Transcript SOMC Hospice - Scioto County Medical Society

SOMC Hospice
& Palliative Care
a special kind of caring…
A Department of Southern Ohio Medical Center
Objectives:
Discuss the philosophy, admission
criteria, referral process and services
for Hospice and Palliative Care
programs
 Describe the functions and duties of
the Interdisciplinary Team approach
 Discuss limited pain and symptom
management strategies
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Hospice Philosophy
To recognize death as a universal
experience
 To recognize dying as a normal
process
 To affirm life and discount death
denial
 To acknowledge that a person is part
of a family unit
 To provide end of life palliative care –
comfort, care and support services

Hospice Philosophy (cont)
To provide comfort without prolonging
life or hastening death
 To focus on holistic care
 To encourage all persons to live fully,
even as death approaches
 To encircle the family unit with support
and caring through the use of the
Interdisciplinary Team

Hospice Admission Criteria
Be willing to accept the hospice
philosophy of care and make an
informed choice
 Have a life expectancy of six months
or less, (months instead of years), if
the disease runs its expected course
 Choose supportive care instead of
curative treatment
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Admission Criteria (cont)
Have a physician willing to be the
primary physician for hospice care
 Have a need for supportive care, even
if the patient is ambulatory and not
home bound
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Admission Criteria (cont)
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Diagnosis
categories
appropriate for
Hospice Care:
Cancer
 Alzheimer’s
 Stroke & Coma
 Cardiac
 Renal
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Hepatic
 Dementia
 ALS
 Failure to Thrive
 Debility
 HIV
 General
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Admission Criteria (cont)
For non-cancer diagnoses, Medicare
has agreed upon criteria for
determining prognosis – as depicted
by the disease categories listed
previously
 These criteria apply to all non-cancer
hospice patients regardless of
reimbursement
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Referral Process
Anyone can make a referral to
hospice
 When referral is received, a hospice
admissions nurse will follow-up within
24 hours
 Hospice nurse will phone the
physician for orders to evaluate the
patient for hospice appropriateness
 Imminent death referrals are followedup within one hour
The Hospice Team

Skilled Nursing –
Provided under the direction of the
physician
 Weekly visits and as needed
 Provide comprehensive assessment
with each visit
 Provide emotional support
 Focus on patient/caregiver education
 Nurses available 24 hours a day,
seven days a week
 Coordinate the patient’s individualized
Plan of Care with the IDT

The Hospice Team (cont)

Hospice Aides –
Provide care under the direction of the
Primary RN
 Assist the patient/family in a caregiver
role
 Provide personal hygiene
 Assist family members in learning
care-giving skills
 Visit 1 – 5 times per week based upon
need

The Hospice Team (cont)

Medical Social Work –
Provide special insight into problems
created within families as they
experience crisis and loss
 Provide assistance with legal and
financial needs
 Assist with community resources
 Provide social and psychosocial
counseling
 Assistance with advance directives
 Participate in the IDT Plan of Care

The Hospice Team (cont)

Spiritual Care –
Presence ministry
 Life review
 Sacramental needs
 Contacting patient’s church/personal
clergy
 End of life spirituality
 Special Services

The Hospice Team (cont)

Medical Director –
Certifies and re-certifies patient
appropriateness for hospice care,
including Face to Face visits as
needed
 Provides consultative service to the
IDT and to the patient’s attending
physician regarding patient plan of
care

The Hospice Team (cont)

Medical Director – (continued) –
Participates in IDT meetings
 Covers patient admissions to the
Hospice Center as needed
 Contributes to the patient’s IDT
Comprehensive Care Plan

The Hospice Team (cont)
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Volunteer Services –
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Provide patient visits in the home setting
Visit patients in hospital setting
Sit with patients
Provide respite services for caregivers
Light housekeeping
Running general errands
Delivering supplies, medications, etc
Telephone contacts and support
Office work, fund raising support
Eleventh Hour Team support
The Hospice Team (cont)
Pharmacy consultation
 Nutrition consultation
 Physical therapy
 Occupational therapy
 Speech therapy
 Attending Physician
 Patient and Family

Areas of Expertise
Pain Management
 Symptom Management

Nurses attend on-going lectures to
stay current with evidence based
practices
 IDT also attends lectures regarding
their roles in pain and symptom
management
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Care Settings
Home Care
 Acute Inpatient Care
 Respite Care
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Palliative Sedation:
Voluntary election to use medications
for the express purpose of relieving
refractory pain and/or symptoms in the
form of drug induced sleep state.
*Not comparable with euthanasia or
physician assisted suicide
Palliative Sedation:
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Ethical Justification
Intent: Relief of suffering, as a last
resort
 Outcome: Patient is made unaware of
suffering through sedation/sleep
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Studies show that death is not
hastened during this process
Palliative Sedation:
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Facts Sedation may be partial, intermittent
or complete based upon patient/family
preference
 Not irreversible
 Indicated only for refractory symptoms
– when nothing else is working
 Appropriate when patient is imminent
or getting close to death

Palliative Sedation:
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Reasons for sedation –
Pain
 Terminal restlessness/delirium
 Dyspnea
 Bleeding
 Nausea/vomiting
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**Symptoms must be truly refractory
Palliative Sedation:
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Drug Classifications –
Opioids
 Benzodiazepines
 Antipsychotics
 Barbiturates
 General anesthetics
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• IV route is optimal
• Specific doses are less important than the
goal of symptom relief
Palliative Sedation:
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Suggested Guidelines –
Terminal illness with refractory
symptom(s)
 DNRCC
 All other treatments must have been
exhausted
 Psychosocial assessment
 Spiritual assessment
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Palliative Sedation:
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Suggested Guidelines Second physician opinion
 Nutrition/hydration futility addressed
 Reason(s) well documented
 Consideration of a trial of respite
sedation first
 Use of a proper sedation scale
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Hospice Service Areas
Scioto County
 Pike County
 Jackson County
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Counties partly covered:
Lawrence
 Adams
 Ross
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SOMC Hospice Center
Home-like atmosphere designed to
provide quality care for hospice
patients and families
 Not a residential facility – goal of care
is short term stay
 Visitors welcome 24/7
 Patient rooms designed for families to
stay with patients
 Laundry and kitchen facilities
available
 Menu and room service available
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SOMC Hospice Center (cont)
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Reasons for admission to the center:
Must be an SOMC Hospice Patient
 Acute stay – pain and/or symptoms
unable to ideally be treated in home
setting
 Imminent death – when not optimal for
the patient’s death to occur in the
home setting
 Respite stay – five day stay, monthly
as needed to give caregiver(s) a rest
from 24/7 care
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Pet Therapy – “Marley”
Staff member who walks on four legs
 A “People Person”
 Offers comfort to patients and families
 Intuitive caring
 Loves attention
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Honorable mention – “Swann”, our first
Hospice dog has retired after years of
great service
Bereavement Services
Designed to help families and loved
ones cope with terminal illness and
loss
 Emotional support provided free of
charge from the time of the patient’s
admission to hospice services and up
to 13 months after the patient’s death
 Individual, adult, child and family
counseling upon request
 Not limited only to hospice families
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Bereavement Services (cont)
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Phone calls; Visits; Cards and letters
commemorating special dates; Bi-monthly
newsletter – “Resolutions”; Educational
materials
Memorial Quilt Project
Memorial Life Celebration
Support groups – different themes
All bereavement services are free of charge
Reimbursements
Medicare
 Medicaid
 Insurance payors
 VA
 Self-pay
 Indigent
 Donations/fund raisers
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Living With Hope
Talk openly and honestly with one
another
 Recognize that death is a part of life
 Consider each day as full of potential
to be enjoyed as much as possible
 Realize that life is never perfect – it
was not perfect before illness and will
not be perfect after
 Use faith and spiritual strengths for
support
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Living With Hope (cont)
See oneself as living with illness
instead of dying from it
 Enjoy the simple things in life – it is
often these that give life meaning and
enjoyment
 Include loved ones in the experience
by talking about fears, concerns and
feelings
 Daily private time is a healthy practice
 Physical pain can be increased with
social, emotional or spiritual pain
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Palliative Care Services
Nurses specializing in palliative care
provide weekly home visits and more
if need is indicated
 Hospice Department assists as
needed and covers after hours calls
and visits
 Indicated for patients with a lifelimiting illness
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Palliative Care Services
Patient must be homebound and have
a skilled need
 Hospice has partnered with SOMC
Home Care for billing purposes
 Goal to keep patient out of the
hospital
 Very similar to hospice services in
providing pain and symptom
management
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Palliative Care Services
Prognosis is not limited to 6 months
 Can provide curative, life sustaining
care
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Palliative Care – Nurse
Practitioner Program
Services provided in the patient’s
home or homelike setting (SNF;
Assisted Living) by a Nurse
Practitioner
 Patients do not require a skilled need
or homebound status
 Visits are based on medical necessity
– per week, per month, etc.
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Palliative Care – Practitioner
Program
Can be in addition for the Home Care
program or can be independent,
based upon patient need
 24/7 access to on-call nursing
services
 Does not replace physician – NP will
collaborate with the patient’s
physician on-going to determine
appropriate interventions
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Referrals:
Hospice and Palliative Care
(740) 353-2567 (24/7)
Ext. 2651 (During business
hours only)
Questions???