when is the right time for hospice

WHEN IS THE RIGHT TIME FOR HOSPICE?

We are there when you need us most.

It is about living as well as possible, with comfort, care and safety, up to the time of death.

HOSPICE IS NOT ABOUT DYING

When is the Right Time for Hospice?

Highlight a brief history of the Hospice movement

Review the similarities and differences between Palliative Care and Hospice Care

Explore what Hospice services include

Examine when it might be the right time for Hospice

PRESENTATION OBJECTIVES


The concept of hospice dates back to 475 AD

Derived from the word hospitium

The words hospice, hospital, and hostel were used interchangeably

.

HISTORY OF HOSPICE: “HOSPITALITY”


Originally, hospitia or traveler’s rest provided food, shelter, as well as care for the sick or dying

Until the 1950’s, most Americans were born at home and died at home, surrounded by loved ones.

Death was a natural part of life’s journey.

The goals of healthcare shifted from easing suffering to curing disease; dying patients were given less priority.

Cicely Saunders, the founder of modern hospice, believed that each one of us is unique and has important physical, emotional, social and spiritual needs. She founded the first modern hospice in London in 1967.

HISTORY OF HOSPICE


Today, Americans have come full circle with 85% of us wanting to die at home, yet only about 24% actually die at home.

Visiting Nurse & Hospice Care provides specialized and compassionate care for terminally ill patients with a focus on comfort, symptom management, quality of life, and patient choice.

We have been serving Santa Barbara County since 1908 as a nonprofit home care organization founded by a group of nurses.

HISTORY OF HOSPICE


FOUR LEVELS OF HOSPICE CARE


RoutinePatient at home with symptoms controlled

ContinuousPatient at home with uncontrolled symptoms

Respite CareSkilled Nursing Facility for 5 Days

InpatientSerenity House or contracted hospital or skilled nursing facility

Uncontrolled pain and other symptoms which cannot be managed in another setting

UNDERSTANDING PALLIATIVE CAREvs

HOSPICE CARE

When is the Right Time for Hospice??

SIMILARITIES

Hospice Medicare Benefit: When is the Right Time?

Palliative Care Hospice Care

Pain and Symptom Management Yes Yes

Social, Emotional, and Spiritual Support Yes Yes

Focus on Quality of Life Yes Yes

Family is the Unit of Care Yes Yes

Interdisciplinary Team: RN, MD, MSW, Chaplain Yes Yes

Physician Order for Service Required. Yes Yes

DIFFERENCES

Hospice Medicare Benefit: When is the Right Time?

Palliative Care Hospice Care

Type of Illness Life Threatening Illness Terminal Illness (6 months or less); can be renewed without penalty if in decline

Type of Care Office and home visits by MD, NP, or RN

RN available 24/7 for home visits

Type of Treatment Continue with curative treatments

No longer curative, focus on comfort only

Type of Focus Addresses end of life issues

Focuses on end of life issues

Hospice care is provided to all medically qualified patients and is covered by Medicare, MediCal, insurance companies, or private payment. Under Medicare Part A, Hospice Benefit Terminal illness with 6 month or less prognosis; defined by

Medicare as 180 day prognosis You may have unlimited supply of 60 day Medicare Benefit

periods; you do not run out Patient chooses to receive Hospice care rather than curative

treatments Patient enrolls in a Medicare approved Hospice program

HOW IS HOSPICE PAID FOR?


Cancer patient with metastatic disease

COPD patient with multiple hospital visits

Heart failure patient with shortness of breath in spite of medications

Stroke patient who decided not to have tube feedings

TYPICAL HOSPICE PATIENTS


Advanced Renal Disease

ALS: No Feeding Tube or Ventilator

End Stage Liver Disease

Advanced Dementia: Functional Assessment Scale (FAST) score of 7 and greater, minimal speech, non-ambulatory, Activities of Daily Living (ADL) dependent

Debility/failure to thrive

OTHER DIAGNOSISES QUALIFY FOR HOSPICE


• To respect the values and honor the decisions of our patients

• To relieve pain, fear, and other complex symptoms

• To be by the patient’s side and caregiver’s side so they will not feel alone

• To emphasize and enhance the quality of life

• To support and comfort the entire family

GOALS OF HOSPICE


HOSPICE SERVICES INCLUDE

When is the Right Time for Hospice??

• Specialized healthcare coordinated by the Primary Care Physician and VNHC, including: Medical Director, RNs, Medical Social Workers, Hospice Aides, Chaplains, Bereavement Counselors and trained volunteers

• Medications and equipment related t the primary illness• 24/7 access to RN consultation• Nursing visits as needed, 24/7• Emotional and spiritual support for the patient and family• Assistance with bathing and personal grooming• Education and training on how to care for your loved one at

home.

Registered Nurse

Hospice Physician

Medical Social Worker

Home Health Aide

OUR HOSPICE CARE TEAM INCLUDES


Chaplain

Bereavement Counselor

Integrative Therapies

Music Therapy Trained volunteers including pet therapy

Aromatherapy

Gentle Reflexology

Guided Imagery

Mindfulness Practice

Music Therapy

Reiki

INTEGRATIVE THERAPIES OFFERED


In surveys, 9 out of 10 Americans say that when the end is near, they would prefer to maximize their comfort and minimize the pain and turmoil of treatments.

Despite these expressed wishes, more patients are experiencing ICU admission in the last 30 days (24% in 2000 to 29% in 2009).

Half of all Hospice patients in the U.S. die within one month of enrollment.

28% of patients receiving hospice services were served for less than 4 days.

HOSPICE IN AMERICA


Hospice strives to provide comfort, safety, compassion, and to relieve pain and suffering on many levels.

WHEN IS THE RIGHT TIME FOR HOSPICE?


There has been substantial, unintentional weight loss (10% in the past six months), or a decreased albumin (a blood protein) level.

Your loved one is short of breath at rest and oxygen dependent.

Your loved one is bed bound, incontinent and unable to carry on a meaningful conversation.

There are recurrent urinary infections or aspiration pneumonias.

There has been a debilitating stroke or other acute event from which your loved one is not expected to recover.

THINK OF HOSPICE WHEN…


There has been a rapid functional decline.

There is disease progression despite aggressive chemotherapy or radiation.

A person decides to stop or is failing dialysis.

There have been multiple ED visits or hospitalizations within the past year.

Your loved one or family requests aggressive treatments and/or hospitalizations cease.

A patient seems to be “giving up” and is just dwindling away.


These words may indicate it is time for hospice and Advanced Care Planning

“Dad wouldn’t want this” “There is no quality of life” “We don’t want to go back to the hospital”

Hospice can be an “the best choice” for families and facilities with staff available 24 hrs/day.

HOSPICE AS A PLAN FOR THE FUTURE


A Physician Order for Life Sustaining Treatment (POLST) is a form that gives seriously ill patients more control over their end of life care, including medical treatment, extraordinary measures (such as a ventilator or feeding tube) and CPR.

The POLST is signed by both a doctor and a patient.

It can prevent unwanted or ineffective treatments, reduce patient and family suffering, and ensure that a patient’s wishes are honored.

PHYSICIAN ORDER FOR LIFE SUSTAINING TREATMENT (POLST)


“We wish we would have asked

for hospice services sooner.”

THE MOST COMMON STATEMENT FROM HOSPICE FAMILIES IS


• Discuss the changes you see in your loved ones with them and with their physician.

• Have the discussion about specific choices of care and ask what your loved one will/will not tolerate.

• Have a written Advanced Directive

• Be mindful that patients’ needs can be better served when referred to hospice on a timely basis.

• Request a (no charge) hospice evaluation.

WHAT CAN YOU DO?


We are a nonprofit homecare service and are very proud of our history and commitment to provide compassionate and trusted care for all. Here is a summary of our services during 2014:

• Helped nearly 13,500 people maintain their health, live independently, recover from illness, or transition at end of life with dignity and comfort

• Provided over $2.1 million in charitable community benefit for residents

• 71,285 home health & hospice visits were made to patients

VISITING NURSE & HOSPICE CARE


• 1,212 patients and their families were cared for during the last stage of life, at home or in our Serenity House

• 2,628 patients & families were helped to recover from illness or surgery

• 540 people were helped to remain safe & independent in their homes

• 1,477 family and community members were provided support as they recovered from the loss of a loved one

• 3,389 people borrowed medical equipment, free of charge

• 15,243 hours were donated by volunteers in our community


“You matter because of who you are. You matter

to the last moment of your life, and we will do all we can, not only to help you die peacefully, but also to

live until you die.”

-Dame Cicely Saunders

There when you need us most


Santa Barbara 805.965.5555 ♥ Santa Ynez 805.693.5555 ♥ Lompoc 805.735.4444

www.vnhcsb.org se habla español

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when is the right time for hospice