HOSPICE 101 Another choice for patients facing a terminal prognosis. De Anna Looper, RN, CHPN, CHPCA Senior Vice President of Clinical Operations Carrefour Associates L.L.C.
HOSPICE 101 Patients and their families want better end-of-life care, and healthcare professionals, especially physicians, would like to provide it. But in today s society, where aggressive, high-tech care is the norm, presenting the option of palliative care can be difficult. Hospice care can offer patients and families another choice when facing a terminal prognosis. Determining Prognosis Determining when a patient has reached the terminal phase is paramount. The earlier hospice is introduced to a patient and their families, the more benefits they can receive. Hospice criteria and eligibility is not as difficult as it may seem. Hospice utilizes Local Determination Coverage guidelines (LCD), which were implemented by CMS (Centers for Medicare and Medicaid Services). Disease Specific Criteria Identifying a hospice eligible patient can be simplified by first, identifying a diagnosis. Malignant diagnoses are much easier to determine a prognosis. Non-malignant diseases are sometimes overlooked. There is a set of simplified criteria that can be followed based on the patient s diagnosis.
Disease Specific Criteria Guidelines Malignant / Cancer Diagnosis Patient with cancer qualifies for hospice once they have elected to forgo further curative treatment. Any type of cancer qualifies for hospice. Dementia and Alzheimer s Disease Weight Loss Change in Functional Status Skin breakdown Change in orientation status Change in ambulatory status Change in intake Speech impairment Urinary & fecal incontinence Dysphagia Aspiration Pneumonia Albumin < 2.8 gm/dl Comorbid conditions Cardiopulmonary Disease Respiratory Infections Angina Changes in cardiac output Edema Cough Dyspnea Oxygen dependence Changes in functional status Fatigue Weight changes Comorbid conditions
Disease Specific Criteria Guidelines (cont.) Debility / Failure to Thrive Weight loss BMI < 22 Change in functional status Dependence with ADL s Frequent medication changes / adjustments Fatigue Weakness Muscle Wasting Frequent Infections Comorbid conditions Discontinuing Hospice Care Discontinuing hospice care is simple. If a patient / family has decided to pursue curative treatment at any time, the patient is immediately discharged. The hospice will ensure that the care from hospice to conventional care is coordinated during the discharge process. If at any time in the future the patient decides to choose hospice, they can be readmitted easily.
Bereavement Support Hospice doesn t stop after the death of the patient. The patient and family are viewed as one unit; therefore the family continues to receive hospice support after the death of the patient for a minimum of 13-months. Grief cannot be placed on a timetable; therefore Crossroads Hospice will continue to support the family as long as they need support. Referring a Patient to Hospice Referring a patient to Crossroads Hospice is simple. Contact the Crossroads Hospice in your area and we will do the rest. A qualified Registered Nurse will perform an assessment to determine if the patient qualifies for services. Once the patient has been deemed appropriate, care begins as soon as the family/patient elects hospice care. The nurse will contact the physician for specific orders and a hospice plan of care is implemented to ensure the comfort and dignity of the patient is maintained throughout the hospice admission. How to Locate a Reputable Hospice? You can contact your local hospice and palliative care organization to find a reputable hospice in your area or you can contact Crossroads Hospice at www.crossroadshospice.com or by calling (888) 909-6673.
888-909-MORE (6673) www.crossroadshospice.com