Hospice care focuses on comfort and quality of life for those in their last phases of terminal illness. It is appropriate when curative treatment is no longer an option and the prognosis is typically six months or less. Hospice services include pain management, nursing care, emotional support, and other services to allow patients to live as fully as possible until death. Many families wish they had accessed hospice sooner to maximize time with loved ones and avoid unwanted medical interventions at the end of life. The presentation provides information about hospice eligibility, services, and when it may be the right time to consider hospice based on physical signs of decline.

2. WHEN IS THE RIGHT TIME FOR
HOSPICE?
We are there when you need us most.

3. It is about living as well as
possible, with comfort, care
and safety, up to the time of
death.
HOSPICE IS NOT ABOUT DYING
When is the Right Time for Hospice?

4.  Highlight a brief history of the Hospice movement
 Review the similarities and differences between
Palliative Care and Hospice Care
 Explore what Hospice services include
 Examine when it might be the right time for Hospice
PRESENTATION OBJECTIVES
When is the Right Time for Hospice?

5. The concept of hospice dates
back to 475 AD
Derived from the word hospitium
The words hospice, hospital, and
hostel were used interchangeably
.
HISTORY OF HOSPICE: “HOSPITALITY”
When is the Right Time for Hospice?
Originally, hospitia or
traveler’s rest provided
food, shelter, as well as
care for the sick or dying

6. Until the 1950’s, most Americans were born at home and
died at home, surrounded by loved ones.
Death was a natural part of life’s journey.
The goals of healthcare shifted from easing suffering to
curing disease; dying patients were given less priority.
Cicely Saunders, the founder of modern hospice, believed
that each one of us is unique and has important physical,
emotional, social and spiritual needs. She founded the first
modern hospice in London in 1967.
HISTORY OF HOSPICE
When is the Right Time for Hospice?

7. Today, Americans have come full circle with 85% of us
wanting to die at home, yet only about 24% actually die at
home.
Visiting Nurse & Hospice Care provides specialized and
compassionate care for terminally ill patients with a focus on
comfort, symptom management, quality of life, and patient
choice.
We have been serving Santa Barbara County since 1908 as a
nonprofit home care organization founded by a group of
nurses.
HISTORY OF HOSPICE
When is the Right Time for Hospice?

8. FOUR LEVELS OF HOSPICE CARE
When is the Right Time for Hospice?
Routine
Patient at home with symptoms controlled
Continuous
Patient at home with uncontrolled symptoms
Respite Care
Skilled Nursing Facility for 5 Days
Inpatient
Serenity House or contracted hospital or skilled nursing facility
Uncontrolled pain and other symptoms which cannot be managed in another
setting

9. UNDERSTANDING PALLIATIVE CARE
vs
HOSPICE CARE
When is the Right Time for Hospice?

10. SIMILARITIES
Hospice Medicare Benefit: When is the Right Time?
Palliative Care Hospice Care
Pain and Symptom Management Yes Yes
Social, Emotional, and Spiritual Support Yes Yes
Focus on Quality of Life Yes Yes
Family is the Unit of Care Yes Yes
Interdisciplinary Team: RN, MD, MSW, Chaplain Yes Yes
Physician Order for Service Required. Yes Yes

11. DIFFERENCES
Hospice Medicare Benefit: When is the Right Time?
Palliative Care Hospice Care
Type of Illness Life Threatening Illness Terminal Illness (6
months or less); can be
renewed without
penalty if in decline
Type of Care Office and home visits
by MD, NP, or RN
RN available 24/7 for
home visits
Type of Treatment Continue with curative
treatments
No longer curative,
focus on comfort only
Type of Focus Addresses end of life
issues
Focuses on end of life
issues

12. Hospice care is provided to all medically qualified patients and is covered by
Medicare, MediCal, insurance companies, or private payment.
 Under Medicare Part A, Hospice Benefit
 Terminal illness with 6 month or less prognosis; defined by
Medicare as 180 day prognosis
 You may have unlimited supply of 60 day Medicare Benefit
periods; you do not run out
 Patient chooses to receive Hospice care rather than curative
treatments
 Patient enrolls in a Medicare approved Hospice program
HOW IS HOSPICE PAID FOR?
When is the Right Time for Hospice?

13.  Cancer patient with metastatic disease
 COPD patient with multiple hospital visits
 Heart failure patient with shortness of breath in spite of
medications
 Stroke patient who decided not to have tube feedings
TYPICAL HOSPICE PATIENTS
When is the Right Time for Hospice?

14.  Advanced Renal Disease
 ALS: No Feeding Tube or Ventilator
 End Stage Liver Disease
 Advanced Dementia: Functional Assessment Scale (FAST)
score of 7 and greater, minimal speech, non-ambulatory,
Activities of Daily Living (ADL) dependent
Debility/failure to thrive
OTHER DIAGNOSISES QUALIFY FOR HOSPICE
When is the Right Time for Hospice?

15. • To respect the values and honor the decisions of our
patients
• To relieve pain, fear, and other complex symptoms
• To be by the patient’s side and caregiver’s side so they
will not feel alone
• To emphasize and enhance the quality of life
• To support and comfort the entire family
GOALS OF HOSPICE
When is the Right Time for Hospice?

16. HOSPICE SERVICES INCLUDE
When is the Right Time for Hospice?
• Specialized healthcare coordinated by the Primary Care
Physician and VNHC, including: Medical Director, RNs,
Medical Social Workers, Hospice Aides, Chaplains,
Bereavement Counselors and trained volunteers
• Medications and equipment related t the primary illness
• 24/7 access to RN consultation
• Nursing visits as needed, 24/7
• Emotional and spiritual support for the patient and family
• Assistance with bathing and personal grooming
• Education and training on how to care for your loved one at
home.

17.  Registered Nurse
 Hospice Physician
 Medical Social Worker
 Home Health Aide
OUR HOSPICE CARE TEAM INCLUDES
When is the Right Time for Hospice?
 Chaplain
 Bereavement Counselor
 Integrative Therapies
 Music Therapy
 Trained volunteers including pet therapy

18. Aromatherapy
Gentle Reflexology
Guided Imagery
Mindfulness Practice
Music Therapy
Reiki
INTEGRATIVE THERAPIES OFFERED
When is the Right Time for Hospice?

19. In surveys, 9 out of 10 Americans say that when the end is near,
they would prefer to maximize their comfort and minimize the
pain and turmoil of treatments.
Despite these expressed wishes, more patients are experiencing
ICU admission in the last 30 days (24% in 2000 to 29% in 2009).
Half of all Hospice patients in the U.S. die within one month of
enrollment.
28% of patients receiving hospice services were served for less
than 4 days.
HOSPICE IN AMERICA
When is the Right Time for Hospice?

20. Hospice strives to provide comfort, safety, compassion, and
to relieve pain and suffering on many levels.
WHEN IS THE RIGHT TIME FOR HOSPICE?
When is the Right Time for Hospice?

21. There has been substantial, unintentional weight loss (10% in the
past six months), or a decreased albumin (a blood protein) level.
Your loved one is short of breath at rest and oxygen dependent.
Your loved one is bed bound, incontinent and unable to carry on a
meaningful conversation.
There are recurrent urinary infections or aspiration pneumonias.
There has been a debilitating stroke or other acute event from
which your loved one is not expected to recover.
THINK OF HOSPICE WHEN…
When is the Right Time for Hospice?

22. There has been a rapid functional decline.
There is disease progression despite aggressive chemotherapy or
radiation.
A person decides to stop or is failing dialysis.
There have been multiple ED visits or hospitalizations within the
past year.
Your loved one or family requests aggressive treatments and/or
hospitalizations cease.
A patient seems to be “giving up” and is just dwindling away.
When is the Right Time for Hospice?

23. These words may indicate it is time for hospice and
Advanced Care Planning
 “Dad wouldn’t want this”
 “There is no quality of life”
 “We don’t want to go back to the hospital”
Hospice can be an “the best choice” for families and
facilities with staff available 24 hrs/day.
HOSPICE AS A PLAN FOR THE FUTURE
When is the Right Time for Hospice?

24. A Physician Order for Life Sustaining Treatment (POLST) is a form
that gives seriously ill patients more control over their end of life
care, including medical treatment, extraordinary measures (such
as a ventilator or feeding tube) and CPR.
The POLST is signed by both a doctor and a patient.
It can prevent unwanted or ineffective treatments, reduce patient
and family suffering, and ensure that a patient’s wishes are
honored.
PHYSICIAN ORDER FOR LIFE SUSTAINING
TREATMENT (POLST)
When is the Right Time for Hospice?

25. “We wish we
would have asked
for hospice services
sooner.”
THE MOST COMMON STATEMENT FROM
HOSPICE FAMILIES IS
When is the Right Time for Hospice?

26. • Discuss the changes you see in your loved ones with
them and with their physician.
• Have the discussion about specific choices of care and
ask what your loved one will/will not tolerate.
• Have a written Advanced Directive
• Be mindful that patients’ needs can be better served
when referred to hospice on a timely basis.
• Request a (no charge) hospice evaluation.
WHAT CAN YOU DO?
When is the Right Time for Hospice?

27. We are a nonprofit homecare service and are very proud of our
history and commitment to provide compassionate and trusted
care for all. Here is a summary of our services during 2014:
• Helped nearly 13,500 people maintain their health, live
independently, recover from illness, or transition at end of life
with dignity and comfort
• Provided over $2.1 million in charitable community benefit for
residents
• 71,285 home health & hospice visits were made to patients
VISITING NURSE & HOSPICE CARE
When is the Right Time for Hospice?

28. • 1,212 patients and their families were cared for during the last
stage of life, at home or in our Serenity House
• 2,628 patients & families were helped to recover from illness or
surgery
• 540 people were helped to remain safe & independent in their
homes
• 1,477 family and community members were provided support as
they recovered from the loss of a loved one
• 3,389 people borrowed medical equipment, free of charge
• 15,243 hours were donated by volunteers in our community
When is the Right Time for Hospice?

29. “You matter because of
who you are. You matter
to the last moment of your
life, and we will do all we
can, not only to help you
die peacefully, but also to
live until you die.”
-Dame Cicely Saunders
There when you need us most
When is the Right Time for Hospice?

30. Santa Barbara 805.965.5555 ♥ Santa Ynez 805.693.5555 ♥ Lompoc 805.735.4444
www.vnhcsb.org se habla español