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SOMC Hospice
New name
Same special kind of caring
Dr. Suzann Bonzo
February 2007
What is hospice?
• Emphasis of comfort care, rather than
curative
• Holistic, addressing physical, emotional and
spiritual well-being
• Hospice regards the entire family, rather than
the patient alone, as its “unit of care”
• Supportive services offered to family
What services are
offered by hospice?
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Pain and symptom management
Emotional and spiritual support
Home health aides and trained volunteers
Respite for family caregivers
Medications, equipment and supplies
Grief support for loved ones
Where are hospice
services provided?
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In the home
In the hospital
In the long-term setting
In the Hospice Center (March 2007)
How many families are
served by hospice?
• We serve over 100 patients and their
families every day.
• 2004 - 22,254 patient days
• 2005 - 31,425 patient days
• 2006 - 39,579 patient days
What is the average
length of stay?
• 2004 - Average length of stay 41 days
• 2005 - Average length of stay 65 days
• 2006 - Average length of stay 63 days
How is hospice
growing?
• 2004 - Referrals 452
• 2005 - Referrals 465
• 2006 - Referrals 488
What are typical
diagnoses?
• Acute Respiratory Failure
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Cirrhosis Liver
Alzheimer’s Disease
Anoxic Brain Damage
CHF
Coronary Artery Anomaly
CVA
Dementia
Failure to Thrive
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Debility
Parkinson Disease
Renal Failure
HIV
Cancer
Pulmonary Disease
• 1. Disabling dyspnea at rest resulting in decreased
functional capacity (may be documented by FEV1 post
bronchodilator <30%)
– AND
• 2. Progression documented by increasing ED visits or
hospitalizations or decreasing FEV1>40cc per year
– AND
• 3. Hypoxemia with PO2<=55 or O2 sat <=88 on
supplemental oxygen
– OR
• 4. Hypercapnia with PCO2>=50
Heart Disease
• 1. Optimal treatment with diuretics and
vasodilators
– AND
• 2. Significant symptoms of recurrent
congestive heart failure at rest, classified as
NYHA Class IV. (May be documented by an
ejection fraction <=20%)
Dementia
• 1. Stage 7 or beyond of the Functional Assessment Staging
Scale (as follows):
– a. Unable to ambulate without assistance
– b. Unable to dress without assistance
– c. Unable to bathe without assistance
– d. Urinary and fecal incontinence, intermittent or constant
– e. No meaningful verbal communication, stereotypical
phrases only, or ability to speak is limited to six or fewer
intelligible words;
Dementia (Cont’)
– AND ONE OF THE FOLLOWING IN THE LAST 12 MONTHS:
» Aspiration pneumonia
» Pyleonephritis or other upper urinary tract infection
» Septicemia
» Decubitus ulcers, multiple, stage 3-4
» Fever, recurrent after antibiotics
• Inability to maintain sufficient fluid and calorie intake with
10% weight loss during the previous 6 months or serum
albumin <2.5.
Stroke & Coma
• Stroke and Coma: (Chronic phase patients)
• 1. Meet the criteria for DEMENTIA
– AND
• 2. Karnofsky score <=40
– AND
• 3. Poor nutritional status evidenced by weight loss >
10% over the last 6 months or serum Albumin <2.5
Liver Disease
• 1. Prothrombin time prolonged more than 5 seconds
over control , or INR > 1.5
– AND
• 2. Serum albumin < 2.5
– AND
• 3. Endstage disease showing at least one of the
following:
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Refractory ascites or ascities with noncompliance
Spontaneous bacterial peritonitis
Hepatorenal syndrome
Refractory hepatic encephalopathy or due to noncompliance
– Recurrent variceal bleeding, despite intensive therapy
What is the role of the
medical director?
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Available for consultations
Medical coverage for hospital stays
Medical coverage for Hospice Center stays
Coverage for pain management
After hour back-up for Hospice team
What is the SOMC
Hospice Center?
• Facility designed to offer hospitality to those
who enter, a building which can allow the staff
to take care of seriously ill people in an
efficient manner, yet appear non-institutional
and comforting to those entering as patients or
as their caregivers.
Who is admitted to the
SOMC Hospice Center?
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Pain and symptom management
Medication change and observation
Caregiver crisis
Imminent death
Respite care
What does the SOMC
Hospice Center include?
• Patient and family suites – each containing
patient room, family room w/ sleeper sofas, and
kitchenettes
• Facility kitchen with the ability to prepare meals
in the patient and family room
• Family kitchen
• Meditation room with digital baby grand piano
• Family gathering area with pool table and
entertainment center
• Patient and family library
What does the SOMC
Hospice Center include?
• Courtyard area with gazebo, fish pond and
waterfall and fire pit
• Internet access for patients and families
• Private patio area
• Children’s room
• Interior waterfall feature
• Family laundry room
• Homelike décor
Who provides care at the
SOMC Hospice Center?
• All physicians welcome to Center to provide care for their
patients. Medical Director available to provide temporary
coverage while patient is in the Center.
• Scheduled Open House - March 4th, 2007
• Staffing:
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Physicians
LPN
Chaplain
Dietary
Volunteers
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RN
Aides
Social Work
Pharmacy
Any Questions?