to hospice care.