End of a life: A new perspective Janet N. Goldberg, CrNP Chief Nurse Practitioner, Medical House Call Program MedStar Washington Hospital Center ©AAHCM

cure comfort curehospice cure comfort Patient Clinician Usual Care WHO Model MHCP ©AAHCM

 Hospitalization  Chronic illnesses  Goals of care  Home transition ©AAHCM

 NP Management at home ◦ HF ◦ Dementia/delirium ◦ DM/PVD/Wounds ◦ Pain ◦ FTT ◦ PE/DVT (coumadin management) ◦ ESRD  Re-hospitalized ©AAHCM

 PVD  PE/DVT  Dementia  HF  Anorexia  Hospice? “will talk to family”  Urgent visits ©AAHCM

 Acute UGIB:  “What can we do”  Decision:Hospice  Peaceful death at home ©AAHCM

 Individualized  Partnership  Requires guide and witness  Ongoing system of care ◦ Relationship ◦ Home based  “Good” Death ©AAHCM