Rehabilitation Hospice and Palliative Care

8/8/2019 Rehabilitation Hospice and Palliative Care

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REHABILITATION FACILITIES

AND HOSPICE ANDPALLIATIVE CARE


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REHABILITATION HOSPITALS OR

FACILITIES Special facilities exist to provide sub acute care to patients

w/ complex health needs. e.g. Head injuries/with ventilators

Require services and intensive treatment from specialistlike

y Physiciany Occupational therapisty Dietitiansy Psychologisty Physical therapisty PsychiatristRequire agressive rehabilitation after injury and surgery


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HOSPICE Historically...

Derived from a term use todesignate a resting place for wearytravellers.

Today...

Is a multidimensional and

interdisciplinary package thatprovides rest for weary patients andtheir families.


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Hospice patients have usually been through different

treatment for curative purposes including ...y Chemotherapeutic protocols

y Radiation therapy

y Surgeries

y Multiple regimens


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Those battling diseases like..y Cancer

y AIDS

y Cardiac disease

y Pulmonary diseases

y And other for years...


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What is a hospice?y

Provides support and care for persons in the lastphases of incurable diseases so that they may live asfully and comfortably as possible.

y Recognizes dying as part of the normal process of

living and focuses on maintaining the quality ofremaining life.

y Affirm life and neither hastens nor postpones death.

y Exist in the hope and belief that through appropriate

care, patients and families may be free to attain adegree of mental and spiritual preparation for deaththat is satisfactory for them.


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HOSPICE CARE

y Is a special approach to caring for terminally illpatients that stresses palliative care (relieve of pain

and uncomfortable symptoms)y Focus is on care, not cure

y Emphasis of the hospice program is keeping patientwith family at Home

y Some are located in the hospital, skilled nursingfacilities (SNFs) and Home Health Agencies (HHAs)


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HOSPICE SETTINGy Emphasis of the hospice program is keeping patient

with family atHome

y Primary community based

y Some are located in they hospital,

y skilled nursing facilities (SNFs) and

y

Home Health Agencies (HHAs)y Continuing Care Retirement Community (CCRC)


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PATIENTS SEEN IN HOSPICEy Admission to hospice is predicted on-poor prognosis of the patient .

- 6 months or less if the disease runs its expectedcourse.

- Infant,child and adult are also cared in hospice.

- Disease s like:

- Various cancer ,AIDS, end stage renal, cardiac andlung diseases,dementia,and other disease that areassociated with limited life expectancy.


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The Interdisciplinary Team The IDT is the key component of hospice .The team

members are:

y Patients and familiesy Clinician

y Social worker

y Physicians (including hospice medical directors

y Dietitians /dietary counselors

y Bereavement councilors/chaplains

y Volunteers


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y Physical therapist

y Occupational therapisty Speech language therapies

y Home health aids

y Home makers

y Pharmacists


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Conditions for Hospice Eligibility under

Medicare

y Limited life expectancy (less than 6 months )- certifiedby physician.

y Patient chooses palliation as a goal rather than curey Care provided by medicare certified hospice program

y A physician to direct care,

y available /willing caregiver at home

Patient may choose to stop hospice care and revert toCure-oriented Care anytime.


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Palliative Care

y The active total care of patients whose disease is notresponsive to curative treatment.

yControl pain, of other symptoms, and psychological,social, and spiritual problems.

y Goals is achievement of the best quality of life forpatients and families. (WHO,1990)

y Maybe combined with curative therapies or may be thefocus of care.


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Mrs. A.W

hat her prognosis?y 94 y /o with congestive heart failure, severe

peripheral vascular disease, a systolic bloodpressure of 100, and shortness of breath at rest orwith mild exertion. She is judiciously

With medication.

Is the patient terminally

Ill?


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Potential goals of Carey Cure of disease

y Avoidance of premature death

y Maintenance of improvement in function

y Prolong life

yRelief of suffering

y Quality of life

y Staying in control

y A good health

y Support for families and loved ones


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ComparingHOSPICE CARE VS PALLI

y Prognosis of 6 months or less

y Focus on comfort of carey Medicare hospice benefit

y Volunteers Integral andrequired aspect of theprogram

y Anytime during illness

y Maybe combined with curativecare

y Independent payer

y Health care professional


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Responsibilities of Hospice Nursey Specialist in the management of pain and control

symptom

y

Assess the patients and families coping mechanismsy Check available resources

Care of the patient

Patient wishes

Support system in place

Continue supportive care after death.

Rehabilitation Hospice and Palliative Care

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