8/20/2013 1 NAHC Annual Meeting November 3, 2013 The Palliative Home Care Program: Our Agency’s Experience Washington, D.C. NAHC Annual Meeting NAHC Annual Meeting November 3, 2013 Washington, D.C. Presented by: Karen Marshall Thompson, RN, MS, CNS Jenni Smathers, RN, BSN SOMC Home Health Services Portsmouth, OH • First Hospital‐Based Agency in OH SOMC Home Health Services SOMC Home Health Services • Medicare‐certified in 1966 • Serve three counties • Currently opening a new office in KY • Expanding into two additional counties in OH • Home Care Elite 2006, 2007, 2008, 2011, 2012 JCAHO A di d • JCAHO – Accredited • Offer traditional Medicare – certified home health services
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SOMC Home Health Services Portsmouth, OH · 2017-10-31 · SOMC Home Health Services Portsmouth, OH • First Hospital‐Based Agency in OH SOMC Home Health Services • Medicare‐certified
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8/20/2013
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NAHC Annual MeetingNovember 3, 2013
The Palliative Home Care Program: Our Agency’s Experience
•Multiple exacerbations, medication changes and education needs
•Able to attend multiple Dr. appointments
•Obtained standing orders for lab/increased diuretics
•Length of stay = 160 days
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The Case for BobThe Case for Bob
Declined Declined DNRCCDNRCCUntil after Dyspnea
Episode ED Visit w/o Admission
EF EF Declined Declined to 15%to 15%
Recognized Recognized Decline & Decline & Agreed to Agreed to
Hospice CareHospice Care
Passed Passed Peacefully Peacefully At HomeAt Home5 Days after Hospice Admissionw/o Admission
CHF ManagementCHF Management• Due to non‐reimbursement if readmission in 30 days, PC provides CHF patients with:PC provides CHF patients with:– Aggressive education and frequent visits– Better continuity due to smaller case loads– Frequent communication with their physician– Telehealth monitoring (includes weight, BP, et pulse oximetry)for chronic intervention and management of diseasedisease
– Encouragement of SNV before ED if non‐emergent– 24 hour on‐call service per Home Care staff
• Physicians more willing to give standing lab/diuretic orders based on assessment.
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The Case for AngieThe Case for AngieDemographics:• 34 y/o married mother of 3 diagnosed• 34 y/o married mother of 3, diagnosed
with cervical cancer in 2009 • Metastasis to lymphatic system, bilateral
pleura, et pericardium• Multiple chemotherapy attempts at The
James Cancer Center OSU, Cancer Treatment Centers of America in Chicago, and lastly with local oncologistR f l d f i / t• Referral made for pain/symptom management and disease process teaching
• Utilized IV pain control per CADD pump• Length of stay = 56 days
The Case for AngieThe Case for Angie
Palliative Palliative Performance Performance
Scale (PPS) 60%Scale (PPS) 60%11
Upon Admission
MSW Involved for MSW Involved for Advanced Advanced DirectivesDirectives
Remained Full Code
Significant Significant Decline in Decline in ActivityActivity
Increased Dyspnea & Increased Dyspnea & PainPain
1Anderson F, Downing GM, Hill J. Palliative Performance Scale (PPS): A New Tool. Journal of Palliative Care. 1996; 12(1); 5‐11.
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The Case for AngieThe Case for Angie
Oral Pan Meds Oral Pan Meds IneffectiveIneffective