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

2. 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.

3. 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

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

5. Predictive Tools
Karnofsky
Palliative Performance Scale

6. 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

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

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

9. 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.”

10. “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?

11. 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

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

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

14. 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

15. Thank you

16. 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.