Working Together Providing Quality End of Life Care

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Working Together Providing Quality End of Life
Care
Presented by Jan Nowak LBSW Brenda
Schoenherr Social Worker Program
Director Dowagiac Nursing Home RN, NHA, BBL, MBA
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(No Transcript)
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Interesting Statistic

• Did you know that the studies are showing that
  10 to 20 of the residents in a Long Term Care
  setting, at any time, are appropriate for Hospice
  care?

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Changes in the Environment

• Decreasing Length of Stay
• Increase in number of younger residents
• Increase in complex/high tech admits
• Increase in elderly care givers
• Increase in working care givers

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The Continuum of Care

• ACUTE CARE
• Focus is on active treatment/intervention to
  cure, alter or prevent disease and/or to prolong
  life.
• May include palliative care as part of the
  continuum.
• Delivered by multiple disciplines in various
  modes.

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Curative/Disease Focus

• Diagnosis of disease related symptoms
• Curing of disease
• Treatment of disease
• Alleviation of symptoms

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The Continuum of Care contd

• PALLIATIVE CARE
• Focus is on relief of suffering and improving the
  quality of life.
• May be combined with curative therapies.
• Delivered in an interdisciplinary manner.

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Palliative Focus

• Pt/family identify unique end-of-life goals
• Assess how symptoms, issues are helping/
  hindering reaching goals
• Interventions to assist in reaching end-of-life
  goals
• Quality of life closure

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Location of Death, 1997
www.chcr.brown.edu/dying/forresearcherssod.htm
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Applicability of Palliative Care
Life Closure
Last Hours of Life
Therapy to Modify Disease
Palliative Care
Bereavement Care
Therapy to Relieve Suffering and/or
Improve Quality of Life
6 Mos
Death
Presentation/ Diagnosis
Illness
Advanced Life-threatening
Acute
Chronic
Hospice Care
Attribution Ferris FD, Balfour HM, Farley J,
Hardwick M, Lamontagne C, Lundy M, Syme A, West
P, 2001 Proposed Norms of Practice for Hospice
Palliative Care, Ottawa, ON Canadian Palliative
Care Association, 2001
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Hospice care is always palliative.Palliative
care is NOT always Hospice.
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Why Partner?

• A partnership between the nursing facility and
  the hospice interdisciplinary team provides the
  best approach to palliative care and optimal
  end-of-life experiences for dying residents and
  their family members.

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Benefits

• A partnership allows for
• Expertise by varied disciplines from both the
  hospice and nursing facility.
• Collaborative care planning.
• Resident and family involvement in
  decision-making.

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Certification for Care

• To qualify for hospice care a physician needs to
  certify that the resident has a life expectancy
  of 6 months or less if their illness runs its
  expected course.

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The Medicare Hospice Levels of Care

• There are 4 levels of care provided by Hospice.
• 1. Respite. The resident is entitled to up to 5
  days of Respite care usually provided in our
  contracted Long Term Care facilities to give the
  family a rest period from the care of the
  resident
• 2. Continuous Care. When the residents symptoms
  are out of control, Hospice will provide
  continuous care, 11 staffing. Examples of
  symptoms out of control include pain, severe
  anxiety, nausea/vomiting.

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Level of Care, continued

• 3. Inpatient. The hospice resident may be
  admitted to a hospital or in a Long Term Care
  facility for treatment or symptoms out of
  control. An RN must be on the floor providing
  care to meet regulatory compliance.
• 4. Home Hospice Care. Hospice Home care visits
  are made to residents and caregivers to assess
  their needs. The facility is the residents home
  and the facility staff are also the primary
  caregivers.

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Locations for Hospice Care

• Care can be provided in
• Home
• Nursing Home
• Hospice facilities
• Adult foster care
• Assisted living facilities
• Hospital

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Interdisciplinary team

• RN
• MSW
• Physician
• Medical Director
• Chaplain
• Hospice Health Aide

• Volunteer
• Therapy
• Dietician
• Bereavement

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Medicare Hospice finances

• The Medicare Hospice Care benefit does not pay
  for room and board charges.
• Under the Medicare and Medicaid Hospice Care
  benefit the hospice does pay for
• 1. Medications related to the terminal diagnosis
• 2. Durable Medical Equipment
• 3. O2
• 4. Therapy services when in the plan of care

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Medicare Hospice finances continued

• For services to be covered that are related to
  the terminal illness they must be a part of the
  hospice plan of care

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Coordination and Collaboration

• The Hospice staff supplement the care plan with
  the additional problems, goals and interventions
  where applicable.

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Coordination and Collaboration

• The Hospice personnel should conference with a
  facility staff member to discuss the resident
  visit, any new orders, change in plan of care,
  and answer any questions or concerns. This also
  facilitates showing coordination in care.

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Hospice Home Health Aide Requirements

• Hospice Requirements
• Long-Term Care Requirements

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Orientation
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Facility Staff Needs to Know

• What is in the contract
• Hospice Philosophy
• Who to call when
• When will hospice staff visit
• How are standing orders managed
• How the facility staff input is included in the
  Hospice IDG meeting

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Hospice Staff Need to Know

• What is in the contract
• Facility layout
• Facility chain of command
• Nursing Home Federal and State regulations
• Impact on annual survey

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Hospice Staff Needs to Know, Continued

• Where to document in the chart
• When and where are the resident care conferences
  held

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Change in Status

• Hospice and NH staff must derive resident care
  decisions from the same core data
• Rehabilitation/curative vs. palliative
• Further changes anticipated team review
• Change related to progression of terminal
  illness?
• Was the change already anticipated and documented
  on MDS?

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• In an end-stage disease status, a full
  reassessment is optional, depending on a clinical
  determination of whether the resident would
  benefit from it. The facility is still
  responsible for providing necessary care and
  services to assist the resident to achieve
  his/her highest practicable well being. However,
  provided that the facility identifies and
  responds to problems and needs associated with
  the terminal condition, a comprehensive
  re-assessment is not necessarily indicated.
• --Source Federal RAI manual, page 2-11

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Need to know.
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Hospice Jargon

• Pre-Active
• Actively Dying
• Comfort Packs
• Bereavement
• LCD, LMRP, NHO Guidelines

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Level of Coverage Determination
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Questions and Answers
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Resources

• Michigan Hospice and Palliative Care
  WWW.MIHOSPICE.ORG
• Ethics Committee
• Your local Hospice provider
• www.growthhouse.org
• www.lastacts.org
• www.capc.org

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Resources

• www.TNEEL.org
• www.elnec.org
• Means to a Better End A Report on Dying in
  America Today (Last Acts, November 2002)
• Level of Coverage Determination (LCD)

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The End