Part three palliative care and hospice
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Part Three- Palliative Care and Hospice. Improving care at the end-of-life: Hospice Palliative Care Interdisciplinary teamwork Types of palliative care programs. HOSPICE. Various meanings: A place An organization or program An approach to or philosophy of care A system of reimbursement.

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Part Three- Palliative Care and Hospice

  • Improving care at the end-of-life:

  • Hospice

  • Palliative Care

  • Interdisciplinary teamwork

  • Types of palliative care programs

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  • Various meanings:

  • A place

  • An organization or program

  • An approach to or philosophy of care

  • A system of reimbursement

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Medicare Hospice Benefit

  • Certified organization (non-profit or for-profit)

  • Receives a capitated fee (approx. $100 daily per patient) to provide care to qualified patients,usually at home

  • Pays staff salaries, overhead , durable medical supplies, medications for admitting condition

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Hospice Medicare Benefit

  • Patient must have 6 mo. prognosis if disease follows expected course; some live longer- can recertify if still qualifies

  • Request to enter usually by MD; patient or family can request admission

  • Hospice is a choice- can revoke anytime

  • Provide bereavement services for 13 mo. for family

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  • Referral visit- to explain program

  • Admit by RN- assessment , sign papers

  • Establish plan of care, scheduled visits

  • Visits by team members (within 72 hrs)

  • Re-assess q 2 wks at full team meeting

  • Re-certify in 90 days, then q 60 days if still qualifies

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Hospice Medical Director

  • Administrative role: certifies,re-certifies,attends weekly team meetings, has little contact with patients( part-time)

  • Active in patient care, makes some home visits, manages pain and other symptoms

  • Teaches end-of-life care to healthcare professionals, students, and community

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Palliative Care

  • What is it? Short answer : care that aims to relieve suffering and improve quality of life.

  • WHO and Institute of Medicine definition: It seeks to provide the total active care of patients whose disease is not responsive to curative treatment.

  • Control of pain, of other symptoms, and of psychological, social, and spiritual problems is paramount.

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Palliative Care (cont’d)

  • It’s goal is to achieve the best quality of life for patients and families.

  • It affirms life and regards dying as a normal process. It neither hastens nor prolongs death

  • Palliative Care can be applied to anyone undergoing active or aggressive Rx for cancer or other disease

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Curative / remissive therapy




Palliative care

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The Team

  • The Nurses: Director, Patient Care Coordinator, and Nurse Specialists

  • Social Workers

  • Chaplain and Bereavement Coordinator

  • Compounding Pharmacist

  • Volunteer Coordinator and Volunteers

  • Certified Nursing Aides

  • Medical Director

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Levels of Palliative Care

  • Level 1 Personal Physician

  • Level 2a. Palliative Medicine Consultant ; office or hospital based, for pain and other symptom management

  • Level 2b. Hospice- Hospital partnership, with inpatient and outpatient components and with elements of the interdisciplinary team

  • Level 3 Tertiary academic and treatment centers

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Cost-effectiveness of Hospital-based Palliative Care

  • Recent evidence presented by the Center to Advance Palliative Care indicates:

  • Reduction in symptom burden- less pain, dyspnea, etc.

  • Improved patient and family satisfaction

  • Reduction in ICU and hospital length of stay

  • More appropriate use of high-tech. therapy

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Teaching Palliative Care

  • Survey: 806 of 4000 hospitals have palliative care programs, including 26% of teaching hospitals. (CAPC,2003). Rapid growth in past year.

  • Approx. 1000 certified EPEC trainers

  • 1200 board-certified in Palliative Medicine & Hospice

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Summary- Part Three

  • Improving the quality of life for the dying is our responsibility

  • Suffering is treatable!

  • We CAN change the ways we care for those at the end-of-life