1. Unity Point Palliative Care Services

2. Iowa Physician Orders for Scope of Treatment
Ipost
Iowa Physician Orders for Scope of Treatment

3. Palliative Care
Health
Palliative Care
Hospice

4. Who is appropriate for palliative Care
Life limiting disease COPD CHF Cancer
Frequent admissions
Goal clarification
Symptom management
Support and education
IPOST completion

5. Services Provided Not provided Skilled nursing visits Lab draws
Goal clarification
Ipost development
Symptom management
Education/ chronic disease management
Coordination of care
Skilled nursing visits
Lab draws
Physical therapy
(*can be in addition to home care)
Extra layer of support.
In addition to home health .

6. Who pays for palliative care
Some insurance pay for palliative care
Patients are not billed if service is not covered
Patient would pay a co-pay (same as clinic visit) if seen by the ARNP

7. Hospice care
Statistically, patients who are hospice appropriate and elect hospice services live longer. (Journal of pain and symptoms management Vol. 33 No. 3 March 2007)
Palliative care offers a seamless transition into hospice when appropriate and when patient requests.

8. “I don’t think my patient is ready for palliative care!”

9. 66 year old male
66 year old male patient with ESRD on dialysis with COPD. Presents to the hospital with respiratory failure. He is in the ICU on Bipap. He is a “full code”.
Is he “ready” for palliative care?

10. 74 year old male patient
74 year old male with diabetes and obesity. Presents to clinic with intractable pain. Work up identifies multiple metastatic lesions.
Is he “ready” for palliative care?

11. Hospice Is your patient hospice appropriate?
Prognosis of 6 months or less without aggressive treatment
Patients who are not going to continue with dialysis, chemotherapy, or other life sustaining treatments.
Inappropriate use of SNF

12. 90 year old female
90 year old female with CHF, COPD, history of lung CA. Oxygen dependent. Symptoms of shortness of breath at rest. Patient reports that it is her goal to stay out of hospital and remain comfortable.
Is she hospice appropriate?

13. 66 year old male
66 year old male patient with morbid obesity, COPD, and CAD. Multiple hospital admission in last 3 months requiring mechanical ventilation. He is now refusing further intubation.
Is he hospice appropriate?