SOMC Hospice & Palliative Care

1. SOMC Hospice & Palliative Care a special kind of caring… A Department of Southern Ohio Medical Center

2. 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

3. 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

4. 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

5. 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

6. 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

7. Admission Criteria (cont) • Diagnosis categories appropriate for Hospice Care: • Cancer • Alzheimer’s • Stroke & Coma • Cardiac • Renal • Hepatic • Dementia • ALS • Failure to Thrive • Debility • HIV • General

8. 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

9. 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

10. The Hospice Team • Skilled Nursing – • Provided under the direction of the physician • Weekly visits and as needed • Provide comprehensive assessment with each visit • Provide emotional support • Focus on patient/caregiver education • Nurses available 24 hours a day, seven days a week • Coordinate the patient’s individualized Plan of Care with the IDT

11. 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 hygiene • Assist family members in learning care-giving skills • Visit 1 – 5 times per week based upon need

12. 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 resources • Provide social and psychosocial counseling • Assistance with advance directives • Participate in the IDT Plan of Care

13. The Hospice Team (cont) • Spiritual Care – • Presence ministry • Life review • Sacramental needs • Contacting patient’s church/personal clergy • End of life spirituality • Special Services

14. 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

15. The Hospice Team (cont) • Medical Director – (continued) – • Participates in IDT meetings • Covers patient admissions to the Hospice Center as needed • Contributes to the patient’s IDT Comprehensive Care Plan

16. 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

17. The Hospice Team (cont) • Pharmacy consultation • Nutrition consultation • Physical therapy • Occupational therapy • Speech therapy • Attending Physician • Patient and Family

18. 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

19. Care Settings • Home Care • Acute Inpatient Care • Respite Care

20. 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

21. Palliative Sedation: • Ethical Justification • Intent: Relief of suffering, as a last resort • Outcome: Patient is made unaware of suffering through sedation/sleep • Studies show that death is not hastened during this process

22. Palliative Sedation: • Facts - • Sedation may be partial, intermittent or complete based upon patient/family preference • Not irreversible • Indicated only for refractory symptoms – when nothing else is working • Appropriate when patient is imminent or getting close to death

23. Palliative Sedation: • Reasons for sedation – • Pain • Terminal restlessness/delirium • Dyspnea • Bleeding • Nausea/vomiting **Symptoms must be truly refractory

24. Palliative Sedation: • Drug Classifications – • Opioids • Benzodiazepines • Antipsychotics • Barbiturates • General anesthetics • IV route is optimal • Specific doses are less important than the goal of symptom relief

25. Palliative Sedation: • Suggested Guidelines – • Terminal illness with refractory symptom(s) • DNRCC • All other treatments must have been exhausted • Psychosocial assessment • Spiritual assessment

26. Palliative Sedation: • Suggested Guidelines - • Second physician opinion • Nutrition/hydration futility addressed • Reason(s) well documented • Consideration of a trial of respite sedation first • Use of a proper sedation scale

27. Hospice Service Areas • Scioto County • Pike County • Jackson County • Counties partly covered: • Lawrence • Adams • Ross

28. 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

29. SOMC Hospice Center (cont) • Reasons for admission to the center: • Must be an SOMC Hospice Patient • Acute stay – pain and/or symptoms unable to ideally be treated in home setting • Imminent death – when not optimal for the patient’s death to occur in the home setting • Respite stay – five day stay, monthly as needed to give caregiver(s) a rest from 24/7 care

30. 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

31. 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

32. 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

33. Reimbursements • Medicare • Medicaid • Insurance payors • VA • Self-pay • Indigent • Donations/fund raisers

34. 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

35. 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

36. 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

37. 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

38. Palliative Care Services • Prognosis is not limited to 6 months • Can provide curative, life sustaining care

39. 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.

40. 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

41. Referrals: Hospice and Palliative Care (740) 353-2567 (24/7) Ext. 2651 (During business hours only)

42. Questions???