A Program of Morningside Ministries. Webcast. This webcast is possible through the generous support of donors

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1 A Program of Morningside Ministries Webcast This webcast is possible through the generous support of donors

2 Appreciation is extended to Baptist Health Foundation Methodist Healthcare Ministries Foundation The South West Texas Geriatric Education Center Pryor Trust Many other individuals and organizations who support the mission of mmlearn.org

3 Want to Ask a Question or Make a Comment? Click on the Ask bubble above the video player to ask a question or make a comment. OR You may also phone or text your questions to (210)

4 What do you think? Your feedback is important to us. Click on SURVEY in the upper right of the presentation screen. It will take less than 5 minutes.

5 Hospice: What You May Not Know Presented by Lucy Haag, LMSW Enomie Rosenthal, RN VITAS Innovative Hospice Care

6 Goal To educate health care professionals, caregivers, and community members about hospice: the basics, the benefits, and what it means to be a member of the hospice interdisciplinary team. 6

7 Care at the End-of-Life When people are asked where they would prefer to receive medical care if they were terminally ill with a prognosis of 6 months or less Institute of Medicine, Committee on Care at the End of Life. 7

8 Care at the End-of-Life 9 out of 10 respondents cite their home as the preferred site of care. Institute of Medicine, Committee on Care at the End of Life. 8

9 What is Palliative Care? The study and management of patients with active, progressive, far-advanced disease for whom the prognosis is limited and the focus of care is quality of life. Oxford s Textbook of Palliative Medicine 9

10 Palliative Care... Affirms life. Regards dying as a normal process. Neither hastens nor postpones death. Provides relief from pain and other symptoms. Integrates the psychological and spiritual aspects of care. Provides support for patient and family. World Health Organization 10

11 Curative vs. Palliative Care Curative Disease driven Doctor in charge Disease process is primary Few choices Palliative Symptom driven Patient is in charge Disease process is secondary to person Many choices Comfort and quality of life 11

12 Myths and Misconceptions about Hospice 1. Hospice is a place 2. Hospice means giving up, losing hope, and dying 3. Hospice isn t much more than hand-holding at the bedside 4. Hospice means doing nothing and all treatments are discontinued 5. Hospice care is expensive 12

13 Myths and Misconceptions about Hospice 6. Hospice is just for cancer patients 7. Hospice care is for the very old 8. Patients must have a DNR in place to receive hospice care 9. There is a limit to how long a patient can have hospice 10. Hospice care ends with the patient s death 11. Hospice is not needed in long-term care facilities ( they have nurses ) 13

14 Hospice Interdisciplinary Team Hospice Physician Registered Nurse Home Health Aide Attending Physician Patient & Family Social Worker Bereavement Specialists Chaplain Volunteer 14

15 Patients and Families Are the core of the hospice team Are the center of all decision making Have autonomy and can make choices on how final days will be Teach us about the meaning of life and what s really important 15

16 Hospice Registered Nurse Provides hands-on care Is skilled in observing, assessing and documenting Is skilled in management of the patient s physical symptoms, including pain, respiratory distress, agitation, anxiety, etc. Provides education and support about the patient s illness, symptoms, and what to expect 16

17 Hospice Registered Nurse Is a liaison between the patient, family, other caregivers and the patient s physician and/or hospice physician Communicates with the physician(s), the hospice IDT, and facility staff regarding the patient s condition and needs Serves as the Case Manager for the patient and coordinates and manages his or her plan of care Supervises hospice home health aides 17

18 End of Life Physical Symptoms Unrelieved pain Confusion Restlessness Weight loss Shortness of breath Disturbed bladder and bowel function Disrupted sleep Nausea or Vomiting 18

19 Hospice Social Worker Social workers provide emotional support and help with problem solving, concrete services, and EOL planning. Advocate - empowers patients and families voices to be heard Facilitator - assesses needs of patients and families, helps with referral to concrete services, transfers to different settings, and coordination of care Communicator - with patients and families, facility staff, and the hospice IDT 19

20 Hospice Social Worker Educator - on grief and loss with patients, families, facility staff; signs and symptoms of approaching death Companion - provides emotional support to all persons associated with the dying process; normalizes and validates appropriate emotions and reactions to grief Mediator - helps bring more challenging families together 20

21 End of Life Emotional Symptoms Depression Anxiety Ineffective coping Ineffective communication Life role transition Caregiver distress Financial stress 21

22 Spiritual Symptoms Despair/hopelessness Powerlessness Loneliness Need for reconciliation 22

23 Four Levels of Hospice Care Recognized by the Medicare Hospice Benefit Routine Home Care Continuous Care Inpatient Care Respite Care 23

24 Routine Home Care The basic and most frequently delivered level of hospice care. Is provided in the comfort of the patient s own home, family member s home, nursing home, assisted living facility, boarding home, or wherever the patient resides. 24

25 Routine Home Care May be delivered by dedicated, specialized teams such as: Nursing Home Team Assisted Living Team Cultural Diversity Team (ex: Spanish-speaking Team) Diagnosis Specialty Team (ex: ALS Team) Veterans Team 25

26 Continuous Care Short-term Acute symptom management Remains in their home setting 26

27 Continuous Care Criteria same as that for inpatient care Uncontrolled pain, respiratory distress, intractable nausea and vomiting, restlessness or agitation, Changes in level of consciousness, Or any other symptom resulting in distress to either the patient or family 27

28 Continuous Care Shifts of care For a minimum of 8 hours/day Up to 24 hours/day More than 50% of the hours must be provided by a licensed nurse The remaining hours may be staffed by a certified home health aide 28

29 Inpatient Care Short stays Management of acute symptoms that cannot be managed at home 29

30 Inpatient Care Criteria may include Uncontrolled pain, respiratory distress, intractable nausea and vomiting, restlessness or agitation Changes in level of consciousness Or any other symptom resulting in distress to either the patient or family 30

31 Inpatient Care May take place in a Stand-alone hospice facility Dedicated hospice wing/unit in a hospital or long-term care facility Or in contract beds within a hospital or LTC facility 31

32 Respite Care Short-term respite stay only when necessary to relieve the family members or other persons caring for the patient at home Provided on an occasional basis Limited to five consecutive days at a time May be provided in a Medicare-approved, contracted long-term care facility or a hospice inpatient facility 32

33 Coordination of Care in Facility Settings Hospice coordinates the patient s care with the staff in facility settings such as Nursing Homes, Assisted Living, Boarding Homes, and Personal Care Homes. 33

34 When is it Time? Patient Appropriateness Life-limiting illness Medicare regulations Six months or less prognosis Certification by two physicians Patient and/or family request When aggressive, curative treatment is determined to be futile When the burden of current therapies outweigh the benefits When it s time to focus on the patient, not on their disease 34

35 What brought me to hospice and why I love the work I do You are angels on earth. Thank you for telling me what to expect. Thank you for not making me feel like I was going crazy. You helped my Mom enjoy what time she had left. We couldn t have done this without you.

36 Early Access to Hospice Improves the quality of life for both patients and their loved ones. Is most beneficial when it is provided for months, rather than weeks or days. 36

37 Food for Thought The Journal of Pain and Symptom Management published research finding that Medicare beneficiaries who opted for end-of-life hospice care lived, on average, 29 days longer than similar patients who did not take advantage of hospice. 1 1 Connor SR, Pyenson B, Fitch K, Spence C, Iwasaki K. Comparing hospice and nonhospice patient survival among patients who die within a three-year window. J Pain Symptom Manage Mar;33(3):

38 Food for Thought VITAS Innovative Hospice Care patient surveys indicate that 99 percent of families wish they had known about hospice sooner. 2 2 Data on file at VITAS. 38

39 Q&A

40 Again, we want to thank our donors and partners: Baptist Health Foundation Methodist Healthcare Ministries Foundation The South West Texas Geriatric Education Center Pryor Trust Many other individuals and organizations who support the mission of mmlearn.org

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