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End of Life Care Trends . LaToya Thomas, RN, BSN Nova Southeastern University. What is End of Life Care?. Definition Goals

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    1. End of Life Care Trends LaToya Thomas, RN, BSN Nova Southeastern University

    2. What is End of Life Care? • Definition • Goals • “An approach that improves the quality of life of patients and their families facing the problems associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual” ( WHO,2012)

    3. Historical Overview • A volunteer-led movement • In the past, death occurred at home after a short illness with help provided to the dying person through the care of family members. • In the 1960s, hospices provided palliative care for people who were dying of cancer • End of life care lacked research and poorly understood

    4. Concerns • Lack of advance planning by patients • Poor communication between patients, families and providers across the span of end-of-life care • Referral inconstancy and hesitancy by physicians • Lack of understanding of end of life treatment modalities by both staff and patients

    5. Literature Review • 20-25% of all health care costs are spent in the last year of life • Costs for patients who died in an acute setting were two times greater than patients that died in a hospice setting • Hospice reduced Medicare costs by an average of $2,309 per patient • Fewer than 1/3 of Americans have advance directives. • Medicare expenditures for those with advance directives were significantly lower than for those without.

    6. Hospice versus Palliative Care Hospice is a type of palliative care for those who are at the end of their lives

    7. NHPCO Trends Analysis According to the National Hospice and Palliative Care Organization (2011), the hospice industry has been marked by substantial growth in the number of hospice programs and patients served over the past decade. Total hospice patients served by year (NHPCO,2011)

    8. NHPCO Trends Analysis When hospice care in the US was established in the 1970s, cancer patients made up the largest percentage of hospice admissions. Today, cancer diagnoses account for less than half of all hospice admissions (35.6%)

    9. Top Trends in Hospice Health Care Reform Regulatory and Reimbursement Challenges Hospital-Based Palliative Care Electronic Records Nursing Home Transitions

    10. The Respectful Death Model (RDM) • Holistic, evidence-based • Identifies needs • Problem solves • Assist both patient, family and provider in joint decision making • Evaluates outcomes collectively.

    11. Action Plan • Implementation • A palliative care screening tool will be used to identify all acute care patients for palliative needs • Development of RDM educational programs for a variety of health care providers addressing various aspects of palliative care • Gathering data to quantify medical cost reduction and cost avoidance attributed to palliative care • Provision of tools to monitor culture change attributed to efforts in the focus areas • Action Plan • pilot testing • Redesign refinements • full-scale launch • periodic monitoring and evaluation • over a one year period.

    12. Conclusion • To provide leadership and staff with an end of life care model that would convey a clear and consistent message and assist in decision-making. • To provide patient and families with comfort and help with the grieving process by acknowledging they are making informed decisions regarding their loved one

    13. References Bonebrake, D., Culver, C., Call, K., & Ward-Smith, P. (2010). Clinically differentiating palliative care and hospice. Clinical Journal Of Oncology Nursing, 14(3), 273-275. doi:10.1188/10.CJON.273-275. Gardner, D. B. (2012). Quality in life and death: Can we have the conversations? Nursing Economic$, 30(4), 224-227. Hicks, M., & Distefano, E. (2011). No patient left behind: Universal screening for palliative needs. Health Progress, 92(1), 38-41. Kelley, A., & Meier, D. (2010). Palliative care - a shifting paradigm. New England Journal Of Medicine, 363(8), 781-782. doi:10.1056/NEJMe1004139. Wasserman, L. (2008). Respectful death: a model for end-of-life care. Clinical Journal Of Oncology Nursing, 12(4), 621-626. doi:10.1188/08.CJON.621-626.