BACKGROUND Hospice Care 101: When to refer to Hospice?

BACKGROUND

Seventy percent of people want to die at home, yet only 25% actually do Hospice services became an approved covered benefit for Medicare eligible in 1983. Yet, many people, including providers lack knowledge about what hospice services include. There exists a pervasive belief by patients, families and providers that use of hospice services signifies "giving up"

Less than 50% of all people who die are receiving hospice services at death (NHPCO, 2013). Most end-of life conversations come within the last 30 days of death under acute stress 40% of Medicare beneficiary costs occur during the last month of life (Giovanni, 2012). The number one reason for bankruptcy filing is due to medical costs. Up to ninety percent of patients have not completed an advance directive when they were admitted to the ICU (Clabots, 2012)

Families experience symptoms similar to PTSD when faced with making decisions for loved ones who have never discussed their wishes (Endacott, 2012). Medical providers and nurse practitioners do not have specialized content on palliative and hospice care in their curriculum leading to a lack of provider knowledge. Lack of provider knowledge leads to underutilization of hospice services. Providers report they do not know: a) how to discuss hospice services with patients and families and b) when to refer a patient with a terminal or late-stage chronic disease to hospice

PURPOSE

To educate nurse practitioners on what hospice services are and when to refer patients and their families to hospice

Hospice Care 101: When to refer to Hospice?

BENEFITS OF HOSPICE SERVICES:

Patients can live longer with a higher quality of life with hospice services (Finlay & Casarett, 2009)

Increasing timely referrals to hospice has the ability to improve quality of life and symptom management and decrease the financial burden for patients and their families

KATHRYN (KATHI) LINDSTROM, PHD, FNP-BC, ACHPN, HSMI|VANDERBILT UNIVERSITY SCHOOL OF NURSING

CORE ASSUMPTIONS OF HOSPICE CARE:

Individuals live until the moment of death

Care until death may be offered by a variety of professionals

End of life care is coordinated, sensitive to diversity, offered around the clock, and focuses on physical, psychological, social, and spiritual concerns of the patient and family

DEFINITION OF HOSPICE SERVICES:

Focus on caring and comfort for patients in the last 6 months of life although prognosis can be difficult to predict. Continued documented decline will allow a person to remain on hospice services.

AVAILABLE TO ALL PEOPLE WITH A TERMINAL DISEASE DIAGNOSIS, REGARDLESS OF AGE, RACE, OR RELIGION. SUPPORT AND CARE PROVIDED TO BOTH PATIENT AND FAMILY MEMBERS.

Hospice team includes: Nurses, Physicians, Spiritual Counselors, Social Workers, Bereavement Counselors, Home Health Aides, Therapists, and Volunteers.

SERVICES PROVIDED TO PATIENTS AND FAMILIES:

Management of physical, emotional, psychosocial and spiritual aspects of dying

Provides needed drugs, medical supplies, and equipment

Supports the family on how to care for the patient

Delivers special services like speech and physical therapy when needed

Makes short-term inpatient care available when pain or symptoms become too difficult to treat at home, or the caregiver needs respite

Provides bereavement care and counseling to surviving family and friend

ASSESSING FOR HOSPICE READINESS USING THE SURPRISE QUESTION

Would you be surprised if this patient died in the next 12 months? (Gishen, F., Eades, J, & Tookman, A. 2014)

GENERAL GUIDELINES FOR HOSPICE ADMISSION

Progression of a primary disease process (documented by assessment, labs, xrays, tests, etc.)

Multiple ER or Inpatient visits over previous 6 months

Recent decline in functional and/or nutritional status

Dependence in at least 3 of 6 ADLs

HOW TO TALK TO PATIENTS AND FAMILIES:

Family Meeting Discuss "Goals of Care" Be present and attentive Listen, Listen, Listen Ask, Tell, Ask method

MOST COMMON HOSPICE DIAGNOSES

Heart Disease Renal Disease Alzheimer's or other

neurological diseases Liver Disease ALS HIV Disease COPD Cancer

HOSPICE REFERRAL PROCESS

Identify a person that fits the general criteria for admission

Conduct a family meeting to discuss hospice

Discuss with physician in practice or in hospice

Refer to a local hospice; they will take it from here

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