1. Palliative Care Michele Loos, MS, APRN, FNP-C Clinical Assistant Professor: University of New Hampshire Nurse Practitioner: Supportive and Palliative Care / Prompt Care Wentworth-Douglass Hospital and Wentworth Health Partners

2. Tweet....... Palliative care reduces suffering as elicitation of patient derived goals of care focus interventions at relief of physical, psychosocial and spiritual distress.

3. Cure Sometimes

5. Relieve Often

7. Comfort Always

9. Patient

10. Family

11. Team

12. CURE RELIEVE COMFORT

13. CURE RELIEVE COMFORT

20. Extra Layer of Support Think of us as your girdle.....

21. www.youtube.com

22. CURE RELIEVE √ COMFORT √

23. Cure Sometimes Relieve Often Comfort Always

24. Hospice Palliative Supportive

25. Palliative Care vs Hospice CharacteristicPalliative CareHospice Model of CareInterdisciplinary team, including physicians, nurses, social workers, chaplains, and staff from other disciplines as needed; primary goal is improved quality of life. Interdisciplinary team, including physicians, nurses, social workers, chaplains, and volunteers, as dictated by statute; primary goal is improved quality of life and relief of suffering (physical, emotional, spiritual) EligibilityPatients of all ages and with any diagnosis or stage of illness; patients may continue all life- prolonging and disease directed treatment. Patients of all ages who have a prognosis of survival of < 6 mo, if the disease follows its usual course; patients must forgo Medicare coverage for curative and other treatments related to terminal illness. PlaceHospitals (most common), hospital clinics, group practices, cancer centers, home care programs, or nursing homes. Home (most common), assisted living facilities, nursing homes, residential hospice facilities, inpatient hospice units, or hospice- contracted inpatient beds. PaymentMD and NP fees by Medicare B for IPT/OUTPT, hospital teams Medicare A/commercial insurance. Flex bundle payments Medicare Advantage, Managed Medicaid, ACOs, commercial payers. Medicare hospice benefit; commercial payer benefit, Medicaid (varies by state); medication costs covered for illnesses related to terminal illness. Kelley, A.S. and Morrison, R.S. (2015). Palliative care for the seriously ill. New England Journal of Medicine, 373(8), 747-755.

26. Where are we headed?

27. Source: CAPC.org

31. Be the change you wish to see in the world. -Ghandi

36. “I thought this (dying) would be the worst trip of my life. Instead, it’s turned out to be the best”. “Thank you for helping our father have the best trip of his life, and we are blessed to have been part of this final journey”.

38. Questions? Resources: www.capc.org www.getpalliativecare.org www.aahpm.org www.nhpco.org www.ihi.org www.rwjf.org NEJM