An Overview of Hospice for Health Care & Human Service Providers Dr. BC Farnham & Elizabeth Pugh, LBSW, CM

Important Information This education program for healthcare professionals was developed by The Consortium for Advancements in Health and Human Services, Inc. (CAHHS) and is facilitated by Kindred at Home via a community education partnership agreement. CAHHS is a private corporation and is solely responsible for the development, implementation and evaluation of its educational programs. There is no fee associated with receiving contact hours for participating in this program titled, An Overview of Hospice for Health Care & Human Service Providers. However, participants wishing to receive contact hours must offer a signature on the sign-in sheet, attend the entire program and complete a program evaluation form. The Consortium for Advancements in Health and Human Services, Inc. is an approved provider of continuing nursing education by the Alabama State Nurses Association, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. The Consortium for Advancements in Health & Human Services, Inc., is approved as a provider of continuing education in Social Work by the Alabama Board of Social Work Examiners, #0356, Expiration Date: 10/31/2018. This program is Approved by the National Association of Social Workers (Approval #886506902) for 1- Pain/Symptom Management continuing education contact hour. In most states, boards providing oversight for nursing and social work recognize contact hours awarded by organizations who are approved by another state's board as a provider of continuing education.  If you have questions about acceptance of contact hours awarded by our organization, please contact your specific state board to determine its requirements. Provider status will be listed on your certificate. CAHHS does not offer free replacement certificates to participants. In the event that CAHHS elects to provide a replacement certificate, there will be a $20.00 administrative fee charged to the individual who requests it.

Learning Objectives Participants completing this continuing education program will be able to: Discuss the primary elements of hospice philosophy. Identify basic hospice admission criteria. Discuss trends in the utilization of hospice care. Identify the core services available to patients and their families who receive hospice care.

Hospice Philosophy Hospice is a philosophy of care where death is recognized as a natural stage of life. The goal of hospice is to enable patients to live as alert and pain-free as possible. Symptoms are controlled enabling days to be filled with dignity, quality, and to be shared with loved ones. Delivered by highly skilled professionals with expertise and compassion, hospice offers care to the patient and support for the family unit as a whole. The word “hospice” stems from the Latin word “hospitium” meaning guesthouse. It was originally used to describe a place of shelter for weary and sick travelers returning from religious pilgrimages during medieval times. The modern hospice movement began with Dame Cicely Saunders in London in 1967. She made it possible for patients to have access to the best medication available to control their pain so that they and their families could address important emotional and spiritual challenges.

What is Hospice? Hospice is a specialized form of health care services provided to patients and families experiencing a life threatening illness. Hospice focuses on palliative measures rather than curative measures. Hospice treats the patient and family as one unit. Hospice treats from the holistic modality, which encompasses the medical, social, emotional, and spiritual elements of the patient’s life.

Admission Criteria Patients are appropriately admitted when their physician determines the patient has a life-limiting prognosis of 6 months or less should the disease proceed its normal course; and the patient and family choose a palliative plan of care, rather than curative treatment. Once these are discussed, hospice is called in for a home visit to continue these conversations with the patient and family and determine which services they need and want.

Frequent Diagnosis: Patients with cancer compose 46% of hospice admissions. End stage heart disease Dementia Lung diseases End stage kidney disease Diagnosis worksheets and educational materials are available to support you in determining if a patient is appropriate for hospice services. NOTE TO FACILITATOR: Walk participants through the diagnosis worksheets provided by your organization. Give each participant a copy of your organization’s diagnosis worksheets. It is important to communicate that all hospices are required to use the same admission criteria as it is outlined by CMS or each diagnosis.

An Important Question to Consider: Would you be surprised to learn the patient died within the next 6 months? If you answer “no” to this question, then a hospice referral is likely appropriate.

Growth in US Hospice Programs: NOTE TO FACILITATOR: Review graph with participants. It is important to discuss the upward trend in hospice growth rates, as demonstrated by the graph.

Continued Growth in Patients Served: [SLIDE 10] NOTE TO FACILITATOR: Review graph with participants. It is important to discuss the upward trend in hospice utilization rates, as demonstrated by the graph.

Shift in Cancer Diagnosis Statistics: [SLIDE 12] NOTE TO FACILITATOR: This slide represents the shift in percentage of patients served with cancer. This graph demonstrates that the majority of patients being served by hospice programs are not patients with cancer.

Mission is Being Accomplished [SLIDE 13] NOTE TO FACILITATOR: Review slide with participants, as it has meaningful statistics offered by NHPCO.

Populations Served: [SLIDE 14] NOTE TO FACILIATOR: Simply review slide. It is important to note the lower number or percentages of diverse populations served by hospice. The primary group served is White/non-Hispanic.

Comfort… Nurses expertly trained in pain control and symptom management care for each patient’s individual needs while respecting their personal choices regarding medication and treatment. Home medical equipment and supplies related to the illness, such as wheel chairs and oxygen, are provided to increase patient comfort. Support extends beyond physical needs to include the emotional through the hospice team of social workers, clergy and bereavement counselors. Palliative chemotherapeutics and radiation are available to increase patient comfort as well as physical, occupational & speech therapies for the alleviation of symptoms.

Why is Hospice Care Unique? Hospice services are designed to support both the patient and family members. The core of hospice care is focused on: comfort, support, choice, enriching the quality of life and bereavement care.

Support… Hospice becomes a multifaceted support system to patient and family, arranging every aspect of care in regard to the illness-- physical, emotional and spiritual. Services are based on patient’s needs and include routine home care, general inpatient care, continuous care and respite care. Though family members provide a majority of patient care, it is a cooperative effort between family, friends and hospice. The hospice team approach allows for a broad range of care. Many physicians find that hospice services greatly enhance and extend the care they provide. In all cases there are ongoing assessments of the patient’s health and comfort level. Care is provided by nurses, social workers, certified nursing assistants, pastors, and volunteers.

Support… The depth of hospice services increases as new needs arise and the patient’s health begins to change. While hospice may be needed less frequently in the beginning the team continues to adjust the level of care. Plans of care are developed with the patient, their family and the physician who is actively involved in the caregiving process. Skilled nursing support is available 24 hours, seven days a week.

Choice… Hospice services are about empowerment - empowering patients to maintain their dignity, empowering self-directed care, empowering their freedom of choice. As much as possible, hospice helps patients’ face the conclusion of life on their own terms. Patients and family are involved in all caregiving choices and the caregiving process. Individual plans of care are developed through a team effort with the patient, their physician, family and hospice. A patient may choose to withdraw from the hospice plan of care at any time to seek medical treatment that may become available or for any other reason.

Enriching the Quality of Life… Hospice nurses’ expert training in pain relief and symptom control enhances the patient’s ability to live as actively and pain free as possible. Hospice strives for days free from pain, days free of symptoms, days to participate in life.

Enriching the Quality of Life… Since hospice services are about quality of life, hospice helps patients remain home whenever possible as well as provide care in higher skilled facilities. Hospice encourages an environment where patients have the opportunity to express their feelings, and to share and relish the time that remains. As much as possible hospice helps patients face the conclusion of life on their own terms.

Bereavement Support… Hospice programs bring comfort to those facing the passing of a loved one. Comfort that comes in many forms from a shoulder to cry on, to an understanding ear, but always through the strength of a supportive team trained in bereavement care. Hospice guides the family from understanding their emotions, into coping and forward onto healing. By guiding them through the healing process, hospice help families in time, gain acceptance and refocus their lives. Bereavement support begins at first contact. Becoming an extended member of the patient’s family early on enables hospice to be a stronger support system for the family as the illness progresses. Often, hospice finds patients are comforted by knowing professionals will be there to care for their families in those emotional days to come. Bereavement continues for a year following their loved one’s passing. This depth of support is part of every hospice plan of care making hospice services unique.

Medical Equipment and Supplies Hospital Bed Oxygen Wheelchair Bedside Commode Nebulizer Suction Machine Diapers, Under pads Wound care items Other essentials to provide proper care

Medications All medications related to the terminal diagnosis Ordered by the patient’s physician and coordinated through hospice and approved pharmacy.

Hospitalization / Ambulance Transportation Must be related to the hospice diagnosis Must be pre approved Must be a contracted facility (patients are given a list upon admission)

Levels of Care Routine Continuous Care Respite Care Inpatient Care

Who Pays for Hospice Care? Medicare Medicaid (depending on each State’s guidelines) Private Insurance Some patient’s elect a private pay option.

False Statements About Hospice Care: Patient and family have to be “ready” to die to receive hospice. Patient must give up all treatments related to the terminal illness in order to receive hospice (tube feeding, therapies, wound care, IV’s, chemo, radiation). Patient must have a DNR to receive hospice. Patients can’t go back to the hospital if on hospice. Patients can’t have hospice and home health at the same time. Hospice care only provides medical services Patients have to give up their attending physicians The hospice benefit lasts only 6 months

Tips: Communicating About Hospice Care Points For Health Care Providers to Consider- 1. Don't assume patients and families don't want to talk about death and terminal nature of their illness. Many times they do. 2. Be sensitive to their sensitivities. 3. Be honest, always. 4. Encourage patients and their family members to tell you what they're afraid of, even if it's hard to talk about. 5. Don't dismiss your own fears. They matter, too. 6. Hospice is available to meet with you and your patients to discuss hospice care at your office, the hospital or the patient’s home. Nathan Hurst, Seattle Times staff reporter

They wish they had received services sooner. Did you know…. Most patients and families say their primary complaint with hospice care is--- They wish they had received services sooner.

Additional Benefits to Health Care Providers and Patients Reduced phone calls from patients/ families.  Decrease anxiety especially with out of town families. Better compliance with medication regime and appointments. Hospice team members has a presence in the home providing a better understanding of family dynamics and can help coordinate care. Hospice can coordinate nursing home admission with physician if patient is unable to be cared for at home. Reduced hospitalizations. More satisfied patients.

How Can You Help? Talk with your patients about end-of-life care and hospice services Make a referral Request a speaker for your next staff meeting or community event Help recruit hospice volunteers Tell others what you have heard about hospice today

Questions & Answers:

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