Hospice 101. Janet Montgomery, BSN, MBA Chief Marketing Officer, Hospice of Cincinnati

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1 Hospice 101 Janet Montgomery, BSN, MBA Chief Marketing Officer, Hospice of Cincinnati

2 Hospice of Cincinnati Hospice of Cincinnati creates the best possible and most meaningful EOL experience for all who need care and support in our community

3 A system of care for the patient and family

4 Hospice Extends Life Early engagement of hospice services lead to longer and better quality of life 1 Patients who chose hospice care lived, on average, 29 days longer than similar patients who did not choose hospice care Days Lived Longer CHF LUNG CA COLON CA PANCREATIC CA 12 BREAST CA 1 Paradigm Shift in Advance Cancer Patients, Smith, Comparing Hospice and Non-hospice Patient Survival, Journal of Pain and Symptom Mgmt 2007

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6 What is Most Important to Us at EOL? Relieve me of pain and suffering I want a sense of control over my care and death I do not want to be a burden to my family I want to know I mattered I want to die at home surrounded by people and things I love

7 What is Most Important to Caregivers? My loved one s wishes are honored Include me in the decision process, listen to me Give me support & assistance at home Help me in a crisis Give me honest information Provide me with transportation, medication and medical equipment Remember me and follow me after my loved one's death

8 Dr. Atul Gawande What do you understand about your illness? What is most important to you if your time is short? What are your fears? What are you willing to give up? What are you not willing to sacrifice?

9 Dr. Ira Byock The sobering fact is that there are worse things than having someone you love die. Most basic, is having the person you love die badly, suffering as he or she dies. Worse still is realizing that much of his or her suffering was unnecessary and could be avoided...

10 Where you die is as important as how you die 1:5 of us will die in Intensive Care 90% of us want to die at home It matters how we die The experience lives on in the minds of everyone who survives us

11 How we die

12 B. J. Miller Zen Hospice, San Francisco Click on image to play video

13 In the event you become too sick to recover, what is it that you want? Take charge reclaim a natural death by having some control over how your dying process proceeds At end of life everything is distilled and concentrated there are no do-overs

14 Redesign how we die Scariest think about death isn t being dead, it s suffering Suffering which is necessary Part of life, we make space for this suffering and we grow from it. It unites caregivers and care receivers Healing happens through suffering together Suffering that we can change Palliative Care, focusing on comfort and living well until we die

15 Redesign how we die Dr. B.J. Miller Set our sights on wellbeing Making life more wonderful vs. less horrible Human centered care creatively exploring a way to aging and dying in a way that celebrates life You can always find a shock of beauty or meaning in what life you have left Love such moments ferociously Let death be what takes us, not lack of imagination

16 You matter because you are, and you matter to the last moment of your life. Dame Cicely Saunders

17 The hospice model of care Volunteers RN s and Nurse Practitioners Physicians Pharmacist Patient and Family Spiritual Care Personal Care Specialists Grief Counselors Social Workers

18 Hospice of Cincinnati Who Qualifies Terminal illness with a life expectancy of 6 months or less Qualified by 2 physicians Cancer, lung and heart disease, sepsis, stroke, dementia, any terminal illness Medicare, Medicaid and most private insurances cover this benefit What Hospice Offers Specialists in pain and symptom management Specific disease pathways to improve quality and comfort All meds related to the illness delivered to the patients home All equipment related to illness delivered to the home 24/7 phone or in home nursing care for crisis

19 4 Levels of Care Routine Home Care Continuous Care Respite Care General Inpatient Care provided wherever the patient calls home: a private residence, independent living, assisted living, or residential setting 90% of HOC patients are in their home or the place they call home. One on One Care is provided in the home or in a long term care setting, for crisis management of acute medical symptoms Continuous Care is continued until the crisis has been resolved When stabilized, the patient will likely resume Routine Care Care is provided in one of 4 Inpatient Care Centers. For caregiver support when the family member or direct care providers need rest and respite for up to five days per episode. Admission in our inpatient care center is based on availability Care in one of our 4 Inpatient Care Centers or in a hospital Short-term management of acute symptoms. Once symptoms are under control, the patient is transferred to their home or nursing home with hospice care.

20 2-3 wks. later Hospice Admission RN meets with Mr. Smith, family and hospital SW to plan discharge home with hospice care Saturday 5 am Support Team senses anxiety and deploys an RN to make a crisis visit in the home Saturday 7 am Mr. Smith is actively dying but appears comfortable. Support Team asks on-call chaplain to visit the family. Saturday 10 am Mr. Smith passes away surrounded by people and things he loves. Chaplain provides comfort to the family. RN helps family make arrangements and dispose of meds. TS I Mr. Smith enrolls into Hospice of Cincinnati when Mrs. Smith signs the Election of Hospice Benefits Medications Med Equip 2 weeks later Mr. Smith is rapidly declining, and the family calls Support Team Respite Care x 5 Days Mrs. Smith is experiencing caregiver fatigue with no relief With symptoms controlled, Mr. Smith changes back to Routine Homecare Continuous Care scheduled RTC CC team arrives, to manage care and control symptoms A week later Mr. Smith is experiencing ACUTE SYMPTOMS Level of Care assessed at Routine Home Care hrs / 7 days

21 Free Grief Counseling Resources Conversation Resources HospiceOfCincinnati.org Grief/Counseling Resources Fernside A Center for Grieving Children Fernside.org ConversationsofaLifetime.org The Goldstein Family Grief Center Promoting healing for life after loss

22 Fernside A Center for Grieving Children Click on the image to play video.

23 The 4 Things that Matter Most WORDS TO USE WHEN PARTING FROM SOMEONE FOR AN HOUR, A DAY, OR AT THE END OF A LIFETIME Please forgive me. I forgive you. Thank you. I love you. TAKEN FROM The Four Things That Matter Most A book about living By Dr. Ira Byock