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

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

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

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

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

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

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