Download An Overview of Hospice for Health Care Providers

An Overview of Hospice for
Health Care & Human
Service Providers
Dr. BC Farnham & Elizabeth Pugh, LBSW, CM
This program is made possible through a collaborative community-education partnership between The Consortium for Advancements in Health &
Human Services, Inc. and Kindred at Home. The primary goal of this effort is to increase public awareness and access to hospice and home
health through the provision of community-based education. Contact Hours are awarded to professionals who complete this program by The
Consortium for Advancements in Health & Human Services, Inc. (www.cahhs-partners.org)
The Consortium for Advancements in Health and Human Services, Inc. © 2014
Important Information
•
This education program for healthcare professionals was developed by The Consortium for Advancements in Health and Human Services,
Inc. (CAHHS) and is facilitated by Kindred at Home via a community education partnership agreement. CAHHS is a private corporation and
is solely responsible for the development, implementation and evaluation of its educational programs. There is no fee associated with
receiving contact hours for participating in this program titled, An Overview of Hospice for Health Care & Human Service Providers.
However, participants wishing to receive contact hours must offer a signature on the sign-in sheet, attend the entire program and
complete a program evaluation form.
•
The Consortium for Advancements in Health and Human Services, Inc. is an approved provider of continuing nursing education by the
Alabama State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.
•
The Consortium for Advancements in Health & Human Services, Inc., is approved as a provider of c ontinuing education in Social Work by
the Alabama Board of Social Work Examiners, #0356, Expiration Date: 10/31/2016.
•
This program is Approved by the National Association of Social Workers (Approval #886684291-5175) for 1- Pain/Symptom
Management continuing education contact hour.
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In most states, boards providing oversight for nursing and social work recognize contact hours awarded by organizations who are
approved by another state's board as a provider of continuing education. If you have questions about acceptance of contact hours
awarded by our organization, please contact your specific state board to determine its requirements. Provider status will be listed on
your certificate.
•
CAHHS does not offer free replacement certificates to participants. In the event that CAHHS elects to provide a replacement certificate,
there will be a $20.00 administrative fee charged to the individual who requests it.
Learning Objectives
Participants completing this continuing education
program will be able to:
 Discuss the primary elements of hospice
philosophy.
 Identify basic hospice admission criteria.
 Discuss trends in the utilization of hospice care.
 Identify the core services available to patients and
their families who receive hospice care.
Hospice Philosophy
Hospice is a philosophy of care where death is recognized as a natural stage of
life. The goal of hospice is to enable patients to live as alert and pain-free as
possible. Symptoms are controlled enabling days to be filled with dignity,
quality, and to be shared with loved ones. Delivered by highly skilled
professionals with expertise and compassion, hospice offers care to the patient
and support for the family unit as a whole. The word “hospice” stems from the
Latin word “hospitium” meaning guesthouse. It was originally used to describe a
place of shelter for weary and sick travelers returning from religious pilgrimages
during medieval times. The modern hospice movement began with Dame Cicely
Saunders in London in 1967. She made it possible for patients to have access to
the best medication available to control their pain so that they and their families
could address important emotional and spiritual challenges.
What is Hospice?
 Hospice is a specialized form of health care
services provided to patients and families
experiencing a life threatening illness.
 Hospice focuses on palliative measures rather
than curative measures.
 Hospice treats the patient and family as one unit.
 Hospice treats from the holistic modality, which
encompasses the medical, social, emotional, and
spiritual elements of the patient’s life.
Admission Criteria
• Patients are appropriately admitted when their physician
determines the patient has a life-limiting prognosis of 6 months
or less should the disease proceed its normal course;
•
and the patient and family choose a palliative plan of care,
rather than curative treatment.
• Once these are discussed, hospice is called in for a home visit
to continue these conversations with the patient and family
and determine which services they need and want.
Frequent Diagnosis:
• Patients with cancer compose 46% of hospice
admissions.
•
•
•
•
End stage heart disease
Dementia
Lung diseases
End stage kidney disease
Diagnosis worksheets and educational materials are
available to support you in determining if a patient
is appropriate for hospice services.
An Important Question to
Consider:
 Would you be surprised to learn the patient died
within the next 6 months?
 If you answer “no” to this question, then a
hospice referral is likely appropriate.
Growth in National Census
Levels
Growth in US Hospice
Programs:
Continued Growth in Patients
Served:
Shift in Cancer Diagnosis
Statistics:
Mission is Being Accomplished
Populations Served:
Comfort…
 Nurses expertly trained in pain control and symptom
management care for each patient’s individual needs while
respecting their personal choices regarding medication and
treatment.
 Home medical equipment and supplies related to the illness,
such as wheel chairs and oxygen, are provided to increase
patient comfort.
 Support extends beyond physical needs to include the
emotional through the hospice team of social workers, clergy
and bereavement counselors.
 Palliative chemotherapeutics and radiation are available to
increase patient comfort as well as physical, occupational &
speech therapies for the alleviation of symptoms.
Why is Hospice Care Unique?
 Hospice services are designed to support both the
patient and family members.
 The core of hospice care is focused on: comfort,
support, choice, enriching the quality of life and
bereavement care.
Support…
 Hospice becomes a multifaceted support system to patient
and family, arranging every aspect of care in regard to the
illness-- physical, emotional and spiritual. Services are
based on patient’s needs and include routine home care,
general inpatient care, continuous care and respite care.
Though family members provide a majority of patient care,
it is a cooperative effort between family, friends and hospice.
 The hospice team approach allows for a broad range of care.
Many physicians find that hospice services greatly enhance
and extend the care they provide. In all cases there are
ongoing assessments of the patient’s health and comfort
level. Care is provided by nurses, social workers, certified
nursing assistants, pastors, and volunteers.
Support…
 The depth of hospice services increases as
new needs arise and the patient’s health
begins to change. While hospice may be
needed less frequently in the beginning
the team continues to adjust the level of
care. Plans of care are developed with the
patient, their family and the physician who
is actively involved in the caregiving
process. Skilled nursing support is
available 24 hours, seven days a week.
Choice…
 Hospice services are about empowerment -
empowering patients to maintain their dignity,
empowering self-directed care, empowering their
freedom of choice.
 As much as possible, hospice helps patients’ face the
conclusion of life on their own terms. Patients and
family are involved in all caregiving choices and the
caregiving process. Individual plans of care are
developed through a team effort with the patient, their
physician, family and hospice. A patient may choose to
withdraw from the hospice plan of care at any time to
seek medical treatment that may become available or
for any other reason.
Enriching the Quality of Life…
 Hospice nurses’ expert training in pain relief and
symptom control enhances the patient’s ability to
live as actively and pain free as possible. Hospice
strives for days free from pain, days free of
symptoms, days to participate in life.
Enriching the Quality of Life…
 Since hospice services are about quality of life,
hospice helps patients remain home whenever
possible as well as provide care in higher skilled
facilities. Hospice encourages an environment
where patients have the opportunity to express
their feelings, and to share and relish the time
that remains. As much as possible hospice helps
patients face the conclusion of life on their own
terms.
Bereavement Support…
 Hospice programs bring comfort to those facing the passing of a loved
one. Comfort that comes in many forms from a shoulder to cry on, to
an understanding ear, but always through the strength of a supportive
team trained in bereavement care. Hospice guides the family from
understanding their emotions, into coping and forward onto healing.
By guiding them through the healing process, hospice help families in
time, gain acceptance and refocus their lives.
 Bereavement support begins at first contact. Becoming an extended
member of the patient’s family early on enables hospice to be a
stronger support system for the family as the illness progresses. Often,
hospice finds patients are comforted by knowing professionals will be
there to care for their families in those emotional days to come.
 Bereavement continues for a year following their loved one’s passing.
This depth of support is part of every hospice plan of care making
hospice services unique.
Medical Equipment and
Supplies
 Hospital Bed
 Oxygen
 Wheelchair
 Bedside Commode
 Nebulizer
 Suction Machine
 Diapers, Under pads
 Wound care items
 Other essentials to provide proper care
Medications
• All medications related to the
terminal diagnosis
•
Ordered by the patient’s physician and coordinated
through hospice and approved pharmacy.
Hospitalization / Ambulance Transportation
 Must be related to the hospice diagnosis
 Must be pre approved
 Must be a contracted facility (patients are
given a list upon admission)
Levels of Care
 Routine
 Continuous Care
 Respite Care
 Inpatient Care
Who Pays for Hospice Care?
 Medicare
 Medicaid (depending on each
State’s guidelines)
 Private Insurance
 Some patient’s elect a private pay
option.
False Statements About Hospice
Care:
 Patient and family have to be “ready” to die to receive







hospice.
Patient must give up all treatments related to the
terminal illness in order to receive hospice (tube
feeding, therapies, wound care, IV’s, chemo, radiation).
Patient must have a DNR to receive hospice.
Patients can’t go back to the hospital if on hospice.
Patients can’t have hospice and home health at the
same time.
Hospice care only provides medical services
Patients have to give up their attending physicians
The hospice benefit lasts only 6 months
Tips: Communicating About
Hospice Care
Points For Health Care Providers to Consider1. Don't assume patients and families don't want to talk about death and
terminal nature of their illness. Many times they do.
2. Be sensitive to their sensitivities.
3. Be honest, always.
4. Encourage patients and their family members to tell you what they're
afraid of, even if it's hard to talk about.
5. Don't dismiss your own fears. They matter, too.
6. Hospice is available to meet with you and your patients to discuss hospice
care at your office, the hospital or the patient’s home.
Nathan Hurst, Seattle Times staff reporter
Did you know….
 Most patients and families say their primary
complaint with hospice care is---
They wish they had received
services sooner.
Additional Benefits to Health Care
Providers and Patients
 Reduced phone calls from patients/ families.
 Decrease anxiety especially with out of town families.
 Better compliance with medication regime and
appointments.
 Hospice team members has a presence in the home
providing a better understanding of family dynamics
and can help coordinate care.
 Hospice can coordinate nursing home admission with
physician if patient is unable to be cared for at home.
 Reduced hospitalizations.
 More satisfied patients.
How Can You Help?
• Talk with your patients about end-of-life care
and hospice services
• Make a referral
• Request a speaker for your next staff meeting
or community event
• Help recruit hospice volunteers
• Tell others what you have heard about
hospice today
Questions & Answers:
Complete Program
Evaluations
&
Award Certificates