National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Providing Hospice
Care in a Skilled or
Long-Te...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Objectives
• Review the philosophy of hospice ...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Hospice and Facility Regulations
• On June 5, ...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Mission and Vision of Alive Hospice
Our Missio...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
What is hospice care?
• Care at Alive Hospice ...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
What is hospice care?
• Alive Hospice treats t...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Basic Principles of Hospice Care
At Alive Hosp...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Where is hospice care provided?
• Hospice care...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Attitudes Towards Death and Dying
• Each perso...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Attitudes Towards Death and Dying
• American s...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
When is Hospice Care Appropriate?
• A referral...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Hospice Care Diagnoses
• Hospice care is not j...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Patient Rights Under Hospice
• Patient rights ...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Hospice Core Services
• Hospice core services ...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Who Are the Members of the Alive Hospice Team?...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
End of Life Symptoms
• Most patients and famil...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Common End of Life Symptoms
• Pain
– Physical
...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Bereavement After Patient Death
• Alive Hospic...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Bereavement Services are available to:
• Resid...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Partnership for Patients
• The provision of hi...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
The Alive Hospice–Facility Partnership
• The n...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
The Alive Hospice–Facility Partnership
• Succe...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Payment for Hospice Care
• There is a Medicare...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Hospice Service Periods
• The patient’s primar...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Need More Information?
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
“Hope, Dignity, Love…It must be hospice”
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
References
• The National Hospice and Palliati...
National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Alive Hospice
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Presentation: Providing Hospice Care in a Skilled or Long-Term Care Nursing Facility

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Presentation: Providing Hospice Care in a Skilled or Long-Term Care Nursing Facility

  1. 1. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Providing Hospice Care in a Skilled or Long-Term Care Nursing Facility Education program
  2. 2. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Objectives • Review the philosophy of hospice care and discuss what hospice care provides. • Talk about comfort care as a hospice care goal. • Discuss principles of death and dying and individual response to death. • Review hospice patient rights at end of life. • Discuss the hospice – facility partnership.
  3. 3. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Hospice and Facility Regulations • On June 5, 2008, the Centers for Medicare and Medicaid Services (CMS) published new regulations for hospice care. • The regulatory language includes guidance for hospice care for a patient who resides in a facility. (418.112: Condition of participation : Hospices that provide hospice care to residents of a facility). • CMS Facility regulations effective August 26, 2013 [483.75 (t)(3)(v)]
  4. 4. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Mission and Vision of Alive Hospice Our Mission We provide loving care to people with life-threatening illnesses, support to their families, and service to the community in a spirit of enriching lives. Our Vision • To be recognized as expert providers of hospice care, palliative care, management of advanced disease and grief support and to be the agency of choice for the provision of these services. • To be recognized as innovators and leaders in all aspects of end of life resources. • To influence the perceptions within the community and among medical professionals so that the end of life is accepted as a meaningful component of the human experience.
  5. 5. National Hospice and Palliative Care Organization, 2009 All Rights Reserved What is hospice care? • Care at Alive Hospice focuses on improving the quality of life for persons and their families faced with a life-limiting illness. • The primary goals of hospice care are to provide comfort, relieve physical, emotional, and spiritual suffering, and promote the dignity of terminally ill persons. • Hospice care neither prolongs nor hastens the dying process. • Care is palliative (not curative) to control pain and symptoms associated with the terminal illness.
  6. 6. National Hospice and Palliative Care Organization, 2009 All Rights Reserved What is hospice care? • Alive Hospice treats the whole person, not just the disease. • It focuses on the needs of both the patient and the family. • Care is provided by an interdisciplinary team including the physician, nurse, social worker, chaplain, nursing assistant, and volunteers. • Hospice addresses patient and family needs such as: – Pain and symptom management – Emotional, psychosocial, and spiritual support – Help with funeral planning and arrangements – Bereavement for family/ caregivers after the patient’s death
  7. 7. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Basic Principles of Hospice Care At Alive Hospice, we: • Affirm life • Regard dying as normal process • Neither hasten nor postpone death • Relieve pain and other symptoms • Integrate medical, psychological, and spiritual aspects of care • Offer a support system to patients and families
  8. 8. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Where is hospice care provided? • Hospice care is a philosophy or approach to care rather than a place. • Care may be provided in a person’s home, nursing home, hospital, or independent facility devoted to end-of-life care. • Hospice was originally designed to be a non- institutional benefit. However, it is possible to receive Medicare covered hospice care while residing in a nursing facility.
  9. 9. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Attitudes Towards Death and Dying • Each person has his or her own view of death and attitude towards it • Society as the main influencer has a huge impact on people’s perception of death • The attitudes of the society towards death have been changing over the time • Fear has always been one of the most common attitudes towards death • Attitudes towards death change over the lifetime of the person
  10. 10. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Attitudes Towards Death and Dying • American society tends to deny the reality of death. – Previous experiences with death – Circumstances of death – Some medical professionals view death as a failure • Cultural factors can significantly influence patients’ reactions to their illness and the dying process. • There are many different religions and belief systems across the world. Each holds an individual view of death and mourning.
  11. 11. National Hospice and Palliative Care Organization, 2009 All Rights Reserved When is Hospice Care Appropriate? • A referral to hospice is appropriate when the patient and family have opted for palliative treatment rather than curative treatment for life- limiting or “terminal” illness. • Medicare guidelines further require that the physician has determined that life expectancy is six months or less if the disease follows its normal course.
  12. 12. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Hospice Care Diagnoses • Hospice care is not just for patients dying of cancer • Other hospice diagnoses include: – End stage heart disease – End stage pulmonary disease – End stage renal disease – End stage liver disease – Dementia due to Alzheimer’s Disease and Related Disorders – Neurological disorders – HIV disease – Stroke & Coma
  13. 13. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Patient Rights Under Hospice • Patient rights is a regulation for hospice providers under the 2008 Medicare Hospice Conditions of Participation. • Hospice providers must review the notice of patient rights with patients/ family/ representatives at the time of hospice admission and obtain a signature that they received their notice of these rights.
  14. 14. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Hospice Core Services • Hospice core services will be routinely provided by Alive hospice, and will not be delegated to the facility. • Hospice core services include: – Physician services – Nursing services – Social work services – Counseling services • Bereavement and spiritual • Dietary
  15. 15. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Who Are the Members of the Alive Hospice Team? • The Alive Hospice team is an interdisciplinary team (IDT) and together we coordinate the patient’s plan of care. • Members of the hospice team include: – Patient and family/ caregiver – Patient’s primary physician – Hospice physician – Nurse – Social worker – Chaplain – Hospice aide – Volunteers – Bereavement counselor – Additional team members may include dietician, occupational or physical therapist, pharmacist – YOU!
  16. 16. National Hospice and Palliative Care Organization, 2009 All Rights Reserved End of Life Symptoms • Most patients and families who are living with a life-threatening illness can expect to experience multiple physical symptoms • Some of these symptoms are related to the primary illness, others are related to adverse effects of medications or therapy or related conditions. • Hospice care manages a patient’s symptoms to promote comfort and quality of life.
  17. 17. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Common End of Life Symptoms • Pain – Physical – Emotional – Spiritual • Shortness of breath • Nausea / vomiting • Anorexia / Cachexia • Weakness/ fatigue • Constipation • Delirium
  18. 18. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Bereavement After Patient Death • Alive Hospice offers bereavement services to family and loved ones for a minimum of 12 months following the death of a patient. • Services can be: – Phone contact – Short-term counseling – Assessment of need and referrals to community resources – Support groups – Educational forums – Written information on the grief process – Memorial services
  19. 19. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Bereavement Services are available to: • Resident’s roommate • Family members • Staff caregiver who experiences grief from the loss of the patient
  20. 20. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Partnership for Patients • The provision of high quality coordinated end of life care is a win-win scenario for: – A patient and their family – A nursing facility and their staff – A hospice and their staff Patient & family Hospice & staff Facility & staff
  21. 21. National Hospice and Palliative Care Organization, 2009 All Rights Reserved The Alive Hospice–Facility Partnership • The nursing facility staff become part of the interdisciplinary team when a facility resident elects hospice care. • Important for each provider to recognize each other’s knowledge and remain open to two-way learning. ─ Nursing facility staff are skilled in meeting the clinical and psychosocial, and spiritual needs of their residents. ─ Hospice staff are skilled at meeting the special clinical, psychosocial, and spiritual needs at end of life. • Combined expertise allows the nursing facility and hospice to deliver the most comprehensive care patient/ family possible.
  22. 22. National Hospice and Palliative Care Organization, 2009 All Rights Reserved The Alive Hospice–Facility Partnership • Successful partnerships between a hospice provider and a nursing facility include: – Acknowledgement and respect for each other’s regulations – Developing an excellent communication process – Consistent coordination of care by the hospice and the nursing facility – Identification of care plan in both the nursing facility and the hospice medical record • Consistent communication, coordination, and documentation are keys for success!
  23. 23. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Payment for Hospice Care • There is a Medicare hospice benefit for Medicare part A beneficiaries • All but one state (Oklahoma) have a Medicaid hospice benefit • Many commercial insurances also cover hospice care as well • Most hospices are committed to caring for all patients, regardless of an individual’s ability to pay
  24. 24. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Hospice Service Periods • The patient’s primary physician and hospice team evaluate the patient’s eligibility for hospice care on a regular basis. • The first and second certification periods are 90 days; subsequent periods are 60 days. • If a patient no longer meets criteria for hospice care, they may be discharged from hospice and readmitted at a later date.
  25. 25. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Need More Information?
  26. 26. National Hospice and Palliative Care Organization, 2009 All Rights Reserved “Hope, Dignity, Love…It must be hospice”
  27. 27. National Hospice and Palliative Care Organization, 2009 All Rights Reserved References • The National Hospice and Palliative Care Organization. – www.nhpco.org • EndLink - Resource for End of Life Care Education (Northwestern University) – http://endoflife.northwestern.edu/index.cfm • Centers for Medicare and Medicaid Services -42 CFR Part 418, Medicare and Medicaid Programs: Hospice Conditions of Participation; Final Rule ( Pgs. 32216-32217) – http://edocket.access.gpo.gov/2008/pdf/08-1305.pdf • Attitudes Towards Death and Dying, Jeff Stats, APR, 2007. – http://www.articlesbase.com/college-and-university-articles/attitudes- towards-death-and-dying-139943.html
  28. 28. National Hospice and Palliative Care Organization, 2009 All Rights Reserved Alive Hospice

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