August 16, Healthy Living Conference For Seniors and Caregivers VITAS 1. What we Know. Defining Palliative Care: Comfort. Symptom Management.

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1 Comfort. Symptom Management. Respect. & Hospice Care Pam Wright, LCSW Licensed Clinical Social Worker What we Know Defining : Palliative care is medical care that relieves pain, symptoms and stress caused by serious illnesses, improving patients' quality of life. Hospital or Home Program Hospice Care 6 months or less VITAS 1

2 Definition of Palliative care means patient and family-centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care should be given throughout the continuum of illness and involve management physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice. 73 FR 32204, June 5, 2008 Medicare Hospice Conditions of Participation Final RuleVCopyright 2008 Center to Advance. Reproduction by permission only. Defining Curative Care vs. Curative Care Oriented towards curing, healing, or repairing an existing disease or medical condition Treatment, surgeries and therapies are provided with the intent to improve symptoms and cure the medical problem Patient and family centered care Anticipate, prevent, and treat suffering Used during continuum of the illness Physical, intellectual, emotional, social, spiritual needs Facilitate patient autonomy, access to information and choice And Why it s Necessary Suffering Overwhelmed family caregivers Mismatched communication Extreme reliance on the Emergency Room and Hospital to manage symptoms VITAS 2

3 Sirovich et al. Annals Intern Med 2006; 144: What Palliative Patients Want In a 2006 study, patients in highintensity hospital service areas reported lower quality of: Emotional support Shared decision-making Information about what to expect Respectful treatment Image: Macmillan Cancer Support accessed 8/2014; Sirovich et al. Annals Intern Med 2006; 144: Team Interdisciplinary team consultants Focuses on 3 domains: Relieve physical and emotional suffering Improve patient-physician-family communication and decisionmaking Strengthen transition management and ensuring consistent care across settings Billed as a Doctor s Visit Includes curative therapies Pre-hospice services Video: What is? VITAS 3

4 Frequently Asked Questions Who requires palliative care? Palliative care is appropriate for anyone suffering a serious, chronic or life-threatening illness (e.g., cancer, cardiac disease, respiratory disease, kidney failure, Alzheimer s, AIDS, amyotrophic lateral sclerosis (ALS) and more). You can receive palliative care at any age at any stage of an illness. How do you pay for palliative care? Palliative care is treated in the same way as medical services (e.g. cardiology). Most insurance plans, including Medicare and Medicaid, cover all or part of palliative care. Do patients have to give up their own doctor? No. Palliative care teams are consultants and work along with the primary doctor. Hospice Defining Hospice Care: Hospice care is a type of care and philosophy of care that focuses on the palliation of terminally ill patient's pain and symptoms, and attending to their emotional, social, and spiritual needs. Hospital or Home Program Hospice Care 6 months or less VITAS 4

5 Hospice: Distinct from Palliative Care Interdisciplinary care for patients with serious life-limiting illnesses Prognosis estimated at less than 6 months if disease runs its expected course Emphasizes pain and symptom management and psychosocial/spiritual support Primary goals relate to quality of life and symptom control Is tailored to the needs and wishes of patients and their families Hospice Palliative Care How and Hospice Work Together. Which patients might benefit from hospice? Hospice is appropriate for patients with: unrelieved pain frequent infections repeated emergency room visits for the same symptoms or condition repeated hospitalization for the same symptoms or condition intensive care without improvement progressive decline despite optimal swallowing chronic weight loss/difficulty swallowing nausea and vomiting shortness of breath and oxygen dependence 3 VITAS Data on File VITAS 5

6 What benefits does hospice offer? When the side effects and intensity of treatment begin to outweigh any expected benefit, hospice can help: control pain manage symptoms facilitate comfort address the spiritual needs of the patient and family provide grief and bereavement counseling after the patient's death Hospice plays a key role in satisfaction at the end of life. Hospice may actually prolong life by as much as 29 days. 3 3 Connor SR, Pyenson B, Fitch K, Spense C, Iwasaki K. Comparing hospice and nonhospice patient survival among patients who die within a three year window. Journal of Pain and Symptom Management Mar;33(3): ) Patients on Hospice Live Longer Recent study of 4,493 patients with CHF or cancer of breast, colon, lung, prostate or pancreas Mean survival was 29 days longer with hospice care than those with no palliative care Journal of Pain and Symptom Management March, 2007 Addressing the unique needs of each person VITAS 6

7 At what point should hospice be recommended? In general, hospice patients are expected to live 6 months or less. Not based on science Hospice care is optimal when provided for months, rather than for weeks or days. Currently, 30 percent of hospice patients die less than one week after admission because they, their physicians or caregivers waited too long to call hospice. 4 Given the time, hospice patients can visit with loved ones, get outdoors, witness family milestones and put their affairs in order. 4 National Hospice and Organization. NHCPO Facts & Figures: Hospice Care in America VITAS Data on File Who pays for Hospice? Medicare and MediCal cover 100 percent of the cost of care. Most private insurance plans cover hospice. Veterans Administration/ Tricare Charity Care Hospice Care Life expectancy is 6 months or less if the illness runs its normal and expected course and Certified by two physicians Primary MD and Hospice MD Includes Physician house calls, Nursing, Social Work, Chaplain, Home Health Aide Services, and Community Volunteers Medications related to terminal diagnosis delivered to home with comfort pack Medical equipment and supplies (Incontinence supplies, gloves, etc.) delivered to home Labs, Physical Therapy, Occupational Therapy, Dietary and Speech Therapy VITAS 7

8 Thinking ahead and ready to act Hospice Care is 24 Hours a Day, Seven Days a Week, including Holidays. Care is centered around the patient s convenience Routine Inpatient Continuous Care Respite There for those who need us most Bereavement Hospice provides care for the family through comprehensive bereavement services For at least one year following a death, hospice provides: Letters and cards about what to expect Phone calls and Visits Bereavement support groups Annual memorial services Memory Bears Thank You. Questions? VITAS 8