Achieving earlier entry to hospice care: Issues and strategies. Sonia Lee, APN, GCNS-BC
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1 Achieving earlier entry to hospice care: Issues and strategies Sonia Lee, APN, GCNS-BC
2 Objectives The learner will: Describe the benefits of hospice List at least barriers to early hospice care List at least 2 strategies to early hospice admission The presenter has no financial relationships to disclose
3 The hallmark of hospice care View the patients and families as a single unit of care Focus on care and palliation rather than cure Goal of improving quality of life so patients may live until they die
4 An interdisciplinary approach Nurse Volunteer Physician Chaplain Patient & family Nursing assistant Social worker Bereavement counselor Nurse
5 The hospice care team addresses: pain and symptom control Psychosocial distress and spiritual issues Prepare patient and family for dying and death
6 Eligibility for Hospice Care Patients who desire to end curative phase of treatment. Patients who want to be kept as physically, emotionally and spiritually comfortable as possible. Patients with a prognosis of 6 months or less, if the disease is left untreated and follows its natural course.
7 The problem Most of the patients enroll in hospice too late to receive its full benefit Late enrollment is associated with shorter LOS and lower satisfaction with hospice No time to develop plan of care or prepare patient and family
8 The last days Hospice use: Increase from 22% (2000) to 42% (2009) 33% die within 7 days 28% die within 3 days Increase in ICU in the last month of life 24% (2000) to 30% (2009) Only 45% died in hospice
9 Category of barriers to early access Misconceptions of hospice Emotional hindrance Financial issues Regulatory barriers
10 Misconceptions Hospice as a place Unaware of symptom management Reserved for actively dying When care cannot be handled Equate with no treatment Hospice expedite death Only for cancer patients
11 Emotional blockage Refusal or failure to acknowledge terminality Desire to pursue further treatment Denial or avoidance Equate with giving up hope HC providers not communicating and/or not listening to end-of-life wishes
12 Financial issues Use of post-hospital skilled nursing days for end-of-life care Financial penalties for NHs and patients/families Choosing SNF over hospice
13 Regulatory barriers No simultaneous access to SNF care and hospice for the same condition. No home rehab in hospice Need for hospital/hospice models
14 Strategies for early access to hospice Be knowledgeable about hospice and its benefits Have crucial conversations Make recommendation for hospice; Patients depend on HC providers to make hospice referral at the right time Partner with palliative care consult
15 Increase awareness in all sites Clinics- downward trajectory ED- the frequent flyers Physician s office- refractory to treatments Hospitals- complications from the treatments More important to receive a wrong referral than to miss a hospice referral that is needed
16 Know about hospice benefits Misconceptions Hospice as a place Only for cancer patients Unaware of symptom management Reserved for actively dying When care cannot be handled Equate with no treatment Hospice expedite death Defining hospice Quality, compassionate care for people with life limiting or life threatening illness or injury. It is tailored to each patient s needs and wishes. Hospice is not meant to prolong life nor to hasten death but rather to maximize patients quality of life as they travel along this last journey.
17 Why choose hospice? Terminally ill patients who chose hospice care lived an average of one month longer than similar patients who did not choose hospice care
18 Practical tips for early access Would you be surprised if the patient died within the year? Earlier discussion about care options and goals of care Explore patient/family s perception of hospice Explain hospice as an insurance option
19 Hospice as an insurance option Medicare part A What does Medicare cover? Physician and nurse services Medical equipment Medical supplies Medications related to hospice diagnosis Health aide services Social worker services
20 The crucial conversation Discussion about goals of care What does he/she think is happening What are the goals, given the circumstances Identify and assess the benefits and burdens of various options
21 Palliative consult For symptom management Collaboration of care; the big picture Goals of care discussions Co-exist with rehab in SNF No conflict with home health Simultaneous with curative care
22 In summary Hospice care enhances patient s QOL and support family Hospice is an under-utilized The NPs and PA can play a vital role in providing early access to hospice
23 Objectives The learner will: Describe the benefits of hospice List at least barriers to early hospice care List at least 2 strategies to early hospice admission
24 Questions?
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