Transcript Slide 1

Hospice &
Long Term Care
Working Together to Improve
End-of-Life Care
Ann Hablitzel RN, BSN, MBA
Hospice Care of California
Long Term Healthcare Conference
May 13, 2010
Program Objectives
• Discuss services provided
• Questions to help address the
challenges of providing hospice
care in a long term care facility
• How to apply practical strategies
for building the relationship
Nursing Facility as Site of
Death
• By 2020, it has
been estimated
that 40% of
Americans will die
in a nursing facility
• Some states have
nearly met that
level
Home Facility
Philosophy and Guiding
Principles of Hospice
• Hospice recognizes dying as a natural
part of life and focuses on maintaining the
quality of remaining life.
• Hospice affirms life and neither hastens
nor prolongs the dying process.
• The nature of dying and of human
suffering is understood to be a
fundamentally personal experience based
on cultural and spiritual traditions.
The Role of Hospice
• To support the cultural and spiritual orientation
of the patient and family
• To demystify the dying process
• To assist with resolution of interpersonal and
internal conflicts before death
• To help attain a degree of peace in their search
for the meaning and purpose of their lives
• To help the patient and family achieve a positive
end-of-life experience that is defined by them
Eligibility
• Two physicians must
certify that the patient
is terminally ill with a
life expectancy of six
months or less if the
disease follows its
normal course.
• Patient and/or family
are aware of the
prognosis and elect
palliative care rather
than curative
measures.
Medical Conditions
Appropriate for Hospice Care
•
•
•
•
•
Cancer
Heart Disease
COPD
Dementia/ALZ
Stroke
•
•
•
•
MS
Renal Failure
Hepatitis
Debility
Unspecified
Hospice Care for Seniors
(Medicare Eligible)
An HMO senior plan member is still
eligible for the Medicare hospice.
For ALL senior health plans, Medicare
pays for Hospice - which eliminates
the authorization process - which
can take too much time when the
patient needs care.
Five Domains of Care
1. Relieving pain and symptoms
2. Avoiding a prolonged deathrelieving suffering
3. Maintaining control - their choices
honored
4. Relieving others of the burden of
care
5. Strengthening relationship
Singer and Colleagues
Services Provided by
Hospice Care of California
 Visits from
interdisciplinary
team
 Medications
related to the
patient’s hospice
diagnosis
 Durable medical
equipment
 Dietary counseling
 Spiritual counseling
 Volunteer support
 PT, OT, ST, as
necessary to improve
comfort/function
 Bereavement services
for up to one year
following the patient’s
death
Interdisciplinary Team
• Attending
Physician
• Hospice Physician
• RN Case Manager
• Social Worker
• Home Health Aide
• Chaplain
• Volunteer
Levels of Care
•
•
•
•
Routine Level
Respite Level
Inpatient Level
Continuous Care
New COPs – History of Discomfort
“The provision of, and questions
related to, hospice care for
residents of those facilities has
come under scrutiny as a result of
a variety of report findings…”
Preamble, Hospice Conditions of Participation
Federal Register – June 5, 2008
New COPs - §418.112
• Incorporated language and concepts
from previous sub-regulatory releases
• Did not clarify the areas that have
always been puzzling
• Created concern because hospices
now have regulations and SNFs/NFs
do not
In the Middle of Difficulty Lies Opportunity
Albert Einstein
§418.112(b)
Professional Management
Based on the hospice plan of care and
the Medicare regulations, hospice must
assume responsibility for professional
management of all hospice services
provided.
The Reality
Challenging Component
Both parties must continue to provide
services at the same level that they would
have if the other partner were not
involved.
Hospice must only use facility personnel
to carry out the Plan Of Care to the extent
that they would use family.
§418.112(d)
Hospice Plan of Care
• A written care plan must be
established and maintained in
consultation with facility
representatives
• All care must be provided following
this plan
Challenging Component
Where shall we start?
One or two care plans?
Care Plan coordination is a
common logistical problem.
The burden is really on the
Hospice.
Successful Communication
Define the Chain of Communication
Between Hospice and Facility
•
•
•
•
In the event a crisis or emergency develops
Change of condition occurs
Changes to the hospice portion of the plan of care
For complaints and other issues
Top Success Factors
• Relationships at all levels
• Communication
• Provide excellent care – deliver what’s
promised
• Responsive
• Adaptable
• Consistent
• Shared vision and values
• Respect
• Benefit to the patient
“You matter to the last
moment of your life,
and we will do all we
can, not only to help
you die peacefully, but
to live until you die.”
Dame Cicely Saunders
Thank You!!
Hospice Care of California