becoming comfortable with hospice. hospice goals: understand hospice comfortably able to discuss...
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BECOMING COMFORTABLE with
HOSPICE
Hospice
Goals:
• Understand hospice comfortably• Able to discuss hospice with the patient & family• Know when and how to refer
Hospice
• Medicare Benefit (established in 1983)• “Caring not curing”• Right to die pain-free, with dignity and family support• Saves money and improves care quality• 2/3 of hospice patients die at place of residence• Needs 2 physicians that determine less than 6 months to live probable
Hospice
• The Hospice TEAM• Median length of service 2013 = 18.5 days• Average length of service 2013 = 72.6 days• About 50% die/discharged within 14 days• Only 11.5% past 180 days• Includes all aspects of patient care including drugs, medical
equipment and supplies• Affordable Care Act will decrease payments by 7.4% over 10 years
Hospice
• Choose palliative care of symptom management rather than curative treatment – no extreme measures• Helps people live as well as they can for as long as
they can
Hospice
General Guidelines:
• Patient/family choose comfort care• Multiple co-morbidities• Frequent hospitalizations• Progressive weight loss• Deteriorating mental abilities• Recurrent infections• Overall function decline/dependent ADL’s
Hospice
Qualifying Diagnoses:
• Cancer• End-stage Cardiac disease• End-stage Pulmonary disease• Alzheimer’s disease• A.F.T.T.• Stroke/coma• End-stage Liver disease• End-stage Renal disease• ALS/Neurologic disease• HIV/AIDS
References
General Hospice Guidelines• National Hospice and Palliative Care Organizations Copyright 1996 Medical
Guidelines for Determining Prognosis in Selected Non-Cancer Diseases – 2nd Edition• Centers for Medicare and Medicaid Services (CMS) Intermediary 2007 Local
Coverage Determinations (LCD’s)
NYHA Functional Classification• The Criteria Committee of the New York Heart Association Nomenclature and
Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. Boston, Mass: Little, Brown & Co; 1994:253-256.
References
Palliative Performance Scale (PPS)• Anderson, Fern et al. (1996) Palliative Performance Scale (PPS) A New Tool,
Journal of Palliative Care 12(1), 5-11
Functional Assessment Staging (FAST) Scale• National Hospice and Palliative Care Organization Copyright 1996 Medical
Guidelines for Determining Prognosis in Selected Non-Cancer Diseases – 2nd Edition
