SOMC Hospice & Palliative Care

SOMC Hospice& Palliative Care

a special kind of caring…

A Department of Southern Ohio Medical Center

Objectives:

Discuss the philosophy, admission criteria, referral process and services for Hospice and Palliative Care programs

Describe the functions and duties of the Interdisciplinary Team approach

Discuss limited pain and symptom management strategies

Hospice Philosophy To recognize death as a universal

experience To recognize dying as a normal

process To affirm life and discount death denial To acknowledge that a person is part

of a family unit To provide end of life palliative care –

comfort, care and support services

Hospice Philosophy (cont)

To provide comfort without prolonging life or hastening death

To focus on holistic care To encourage all persons to live fully,

even as death approaches To encircle the family unit with support

and caring through the use of the Interdisciplinary Team

Hospice Admission Criteria

Be willing to accept the hospice philosophy of care and make an informed choice

Have a life expectancy of six months or less, (months instead of years), if the disease runs its expected course

Choose supportive care instead of curative treatment

Admission Criteria (cont)

Have a physician willing to be the primary physician for hospice care

Have a need for supportive care, even if the patient is ambulatory and not home bound

Admission Criteria (cont)

Admission Criteria (cont)

For non-cancer diagnoses, Medicare has agreed upon criteria for determining prognosis – as depicted by the disease categories listed previously

These criteria apply to all non-cancer hospice patients regardless of reimbursement

Referral Process

Anyone can make a referral to hospice When referral is received, a hospice

admissions nurse will follow-up within 24 hours

Hospice nurse will phone the physician for orders to evaluate the patient for hospice appropriateness

Imminent death referrals are followed-up within one hour

The Hospice Team Skilled Nursing –

Provided under the direction of the physicianWeekly visits and as neededProvide comprehensive assessment with

each visitProvide emotional supportFocus on patient/caregiver educationNurses available 24 hours a day, seven

days a weekCoordinate the patient’s individualized Plan

of Care with the IDT

The Hospice Team (cont) Hospice Aides –

Provide care under the direction of the Primary RN

Assist the patient/family in a caregiver role

Provide personal hygieneAssist family members in learning care-

giving skillsVisit 1 – 5 times per week based upon

need

The Hospice Team (cont) Medical Social Work –

Provide special insight into problems created within families as they experience crisis and loss

Provide assistance with legal and financial needs

Assist with community resourcesProvide social and psychosocial counselingAssistance with advance directivesParticipate in the IDT Plan of Care

The Hospice Team (cont)

Spiritual Care –Presence ministryLife reviewSacramental needsContacting patient’s church/personal

clergyEnd of life spiritualitySpecial Services

The Hospice Team (cont) Medical Director –

Certifies and re-certifies patient appropriateness for hospice care, including Face to Face visits as needed

Provides consultative service to the IDT and to the patient’s attending physician regarding patient plan of care

The Hospice Team (cont)

Medical Director – (continued) –Participates in IDT meetingsCovers patient admissions to the

Hospice Center as neededContributes to the patient’s IDT

Comprehensive Care Plan

The Hospice Team (cont)

Volunteer Services – Provide patient visits in the home setting Visit patients in hospital setting Sit with patients Provide respite services for caregivers Light housekeeping Running general errands Delivering supplies, medications, etc Telephone contacts and support Office work, fund raising support Eleventh Hour Team support

The Hospice Team (cont)

Pharmacy consultation Nutrition consultation Physical therapy Occupational therapy Speech therapy Attending Physician Patient and Family

Areas of Expertise

Pain Management Symptom Management

Nurses attend on-going lectures to stay current with evidence based practices

IDT also attends lectures regarding their roles in pain and symptom management

Care Settings

Home Care Acute Inpatient Care Respite Care

Palliative Sedation:

Voluntary election to use medications for the express purpose of relieving refractory pain and/or symptoms in the form of drug induced sleep state.

*Not comparable with euthanasia or physician assisted suicide

Palliative Sedation:

Ethical JustificationIntent: Relief of suffering, as a last

resortOutcome: Patient is made unaware of

suffering through sedation/sleep

Studies show that death is not hastened during this process

Palliative Sedation:

Facts -Sedation may be partial, intermittent or

complete based upon patient/family preference

Not irreversibleIndicated only for refractory symptoms –

when nothing else is workingAppropriate when patient is imminent or

getting close to death

Palliative Sedation:

Reasons for sedation – PainTerminal restlessness/deliriumDyspneaBleedingNausea/vomiting

**Symptoms must be truly refractory

Palliative Sedation:

Drug Classifications – OpioidsBenzodiazepinesAntipsychoticsBarbituratesGeneral anesthetics

• IV route is optimal• Specific doses are less important than the

goal of symptom relief

Palliative Sedation:

Suggested Guidelines – Terminal illness with refractory

symptom(s)DNRCCAll other treatments must have been

exhaustedPsychosocial assessmentSpiritual assessment

Palliative Sedation:

Suggested Guidelines - Second physician opinionNutrition/hydration futility addressedReason(s) well documentedConsideration of a trial of respite

sedation firstUse of a proper sedation scale

Hospice Service Areas

Scioto County Pike County Jackson County

Counties partly covered:LawrenceAdamsRoss

SOMC Hospice Center Home-like atmosphere designed to

provide quality care for hospice patients and families

Not a residential facility – goal of care is short term stay

Visitors welcome 24/7 Patient rooms designed for families to

stay with patients Laundry and kitchen facilities available Menu and room service available

SOMC Hospice Center (cont) Reasons for admission to the center:

Must be an SOMC Hospice PatientAcute stay – pain and/or symptoms unable

to ideally be treated in home settingImminent death – when not optimal for the

patient’s death to occur in the home settingRespite stay – five day stay, monthly as

needed to give caregiver(s) a rest from 24/7 care

Pet Therapy – “Marley”

Staff member who walks on four legs A “People Person” Offers comfort to patients and families Intuitive caring Loves attention

Honorable mention – “Swann”, our first Hospice dog has retired after years of great service

Bereavement Services Designed to help families and loved

ones cope with terminal illness and loss

Emotional support provided free of charge from the time of the patient’s admission to hospice services and up to 13 months after the patient’s death

Individual, adult, child and family counseling upon request

Not limited only to hospice families

Bereavement Services (cont)

Phone calls; Visits; Cards and letters commemorating special dates; Bi-monthly newsletter – “Resolutions”; Educational materials

Memorial Quilt Project Memorial Life Celebration Support groups – different themes All bereavement services are free of charge

Reimbursements

Medicare Medicaid Insurance payors VA Self-pay Indigent Donations/fund raisers

Living With Hope Talk openly and honestly with one another Recognize that death is a part of life Consider each day as full of potential to be

enjoyed as much as possible Realize that life is never perfect – it was

not perfect before illness and will not be perfect after

Use faith and spiritual strengths for support

Living With Hope (cont) See oneself as living with illness instead

of dying from it Enjoy the simple things in life – it is often

these that give life meaning and enjoyment

Include loved ones in the experience by talking about fears, concerns and feelings

Daily private time is a healthy practice Physical pain can be increased with

social, emotional or spiritual pain

Palliative Care Services

Nurses specializing in palliative care provide weekly home visits and more if need is indicated

Hospice Department assists as needed and covers after hours calls and visits

Indicated for patients with a life-limiting illness

Palliative Care Services

Patient must be homebound and have a skilled need

Hospice has partnered with SOMC Home Care for billing purposes

Goal to keep patient out of the hospital Very similar to hospice services in

providing pain and symptom management

Palliative Care Services

Prognosis is not limited to 6 months Can provide curative, life sustaining

care

Palliative Care – Nurse Practitioner Program Services provided in the patient’s

home or homelike setting (SNF; Assisted Living) by a Nurse Practitioner

Patients do not require a skilled need or homebound status

Visits are based on medical necessity – per week, per month, etc.

Palliative Care – Practitioner Program Can be in addition for the Home Care

program or can be independent, based upon patient need

24/7 access to on-call nursing services Does not replace physician – NP will

collaborate with the patient’s physician on-going to determine appropriate interventions

Referrals:

Hospice and Palliative Care

(740) 353-2567 (24/7)

Ext. 2651 (During business hours only)

Questions???