Hospice in a Nursing Facility

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Slide 1: 

HOSPICE IN A NURSING FACILITY

Hospice Is…… : 

Hospice Is…… Care for those with limited life expectancy Physical, emotional, social and spiritual comfort (Holistic approach) Support for those caring for the resident

Hospice Philosophy : 

Hospice Philosophy Emphasis on the quality of life Recognizes dying as a natural part of life Neither hastens nor postpones death Celebration of life is as important at end of life as it is in the beginning

The Interdisciplinary Team : 

The Interdisciplinary Team Resident and family Nursing Facility staff Attending Physician Medical Director Nurses CNAs Social Workers Chaplains Volunteers Bereavement Coordinator

Hospice Team : 

Hospice Team Hospice Medical Director and Attending Physician Coordinate care Nurse Care Managers Physical assessment Pain and symptom management Education on end-of-life care issues Coordinating the plan of care with the nursing facility

Hospice Team : 

Hospice Team CNAs Provide personal assistance with ADLs Companionship Social Workers Provide counseling Assist with treatment decisions Assist with financial needs

Hospice Team : 

Hospice Team Chaplains Support the resident’s spiritual belief system Volunteers Provide companionship Bereavement Provides grief support for family

Hospice Provides… : 

Hospice Provides… Team visits Medications related to the terminal illness Supplies related to the terminal illness Equipment which will improve comfort Therapies that meet a specific comfort goal Treatment that is for the resident's comfort

Admission Criteria : 

Admission Criteria Diagnosis of any life-limiting illness Physician Certification Attending Physician and Medical Director Approximate six month prognosis Resident chooses comfort, not curative care

When To Refer : 

When To Refer 10-30% of all Nursing Facility residents will die within the next six months Ask Yourself: “Which residents can I say, ‘I would not be surprised if they died within the next six months?’”

When To Refer : 

When To Refer Diagnosis of advanced illness Weight loss Unintentional progressive weight loss Greater than 10% over the prior six months Multiple and frequent hospitalizations or ER visits over prior six months

When to Refer : 

When to Refer Decline in functional status Dependence in at least three of the six ADLs Decline in cognitive status Increased pain or discomfort May be combination of many of these factors

Referral Process : 

Referral Process Call Attending Physician Request and write the following order “Refer to Hope Hospice and admit, if appropriate” Notify family of referral and let them know that Hope Hospice staff member will be contacting them Call Hope Hospice at 625-7500 and ask to speak to someone in Admissions

Referral Process : 

Referral Process Give the following info to Admissions Demographics: name, DOB, SSN, Medicare/Medicaid number DX, referring and attending physician Family contact information Fax the doctors orders and latest H&P to 624-7027 or toll free 877-625-7502 Admissions will set up appointment with family

Benefits of A Partnership : 

Benefits of A Partnership Expanded services for your residents Expertise by both organizations Focus on comfort care and symptom management Extra staff Decreased hospitalization

Value of A Partnership : 

Value of A Partnership Physician & Government Study Results show: More likely to have their pain controlled Less likely to be hospitalized in the last 30 days, 90 days, and 6 months of life Have superior pain assessments and treatments More comfortable, less traumatic death

Value of A Partnership : 

Value of A Partnership More likely to be treated for persistent depression or anxiety Less likely to be restrained Less likely to receive artificial feedings Less likely to receive IM or IV meds or therapy services Less dyspnea

Hospice’s Responsibility : 

Hospice’s Responsibility Interdisciplinary Team services Develop, collaborate and maintain an integrated care plan Attend your care plan meetings Support and education for your staff on end-of-life care issues

Nursing Facility’s Responsibility : 

Nursing Facility’s Responsibility Develop, collaborate, and maintain an integrated care plan Notify hospice of any change in resident’s condition, medication changes or physician orders

Nursing Facility’s Responsibility : 

Nursing Facility’s Responsibility Notify when medications, supplies, equipment or therapies are needed Notification of scheduled care plan meetings Provide access to resident’s chart

Call for Changes in Resident Status : 

Call for Changes in Resident Status Hospice nurse will: Assess resident and report findings to staff Collaborate with staff regarding Plan of Care updates as needed (medication changes, DME, etc.) Notify Attending Physician as needed Notify family if appropriate

Procedure for Emergencies : 

Procedure for Emergencies Notify Attending Physician & inform them you will call HH nurse CALL Hospice Hospice Examples: Falls Uncontrolled Pain Dyspnea Bleeding Etc

Medication Process : 

Medication Process Hospice will pay for all meds related to resident’s diagnosis All medication orders will be written in the resident’s medical record Medications paid for by Hope Hospice are ordered from Comal Drugs

Use of Comfort Packs : 

Use of Comfort Packs Ordered for all residents on admission Hope Hospice Available medicines for management of symptoms (pain, restlessness, increased secretions, nausea) Notify HH nurse when comfort care meds are started OMS, Ativan, Scopalamine Patch, Phenergan

Federal and State Regulations : 

Federal and State Regulations “The SNF/NF must offer the same services to its residents who have elected the hospice benefit as it furnishes to its residents who have not elected the hospice benefit.”

Who Pays for Hospice? : 

Who Pays for Hospice? Medicare/Medicaid/and insurance pay for hospice Hospice does not pay for room and board Hospice residents are usually not in a Medicare bed. Exception: “dual diagnoses” No cost to the facility for Hospice care

Surveyor’s Concerns : 

Surveyor’s Concerns Is there evidence of coordination of care? Do our care plans match? Are we working toward the same goals?

Who Wins? : 

Who Wins? We all do- The resident and family!!! Your Nursing Facility Hope Hospice