Palliative Care Leonard Hock, DO, MACOI, CMD, HMDC,FAAHPM CMO, Harbor Palliative Care, President, FMDA

Goals and Objectives Understand and define Palliative Care. Know and educate that performance decline is predictable. Be able to use the “Goals of Care” conversation.

Palliative Care Comfort Symptom assessment and management Conversation Any Symptom; Pain, Breathing, Nausea, Depression, Delirium and on. Conversation Breaking Bad News The Difficult Discussion Goals of Care

Deaths 10% are sudden 90% are predicable Accidents and injuries Intentional Medical 90% are predicable Gentle decline Acute change and recovery

Predictive Tools Karnofsky Palliative Performance Scale

Forty Percent, 40% Family member Care Giver Promise maker Spouse or daughter Care Giver Promise maker Exhausted Care Giver Promise breaker Admitted to Nursing home

Nursing Home Care Professional assessment Needs Medications Safety Physician, nurse, social service, therapists, dietary Needs Diet, hygiene, activities Treatments Medications Reviewed and administered Safety

Best Care Care giver and Promise breaker Care manager and supporter Expectations of Plateau effect or stability

Karnofsky and Palliative Performance Care and environment optimized Best Staffing Best Practices The condition decline continues “What got you here won’t keep you here.” Change in condition “Send them out.”

“Send them out” Acute assessment and treatment Hospital admission And risk management Hospital admission Some data points corrected Patient weaker Discharge planning Returned to Nursing home Seamless transition of care?

Emotions of Decline Disbelief Anger Bargaining Depression Acceptance “It couldn’t be. I just saw her yesterday.” Anger “Why did she fall?” “The hospital released her too soon.” Bargaining “Maybe I should find a better Nursing home.” Depression Acceptance

Palliative Care Be trusted Defeat denial Establish prognosis Use Principle of Substituted Judgement Form the Goals of Care

Goals of Care Conversation Plan meeting Sit down Ask, don’t tell How, how and how? What would he/she want? We can help

Palliative Care The Goals of Care conversation can Prepare emotions for condition decline Reduce the “Send them out” factor Reduce futile hospital treatments Save money Respect the wishes of the resident/patient

Thank you

References The Palliative Performance Scale Karnofsky tool Norton SA, et al. Proactive palliative care in ICU. Crit.Care 2007 Henderson RG, et al. Using Rothman Index.JHPN 2017 TrustBridge conversation, proprietory.