Section 1:

1. Section 1: The Patient/Family Value-Directed Model of Care The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

2. Changing Our Approach to CareFrom A Disease Focus to A Patient/Family Experience Focus The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

3. Diagnosis of disease & related symptoms Curing of disease focused goals Treatment of disease & alleviation of symptoms Patient/family identify their end-of-life goals Assess how symptoms, issues are helping or hindering them from reaching goals Interventions to reach end-of-life goals Quality of Life Closure ExperienceFocus DiseaseFocus The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

4. Focus on the Experience ! • Alleviation of suffering • Life Completion and Self-determined Life Closure • Bereavement Support for Survivors The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

5. This model is built around three concepts or beliefs learned from caring for dying patients and their families: •  We live and die as multidimensional beings...having physical dimensions, spiritual dimensions, social/emotional dimensions. •  No dimension exists or functions alone....when one dimension changes, it affects other dimensions. •  When we pay attention to all dimensions and this dynamic relationship between them, we can then best affect quality of life closure for dying patients and their families. The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

6. Patient-Family Value Directed Model of Care • Dying is a personal experience • People experience the last phase of life through many related dimensions • The last phase of life provides continued opportunity for positive growth & development in the face of suffering The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

7. 1. Dying is a Personal Experience: Creating Quality EOL Experiences • Choice • Advocacy • Compassion • Dignity The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

8. 2. People experience the last phase of life through many related dimensions • Five Dimensions • Symptom/Physical • Function • Interpersonal • Well-being (intrapersonal) • Transcendent/Spiritual The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

9. No dimension exists or functions alone.... when one dimension changes, it effects other dimensions…… And quality of life closure The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

10. What Affects Quality of Life Closure? Interpersonal Well-being Transcendent Dimensions Increase In Importance As Symptom & Function Dimensions Decline The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

11. How does an issue/problem/opportunity in one dimension affect others? • Anxiety affect physical state • Physical pain affect one’s ability to focus on communicating life closure • Spiritual fears affect readiness to die • Immobility affect ability to attend to spiritual needs The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

12. Mr. Carey, a patient with cancer of the bone has suffered a pathological fracture of his right arm....Physical dimension • Due to this pain, he is confined to his bed unable to fully bathe and toilet independently....Function dimension • Because any movement is difficult - he is no longer able to leave his room and is isolated from family and friends.....Interpersonal dimension • As a result he begins questioning “Why is this happening to me?”, “What did I do to deserve this?”….Spiritual dimension • He is feeling depressed and guilty because he can’t be self sufficient....Well-beingdimension The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

13. How is this affecting his family - wife? • His wife can’t stand watching his suffering.....feeling helpless to change it.....asking God, “Why are you allowing him to suffer?”....Spiritual dimension • Since he can no longer care for himself independently she is doing all his personal care and is becoming exhausted....Physical dimension • She is no longer able to rationalize his angry outbursts and lashes back at him....Interpersonal dimension • When she does stop to think about his suffering, she feels guilty for lashing out and feels like she is so inadequate. How could she blame him?....Well-being dimension The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

14. How does an issue/problem/opportunity for growth affect the patient/family quality of life closure? • Physical pain (physical). • This not allowing the patient to get out of bed (functional). • This is preventing him from joining family members in the other rooms for meals, TV viewing, visits (interpersonal). • He is becoming isolated and lonely (well-being). The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

15. How does an issue/problem/opportunity for growth affect the patient/family quality of life closure? • Patient has guilt over past “sins” (spiritual). • He is refusing any pain medications because he feels he needs to suffer to have a place in heaven (physical). • His pain is so severe that he is angry at anyone trying to help him (interpersonal). The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

16. The Last Phase of Life Provides Continued Opportunity for Positive Growth in the Face of Suffering The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

17. Life Closure: A Personal Experience The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

18. Completion with Worldly Affairs The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

19. Completion with Worldly Affairs Completion of Community Relationships The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

20. Completion with Worldly Affairs Completion of Community Relationships Meaning About One's Individual Life The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

21. Completion with Worldly Affairs Completion of Community Relationships Meaning About One's Individual Life Love of Self The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

22. Completion with Worldly Affairs Completion of Community Relationships Meaning About One's Individual Life Love of Others Love of Self The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

23. Completion in Family/Friends Relationships The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

24. Completion in Family/Friends Relationships Acceptance of the Finality of Life The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

25. Completion in Family/Friends Relationships New Self Beyond Personal Loss Acceptance of the Finality of Life The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

26. Completion in Family/Friends Relationships Meaning About Life in General New Self Beyond Personal Loss Acceptance of the Finality of Life The Hospice of the Florida Suncoast and VITAS Healthcare Corporation

27. Completion in Family/Friends Relationships Meaning About Life in General New Self Beyond Personal Loss Acceptance of the Finality of Life Surrender to Unknown “Letting Go” The Hospice of the Florida Suncoast and VITAS Healthcare Corporation