Hospice CareSNFshow

PowerPoint Presentation: 

Hospice Care in Skilled Nursing Facilities: Introduction and Philosophy

Brief History of Hospice: 

Brief History of Hospice Word “ hospice ” comes from “ hos ” meaning host. In Middle Ages, Christian institutions called hospices began. Places that provided food, lodging and comfort to weary travelers. 1900 - St. Joseph’s Hospice founded – London 1967 - St. Christopher’s Hospice founded by Dame Cicely Saunders – London -- Beginning model for modern hospice care. 1974 - Connecticut Hospice First hospice in U.S. Focus on giving care in the home.

Napa Valley Hospice: 

Napa Valley Hospice Our History Opened in 1979 Started as a joint venture between QVH and SHH In 1997 we became a free-standing, self-governing corporation Non-profit, 501(c)(3) community based organization Licensed by the State of California and Medicare/ Medi -Cal certified. Our location - 414 South Jefferson Street, Napa

Mission Statement: 

Mission Statement Our staff and volunteers are committed to the comfort and caring of the whole person and family - body, mind and spirit - through illness, death and bereavement. Together we strive to educate the community about end-of-life care, loss and grief.

Most Common Fears of the Dying Person: 

Most Common Fears of the Dying Person Fear of loss of decision making/control over their remaining life and over their dying process. Fear of physical pain/suffering. Fear of isolation or abandonment.

Philosophy of Care Overview: 

Philosophy of Care Overview Recognizes dying as a natural part of life Affirms life and neither hastens nor postpones death Provides relief from pain and symptoms Cares for the person and family as a unit Provides grief support to the family before and after the death. Respects the rights and wishes of the patient and family.

PowerPoint Presentation: 

Principle #1 The focus of hospice care is to enhance the Quality of Life (QOL) for the terminally ill patient. Hospice strives to maximize comfort by: Controlling pain Managing symptoms Providing supportive services for the patient and his/her family The 4 Guiding Principles of Hospice

PowerPoint Presentation: 

Principle #2 Hospice provides palliative vs. curative care Curative Care Focus is on quantity of life Life-prolonging Aggressive care to cure or restore the patient Can actually cause more suffering – decreases QOL May not be honoring the patient’s wishes The 4 Guiding Principles of Hospice

Palliative Care: 

Palliative Care Palliative derives from the word “palliate”: To ease without curing the underlying problem or cause Hospice strives to provide palliative care with a focus on decreasing physical, emotional, spiritual and psychological suffering so the patient can accomplish his/her goals and life closure tasks in the time remaining. Palliative care may need to be aggressive to ensure comfort by management of pain and other symptoms.

The 4 Guiding Principles of Hospice: 

The 4 Guiding Principles of Hospice Principle #3 Hospice is holistic. Comfort is promoted physically, psychosocially, emotionally and spiritually. Care provided by an interdisciplinary team. Not only does hospice deal with the physical assessment and care of the patient and his family, but psychosocial and spiritual assessments, goals and interventions are just as much a part of the foundation of our comprehensive, palliative care plan.

The 4 Guiding Principles of Hospice: 

The 4 Guiding Principles of Hospice Principle #4 The Unit of Care for Hospice is the patient, family & caregiver. Patient Family Caregiver

Admission Criteria: 

Admission Criteria Limited life expectancy as certified by a physician 6 months or less to live if the illness follows it’s usual course. Lives within the service area Napa County, northern Solano County Agreeable to hospice care Chooses comfort care instead of life prolonging measures

ANYONE can refer someone to Hospice !: 

ANYONE can refer someone to Hospice ! 13

Seven Steps to Refer a Patient: 

Seven Steps to Refer a Patient Obtain an order for “Hospice Care” from the patient’s physician. After an M.D.’s order has been obtained, Hospice will screen the patient at no charge to determine eligibility. Know your facility policy on other notifications within the facility. Approach the patient &/or family to determine if they are interested in receiving Hospice services Call Hospice for any questions you may have to determine if the patient is suitable for Hospice services. Call the Intake Nurse at Napa Valley Hospice : 258-9080 or Fax a Referral Form to Napa Valley Hospice : 258-9088

How to Admit a Patient to Hospice: 

How to Admit a Patient to Hospice A patient is admitted to hospice services based on a joint decision between: The patient The family The patient’s physician The facility nursing staff The Hospice Team All patients must be certified by their physician AND the Hospice Medical Director as terminally ill.

PowerPoint Presentation: 

THE SOONER YOU REFER SOMEONE TO HOSPICE - THE BETTER

Patient Rights: 

Patient Rights Hospice affirms the patient/family’s rights including: To receive effective pain management and symptom control To be involved in developing his or her hospice plan of care To refuse care or treatment To choose his or her attending physician To have a confidential clinical record To be free from mistreatment, neglect, or verbal, mental, sexual, and physical abuse, and misappropriation of patient property; To receive information about the services covered under the hospice benefit Receive information about the scope of services that the hospice will provide and specific limitations on those services.

PowerPoint Presentation: 

Nurse Case Manager Patient’s Physician Volunteer Spiritual Care Provider Bereavement Counselor Patient & Family Social Worker Hospice Aide Other Therapists Team Care Hospice Medical Director Dietitian

The Patient’s Physician: 

The Patient’s Physician Agrees to the referral of the patient to Hospice. Authorizes all Hospice initiated orders in person or via the Hospice R.N. Consults on and approves of the patient’s plan of care. Continues to be a valued member of our team!

Hospice Medical Director: 

Hospice Medical Director Corby Kessler, M.D. Consults with Hospice team Consults with the patient’s physician, on request May authorize medications/treatments when the patient’s own physician is unavailable Provides expertise in pain and symptom management Is Board Certified in Hospice & Palliative Care.

Nurse Case Manager: 

Nurse Case Manager Provides on-going assessment and management of pain and other symptoms. Manages and updates the Hospice Plan of Care with the facility team. POC is patient/family directed POC is constantly updated to reflect the patient’s current needs and goals. Educates the patient and family Assumes professional management responsibility for the patient.

Nurse Case Manager: 

Nurse Case Manager Coordinates Hospice Nurse and Aide services Attends IDT meetings with facility staff to coordinate the POC Acts as a resource and support for facility staff A Hospice R.N. is available 24hrs/day, 7 days/week Frequency of Visits: Determined by patient’s/family’s condition and needs No restriction on frequency of visits

Social Worker: 

Social Worker Provides counseling and emotional support for patient and family Assists with financial, legal and insurance issues Identifies community resources and explores options Assists with practical matters: Funeral arrangements Advanced directives, DNR orders

Spiritual Care Provider: 

Spiritual Care Provider Provides spiritual support by counseling, reading, listening, praying. Non-denominational Spiritual – not religious Connects person and family with faith community, coordinates with patient’s clergy. Plans and participates in funerals and memorial services. Provides support for family and caregivers .

Hospice Aide: 

Hospice Aide Provides supplemental personal care: Bathing Oral care Shampoo/shaves Linen changes Assists with ADL’s if indicated on POC: Feeding Dressing Ambulation Transfers

Volunteer: 

Volunteer Specially trained in working with terminally ill patients and their families. Volunteers may provide: Companionship Reading Letter writing Listening to life stories Errands Friendly visitor Drivers for family members to visit Special foods, flowers, music etc. if approved by facility.

Bereavement Counselor: 

Bereavement Counselor Provides support for the family through the grief process Anticipatory grief visits may begin before the patient’s death. Provides individual and group grief counseling services - available for all family members and friends May continue support for up to 13 months after the patient’s death. Available to support facility staff.

SNF Staff Support: 

SNF Staff Support Hospice philosophy promotes providing the same care for staff as is provided for the dying patient and his family. It is natural for us to grieve the loss of our patients. Hospice team members and facility staff are exposed to many deaths. We may feel the effects of cumulative loss.

Other Therapists: 

Other Therapists Dietitian Physical Therapy Occupational Therapy Speech Therapy Pet Therapy

All Therapy Services: 

All Therapy Services Must be authorized by Hospice Must be indicated by the POC Used only to increase comfort or to enhance QOL for the resident. Must be approved of by facility.

How is Hospice paid for?: 

How is Hospice paid for? Medicare Medi-Cal Private Insurance Donations Grants

Other Hospice Services: 

Other Hospice Services Hospice provides medications, supplies and durable medical equipment (DME) to our patients. Included as part of our per diem payment Must be ordered through OUR vendors Must be related to the terminal/hospice diagnosis.

Medications: 

Medications Related to pain caused by the terminal disease. Related to the treatment for terminal/hospice diagnosis Related to the treatment for uncomfortable symptoms: nausea, vomiting, anxiety Bowel medications

3 Goals of Hospice Care at SNFs: 

3 Goals of Hospice Care at SNFs To enhance the QOL for the patient and his family through collaboration and care coordination between the facility staff and Hospice. To join with the facility team in maintaining the dignity of the patient and family. To unite with the facility team to ensure that the patient/family retain their decision making power by providing information, resources and support.

How Can We Meet these Goals?: 

How Can We Meet these Goals? The Hospice team are experts in end-of-life care. Partnership between Hospice and facility staff promotes optimal end-of-life care for the patient and family based on a coordinated plan of care between these two teams. Working together, the resources available to the patient and his family can be maximized. What provides QOL at the end of one’s life is unique to each individual. Only the patient and family can define what will enhance their QOL.

Professional Management: 

Professional Management Professional management for a SNF resident and hospice patient has the same meaning as when the hospice patient is living in his/her own home. Professional management involves assessing, planning, monitoring, directing and evaluating the patient’s hospice care across all settings. Hospice partners with the facility staff to administer medications and therapies included in the plan of care (POC) only to the extent that Hospice would routinely use the services of family members in implementing a POC in the home setting.

Professional Management: 

Professional Management Facility Staff should call Hospice: For ANY change in the patient condition Medications are not effective Patient has a new symptom The patient falls Patient’s catheter is removed or needs to be replaced A new physician’s order is needed Before any transfers to another facility The patient dies 37

Professional Management: 

Professional Management A Hospice Nurse is available: 24 hours a day 7 days a week Weekends and holidays Can make visits as needed Can give phone advice Can call the physician for orders Can support the family at time of death.

PowerPoint Presentation: 

When in doubt call Hospice

In-Service Education: 

In-Service Education To assist staff in understanding and implementing hospice care for the patient and the family. Available topics: Pain Management Comfort Care Symptom Management Death and Dying Grief and Loss Advance Directives

Documentation: 

Documentation Hospice adds a tab to the medical record for easy access to information. Hospice provides documentation of all of the following for every hospice patient in a facility: The most recent hospice POC Hospice election form Advance directives not in the facility chart Physician hospice certification and recertification Hospice staff assigned to that patient Medication list Visit notes

Hospice Does NOT…: 

Hospice Does NOT … Discriminate on the basis of age, gender, race, creed, sexual orientation, diagnosis or ability to pay. Hasten death. Postpone death. Make decisions for the patient or the family. Advocate “protecting” the patient by not being truthful about the patient’s prognosis and disease process. Hospice is not the “Death Team.”

Hospice Does…: 

Hospice Does … Affirm life. Recognize dying as a normal part of life. Recognize dying as a personal experience, with a focus on enhancing the quality of the patient’s remaining life. Promote empowerment by open communication with the patient and family about their disease and its progress so that the patient can exercise freedom of choice by making informed decisions about how he/she wishes to spend the rest of his life and how he/she wants to die.

Hospice Does…: 

Hospice Does … Provide the patient the opportunity to die a comfortable, dignified and natural death. Honor and support the individual choices made by the patient and family. Control pain and other uncomfortable symptoms so that the patient can focus on resolving other life issues such as mending relationships, doing life review, finding the meaning in their lives and in their death process, saying goodbye and obtaining closure.

Hospice Does…: 

Hospice Does … Believe that control of physical, emotional, psychosocial and spiritual pain is paramount and will use aggressive measures to control all types of suffering. Exist in the hope that, if the death process is handled with appropriate care and sensitivity, the patient and family can be free to attain a degree of satisfaction and an opportunity for growth as they prepare for death in the last phase of life.

In Conclusion: 

In Conclusion Optimal end-of-life care can occur when the nursing facility and Hospice can partner to activate a plan of care that is directed by the needs and goals of the patient and family. The sooner that Hospice and the nursing facility can collaborate on the care of a terminally ill patient, the more time Hospice will have to provide support to the patient, the family, and the facility staff.

PowerPoint Presentation: 

“Hospice has given me the vision of things at the end. Not that I’m looking forward to getting there, but I see how it can be. It’s like the word you say the end of a prayer, “Amen”. Hospice is like the amen. It tells me that things are ok. I can rest. I can close my eyes and know it will be okay…” - a hospice patient A Quote from a Facility Patient