Palliative Care and Hospice University of Illinois at Chicago College of Nursing 1
Learning Objectives Upon completion of this module, participants will be better able to: 1. Describe Palliative Care 2. Define Hospice 3. Differentiate between Palliative Care and Hospice 4. Identify qualifications for enrolling in Palliative Care and/or Hospice
What is Palliative Care? Care for a person with a serious illness. (definition) Health condition that carries a high risk of mortality and either negatively impacts a person s daily function or quality of life or excessively strains their caregiver. (Kelley, 2018) A focus on expert assessment and management of: Pain and other symptoms Caregiver needs Coordination of care Care that attends to the physical, functional, psychological, practical and spiritual consequences of a serious illness. (National Palliative Care Consensus Guidelines, 2018)
Palliative Care HOWEVER, depending on the audience, the concept may be defined differently: Center for Medicare and Medicaid Services Center to Advance Palliative Care and The American Cancer Society patient and family centered care that optimizes quality of life by anticipating, preventing, and treating suffering. Palliative care throughout the continuum of illness involves addressing physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice. (cms.gov, 2014) Palliative care is specialized medical care for people with serious illness. It focuses on providing relief from the symptoms and stress of a serious illness. The goal is to improve quality of life for both the patient and the family. Palliative care is provided by a team of palliative care doctors, nurses, social workers and others who work together with a patient s other doctors to provide an extra layer of support. It is appropriate at any age and at any stage in a serious illness and can be provided along with curative treatment. (Center to Advance Palliative Care)
Center to Advance Palliative Care As illness weakens the foundation, Palliative Care provides stronger layers of support
Hospice A specific type of palliative care provided to individuals with a life expectancy measured in months, not years Interdisciplinary care of hospice teams providing patients and families with expert medical care, emotional, and spiritual support, focusing on improving patient and family quality of life Eligibility: adult patients must have a defined, time-limited prognosis (certified by two physicians as six months or less if the disease follows its usual course) and desire care focused on comfort, foregoing insurance coverage for further terminal disease-directed curative treatment efforts
What is Hospice? Hospice is care offered toward a different goal: maintaining or improving quality of life for someone whose illness, disease or condition is unlikely to be cured Individualized care; updated as needed to address the physical, emotional and spiritual pain that often accompanies terminal illness Provider of practical support for the caregiver(s) during the illness and grief support after the death Hospice is something more that is available to the patient and the entire family when curative measures have been exhausted and life prognosis is six months or less (Hospice Foundation of America)
Potential Services by Hospice (required under Medicare rules) Time and services of the care team, including visits to the patient s location by the hospice physician, nurse, medical social worker, homehealth aide and chaplain/spiritual adviser Medication for symptom control or pain relief Medical equipment like wheelchairs or walkers and medical supplies like bandages and catheters Physical and occupational therapy Speech-language pathology services Dietary counseling Any other Medicare-covered services needed to manage pain and other symptoms related to the terminal illness, as recommended by the hospice team Short-term inpatient care (e.g. when adequate pain and symptom management cannot be achieved in the home setting) Short-term respite care (e.g. temporary relief from caregiving to avoid or address caregiver burnout ) Grief and loss counseling for patient and loved ones
What is NOT covered by Hospice? Not all services provided to patients enrolled in hospice care are covered by the Medicare Hospice Benefit. The benefit will not pay for: Treatment intended to cure your terminal illness or unrelated to that illness Prescription drugs to cure your illness or unrelated to that illness Room and board in a nursing home or hospice residential facility Care in an emergency room, inpatient facility care or ambulance transportation, unless it is either arranged by the hospice team or is unrelated to the terminal illness 24-hour care in a private home
Hospice Additional support through Hospice for those in the home: The day-to-day care of a person dying at home is provided by family and friends The hospice team coaches family members on how to care for the dying person and even provides respite care when caregivers need a break Respite care varies in length (individualized not standardized)
Palliative Care vs Hospice Palliative Care is the umbrella term that hospice falls under
Differences
Differences (continued) NIH, 2017)
Hospice What does the 6-Month requirement mean for hospice care? Best professional estimation for life expectancy Some live beyond their initial 6-month hospice enrollment To continue hospice services, must be re-certified by two physicians who again best estimate life expectancy of 6 months or less
How does one decide Palliative Care vs Hospice Care? First step, discuss with the healthcare provider about what to expect for an illness following a typical (downward) trajectory Determine what types of assistance is needed Obtain referral
Model adapted from WHO
Model of Care
Canadian Bow Tie Model of 21 st Century Palliative Care Hawley, 2014
Statistics: Palliative Care Approximately 90 million Americans are living with serious illness, and this number is expected to more than double over the next 25 years with the aging of the baby boomers. Illnesses most commonly treated by palliative care are heart disease, cancer, stroke, diabetes, renal disease, Parkinson s and Alzheimer s disease Approximately 68% of Medicare costs are related to people with four or more chronic conditions the typical palliative care patient Approximately 61% of all hospitals with more than 50 or more beds have a palliative care team today Where you live matters when it comes to access to hospital palliative care. (See the palliative care national and state-bystate report card at capc.org/reportcard) Once informed about Palliative Care, 95% of poll respondents agreed that it is important that patients with serious illness and their families be educated about palliative care. 92% of poll respondents said they would be likely to consider palliative care for a loved one if they had a serious illness. 92% of poll respondents said it is important that palliative care services be made available at all hospitals for patients with serious illness and their families (CAPC)
Statistics: Hospice NHPCO, 2018
Statistics: Hospice NHPCO, 2018
Statistics: Hospice NHPCO, 2018
Statistics: Hospice length of service NHPCO, 2018
Qualifications for Palliative Care Palliative care is NOT hospice care Palliative Care is for people of any age and at any stage in an illness, whether that illness is curable, chronic, or life-threatening Individuals suffering from symptoms of a disease or disorder, should ask their current provider for a referral for a palliative care consult Consultation: Specialty trained Palliative Care Physicians and Nurse Practitioners o Found with Hospitals, Specialty practices, Home Health Agencies, Hospice Programs, Clinics o In turn, referral may be made to others on the team such as chaplain, social worker, therapist or other professions if needed Collaborates, communicates and keeps in touch with the referring provider Location: place of residence, office/clinic, hospital, emergency department
Palliative vs Hospice Care Duration of Palliative Care Services As long as needed; care can increase as condition worsens. Medicare Coverage Medicare Part B Some treatments or medications may not be covered May be subject to the Part B co-pay (plan dependent) Medicaid Coverage Palliative care services may be covered by Medicaid Private Insurance Coverage Most health plans offer coverage; plan dependent
Palliative vs Hospice Care Duration of Hospice Care Services Indefinitely as long as the person meets the qualifications (6-month or less life expectancy) Typically care is provided for months, not years. Medicare Coverage Medicare Hospice Benefit covers pays the costs of care related to the serious illness that qualified the person for hospice coverage. There may be medications, services or equipment not covered. Medicaid Coverage States vary with the Hospice benefits offered under Medicaid Private Insurance Coverage Most health plans offer coverage and follow the Medicare Benefit rules
Client Member Education Palliative Care and Hospice assist individuals with any serious illness.not just cancer Available urban and rural Some programs work together. This promotes continuity of care and care needs change Support is also for the significant others, NOT just the individual
Resources Cancer Care. https://www.cancercare.org/tagged/palliative_care Get Palliative Care. https://getpalliativecare.org/resources/ National Hospice and Palliative Care Organization. https://www.nhpco.org/resources/end-life-care--resources Palliative Doctors. http://palliativedoctors.org/start/resources
Resources
References Center to Advance Palliative Care. Get palliative care. https://getpalliativecare.org/ Centers for Medicare and Medicaid Services, Department of Health and Human Services. Hospice care. Code of Federal Register. 79 FR 50509, August 22, 2014. https://www.ecfr.gov/cgi-bin/textidx?sid=95c732ed603d39aed3682d6371ca27ea&mc=true&node=se42.3.418_13&rgn=div8. Hawley, The Bow Tie Model of 21st Century Palliative Care Hawley, P. H. (2014). Journal of Pain and Symptom Management, Volume 47, Issue 1, e2 - e5. https://www.jpsmjournal.com/article/s0885-3924(13)00609-x/abstract Hospice Foundation of America. https://hospicefoundation.org/hospice-care/hospice-services Kelley AS, Bollens-Lund, E. (2018) Identifying the population with serious illness: the denominator challenge. Journal of Palliative Medicine. 2018; 21(S2). https://www.liebertpub.com/doi/full/10.1089/jpm.2017.0548, Published March 2, 2018. National Consensus Project for Quality Palliative Care. Clinical Practice Guidelines for Quality Palliative Care, 4th edition. Richmond, VA: National Coalition for Hospice and Palliative Care; 2018. https://www.nationalcoalitionhpc.org/ncp. National Coalition for Hospice and Palliative Care http://www.nationalcoalitionhpc.org/ncp/ NHPCO. (2018) Facts and Figures. Alexandria, VA. Revised edition April 2018. DHS. NIH. National Institute on Aging. (2017) https://www.nia.nih.gov/health/what-are-palliativecare-and-hospice-care#palliative-vs-hospice
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