Part Three- Palliative Care and Hospice

1. Part Three- Palliative Care and Hospice • Improving care at the end-of-life: • Hospice • Palliative Care • Interdisciplinary teamwork • Types of palliative care programs

2. HOSPICE • Various meanings: • A place • An organization or program • An approach to or philosophy of care • A system of reimbursement

3. Medicare Hospice Benefit • Certified organization (non-profit or for-profit) • Receives a capitated fee (approx. $100 daily per patient) to provide care to qualified patients,usually at home • Pays staff salaries, overhead , durable medical supplies, medications for admitting condition

4. Hospice Medicare Benefit • Patient must have 6 mo. prognosis if disease follows expected course; some live longer- can recertify if still qualifies • Request to enter usually by MD; patient or family can request admission • Hospice is a choice- can revoke anytime • Provide bereavement services for 13 mo. for family

5. Hospice • Referral visit- to explain program • Admit by RN- assessment , sign papers • Establish plan of care, scheduled visits • Visits by team members (within 72 hrs) • Re-assess q 2 wks at full team meeting • Re-certify in 90 days, then q 60 days if still qualifies

6. Hospice Medical Director • Administrative role: certifies,re-certifies,attends weekly team meetings, has little contact with patients( part-time) • Active in patient care, makes some home visits, manages pain and other symptoms • Teaches end-of-life care to healthcare professionals, students, and community

7. Palliative Care • What is it? Short answer : care that aims to relieve suffering and improve quality of life. • WHO and Institute of Medicine definition: It seeks to provide the total active care of patients whose disease is not responsive to curative treatment. • Control of pain, of other symptoms, and of psychological, social, and spiritual problems is paramount.

8. Palliative Care (cont’d) • It’s goal is to achieve the best quality of life for patients and families. • It affirms life and regards dying as a normal process. It neither hastens nor prolongs death • Palliative Care can be applied to anyone undergoing active or aggressive Rx for cancer or other disease

9. Curative / remissive therapy Presentation Death Hospice Palliative care

11. The Team • The Nurses: Director, Patient Care Coordinator, and Nurse Specialists • Social Workers • Chaplain and Bereavement Coordinator • Compounding Pharmacist • Volunteer Coordinator and Volunteers • Certified Nursing Aides • Medical Director

12. Levels of Palliative Care • Level 1 Personal Physician • Level 2a. Palliative Medicine Consultant ; office or hospital based, for pain and other symptom management • Level 2b. Hospice- Hospital partnership, with inpatient and outpatient components and with elements of the interdisciplinary team • Level 3 Tertiary academic and treatment centers

13. Cost-effectiveness of Hospital-based Palliative Care • Recent evidence presented by the Center to Advance Palliative Care indicates: • Reduction in symptom burden- less pain, dyspnea, etc. • Improved patient and family satisfaction • Reduction in ICU and hospital length of stay • More appropriate use of high-tech. therapy

14. Teaching Palliative Care • Survey: 806 of 4000 hospitals have palliative care programs, including 26% of teaching hospitals. (CAPC,2003). Rapid growth in past year. • Approx. 1000 certified EPEC trainers • 1200 board-certified in Palliative Medicine & Hospice

15. Summary- Part Three • Improving the quality of life for the dying is our responsibility • Suffering is treatable! • We CAN change the ways we care for those at the end-of-life