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The purpose of hospice is to __support and comfort__ the patient and family/friends, not to keep trying to cure the disease.

  • Hospice care means __________ ______ on the person/hope.
  • I have to sign a _________.
  • Once you sign on, you __________ change your mind.

Only patients who are _____________ ___________ or ___________ _____ __________ are on hospice.

  • Hospice care means __giving _up__ on hope.
  • I have to sign a __DNR__ to receive hospice.
  • Once you sign on, you __cannot__ change your mind.*
  • Only patients who are __close to death__ or __actively dying__ are on hospice.

* You can change your mind, even after you sign; depending on your prognosis.

  • By law, the ___________ or Medical Power of Attorney (MPOA) makes the decision to enroll into hospice.

By law, the __patient__ or Medical Power of Attorney (MPOA) makes the decision to enroll into hospice.

  • _______________ failure
  • Complications due to unmanageable _______________
  • ___________ ________ outweigh benefits
  • _______ of life than __________ of life
  • __Treatment__ failure
  • Complications due to unmanageable __side effects__
  • __Treatment_ __risks__ outweigh benefits
  • _Quality_ of life than __quantity__ of life
  • __Medicare and Medicaid__ pay for __100%__ of all charges related to hospice diagnosis.
  • __Private Insurance__ such as __Blue Cross Blue Shield, Aetna, United, etc
  • No insurance or "self pay"
  • Making the most of life; honoring our loved one's requests and dignity
  • 24/7 support (by phone at the very least)
  • Not all hospices are Medicare-approved
  • Not all hospices have an Inpatient Unit

Bereavement Service Coordinator

Hospice Care vs. Palliative Care

Your Interdisciplinary Team

Why comfort care is important to patient as well as family members and friends?

  • Making the most of life; _______ our loved one's requests and ___________
  • ___________ (by phone at the very least)
  • Not all hospices are _______________________
  • Not all hospices have an __________________
  • both address pain and symptoms
  • various levels of emotional, psychological, spiritual, social support
  • pure palliative can be given while undergoing curative treatment; hospice palliative care cannot be given in conjunction with curative for the primary condition unless the patient is under 18.

Can regular medical care continue? Can I keep my primary physician?

Who Pays for Hospice?

Why Choose Hospice?

  • Yes, if the condition is not related to the hospice Dx. *
  • Yes, primary physicians can be kept. *
  • _________ pays for _______ of all charges related to hospice diagnosis
  • __________________________ such as Blue Cross Blue Shield, Aetna, United, etc
  • No insurance or "self pay."

Who can refer?

What happens now?

Beth's and Kathleen's Story

Informational Visit:

  • Eligibility determination
  • What can the patient and family expect
  • Interdisciplinary team introduced
  • Levels of care explained
  • Financial responsibilities explained
  • Information on EOL care
  • How to prepare for the upcoming days and patient's death
  • Bereavement support and services

http://www.myfoxhouston.com/story/28056683/life-and-death-the-life-of-a-hospice-nurse

What do you need when you call?

____________________________

____________________________

____________________________

____________________________

  • The patient and family may opt to choose hospice after the informational visit
  • Legal Consent to Care is signed
  • Hospice Plan of Care (POC) includes coordinated services between hospice and facility or home

At this time, the patient will also be asked about __________________________ and if necessary, _______________________

The Conversation Project

Services and Eligibility

Questions?

BREAK

  • Life expectancy of _____ months
  • Patients can be ___________ age (Houston Hospice introduced the Butterfly Program, the first hospice program, dedicated to pediatric patients in 1996)
  • Conversations can begin _______ and throughout the course of the illness.
  • __Patient or patient's family can self refer ___
  • __Facility__ staff
  • __Physicians__

*ID if eligible, goals with patient and family, written order for hospice

  • __Telephone__ or __On-line referral__

Life expectancy of _6_ months

Patients can be __ANY__ age (Houston Hospice introduced the Butterfly Program, the first hospice program, dedicated to pediatric patients in 1996)

Conversations can start __once diagnosed__ and throughout the course of the illness.

What do you need when you call?

__Demographic information__

__History and Prognosis (H&P)__

__Attending physician's orders__

__Details about family & home situation__

Who Chooses Hospice?

Purpose of Hospice

Brian's Story

The purpose of hospice is to __________ the patient and family/friends, not to keep trying to cure the disease.

Out of Hospital Do Not Resuscitate (OOH DNR) and Medical Power of Attorney (MPOA)

Top 4 Myths

Facility works with hospice

Do you think these are important?

Why or Why Not?

  • __Advanced Directive__
  • __Verbal Order__
  • __Living Will__

What is hospice?

  • Cares for patient with the same standards as other patients in facility
  • Facility aides perform usual care such as bathing and ADLs
  • Provides dietary and housekeeping services
  • Reports condition changes to hospice 24/7
  • Collaborates with POC and IDT meetings
  • Works together at time of death pronouncements, funeral home, and bereavement education for family

What does a day look like for

an RN Case Manager?

Hospice is not a place…

…but a philosophy of care.

This philosophy affirms life and exists to provide support and care for terminally ill persons with the aim of alleviating suffering and augmenting quality of life.

Hospice programs emphasize care at home whether in an individual home or in a supportive care residence.

~ Stanford University

How?

  • _________________
  • _________________
  • _________________

Objectives

By the end of the course, you will be able to:

Identify ...

  • The hospice philosophy approach to care
  • Myths about hospice
  • Services and eligibility
  • Payer sources
  • Who chooses hospice and why?
  • Who are the interdisciplinary team?
  • What does a day in hospice look like?
  • Is a career in hospice and palliative care for me?

Hospice 101

Is hospice a place for you?

What does a day

in hospice look like for an RN Case Manager?

Thank

You

Let's hear from Dr. Atul Gawade

http://video.pbs.org/video/2365422384/

1905 Holcombe Blvd, Houston, TX 77030

713-467-7423 phone

281-469-3353 fax

houstonhospice.org

Presented by Daisy Wong

(c) 2015

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