Unity Point Palliative Care Services

Iowa Physician Orders for Scope of Treatment Ipost Iowa Physician Orders for Scope of Treatment http://iha.mediasite.com/mediasite/Play/96cebe9c88dc4305811cc3be68aa97cf1d

Palliative Care Health Palliative Care Hospice

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

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 .

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

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.

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

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?

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?

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

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?

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?