1. SOMC Hospice & Palliative Care a special kind of caring… A Department of Southern Ohio Medical Center

2. Objectives: Discuss the philosophy, admission criteria, referral process and services for Hospice and Palliative Care programs Describe the functions and duties of the Interdisciplinary Team approach Discuss limited pain and symptom management strategies

3. Hospice Philosophy To recognize death as a universal experience To recognize dying as a normal process To affirm life and discount death denial To acknowledge that a person is part of a family unit To provide end of life palliative care – comfort, care and support services

4. Hospice Philosophy (cont) To provide comfort without prolonging life or hastening death To focus on holistic care To encourage all persons to live fully, even as death approaches To encircle the family unit with support and caring through the use of the Interdisciplinary Team

5. Hospice Admission Criteria Be willing to accept the hospice philosophy of care and make an informed choice Have a life expectancy of six months or less, (months instead of years), if the disease runs its expected course Choose supportive care instead of curative treatment

6. Admission Criteria (cont) Have a physician willing to be the primary physician for hospice care Have a need for supportive care, even if the patient is ambulatory and not home bound

7. Admission Criteria (cont) Diagnosis categories appropriate for Hospice Care: Cancer Alzheimer’s Stroke & Coma Cardiac Renal Hepatic Dementia ALS Failure to Thrive Debility HIV General

8. Admission Criteria (cont) For non-cancer diagnoses, Medicare has agreed upon criteria for determining prognosis – as depicted by the disease categories listed previously These criteria apply to all non-cancer hospice patients regardless of reimbursement

9. Referral Process Anyone can make a referral to hospice When referral is received, a hospice admissions nurse will follow-up within 24 hours Hospice nurse will phone the physician for orders to evaluate the patient for hospice appropriateness Imminent death referrals are followed- up within one hour

10. The Hospice Team Skilled Nursing – Provided under the direction of the physician Weekly visits and as needed Provide comprehensive assessment with each visit Provide emotional support Focus on patient/caregiver education Nurses available 24 hours a day, seven days a week Coordinate the patient’s individualized Plan of Care with the IDT

11. The Hospice Team (cont) Hospice Aides – Provide care under the direction of the Primary RN Assist the patient/family in a caregiver role Provide personal hygiene Assist family members in learning care-giving skills Visit 1 – 5 times per week based upon need

12. The Hospice Team (cont) Medical Social Work – Provide special insight into problems created within families as they experience crisis and loss Provide assistance with legal and financial needs Assist with community resources Provide social and psychosocial counseling Assistance with advance directives Participate in the IDT Plan of Care

13. The Hospice Team (cont) Spiritual Care – Presence ministry Life review Sacramental needs Contacting patient’s church/personal clergy End of life spirituality Special Services

14. The Hospice Team (cont) Medical Director – Certifies and re-certifies patient appropriateness for hospice care, including Face to Face visits as needed Provides consultative service to the IDT and to the patient’s attending physician regarding patient plan of care

15. The Hospice Team (cont) Medical Director – (continued) – Participates in IDT meetings Covers patient admissions to the Hospice Center as needed Contributes to the patient’s IDT Comprehensive Care Plan

16. The Hospice Team (cont) Volunteer Services – Provide patient visits in the home setting Visit patients in hospital setting Sit with patients Provide respite services for caregivers Light housekeeping Running general errands Delivering supplies, medications, etc Telephone contacts and support Office work, fund raising support Eleventh Hour Team support

17. The Hospice Team (cont) Pharmacy consultation Nutrition consultation Physical therapy Occupational therapy Speech therapy Attending Physician Patient and Family

18. Areas of Expertise Pain Management Symptom Management Nurses attend on-going lectures to stay current with evidence based practices IDT also attends lectures regarding their roles in pain and symptom management

19. Care Settings Home Care Acute Inpatient Care Respite Care

20. Palliative Sedation: Voluntary election to use medications for the express purpose of relieving refractory pain and/or symptoms in the form of drug induced sleep state. *Not comparable with euthanasia or physician assisted suicide

21. Palliative Sedation: Ethical Justification Intent: Relief of suffering, as a last resort Outcome: Patient is made unaware of suffering through sedation/sleep Studies show that death is not hastened during this process

22. Palliative Sedation: Facts - Sedation may be partial, intermittent or complete based upon patient/family preference Not irreversible Indicated only for refractory symptoms – when nothing else is working Appropriate when patient is imminent or getting close to death

23. Palliative Sedation: Reasons for sedation – Pain Terminal restlessness/delirium Dyspnea Bleeding Nausea/vomiting **Symptoms must be truly refractory

24. Palliative Sedation: Drug Classifications – Opioids Benzodiazepines Antipsychotics Barbiturates General anesthetics IV route is optimal Specific doses are less important than the goal of symptom relief

25. Palliative Sedation: Suggested Guidelines – Terminal illness with refractory symptom(s) DNRCC All other treatments must have been exhausted Psychosocial assessment Spiritual assessment

26. Palliative Sedation: Suggested Guidelines - Second physician opinion Nutrition/hydration futility addressed Reason(s) well documented Consideration of a trial of respite sedation first Use of a proper sedation scale

27. Hospice Service Areas Scioto County Pike County Jackson County Counties partly covered: Lawrence Adams Ross

28. SOMC Hospice Center Home-like atmosphere designed to provide quality care for hospice patients and families Not a residential facility – goal of care is short term stay Visitors welcome 24/7 Patient rooms designed for families to stay with patients Laundry and kitchen facilities available Menu and room service available

29. SOMC Hospice Center (cont) Reasons for admission to the center: Must be an SOMC Hospice Patient Acute stay – pain and/or symptoms unable to ideally be treated in home setting Imminent death – when not optimal for the patient’s death to occur in the home setting Respite stay – five day stay, monthly as needed to give caregiver(s) a rest from 24/7 care

30. Pet Therapy – “Marley” Staff member who walks on four legs A “People Person” Offers comfort to patients and families Intuitive caring Loves attention Honorable mention – “Swann”, our first Hospice dog has retired after years of great service

31. Bereavement Services Designed to help families and loved ones cope with terminal illness and loss Emotional support provided free of charge from the time of the patient’s admission to hospice services and up to 13 months after the patient’s death Individual, adult, child and family counseling upon request Not limited only to hospice families

32. Bereavement Services (cont) Phone calls; Visits; Cards and letters commemorating special dates; Bi-monthly newsletter – “Resolutions”; Educational materials Memorial Quilt Project Memorial Life Celebration Support groups – different themes All bereavement services are free of charge

33. Reimbursements Medicare Medicaid Insurance payors VA Self-pay Indigent Donations/fund raisers

34. Living With Hope Talk openly and honestly with one another Recognize that death is a part of life Consider each day as full of potential to be enjoyed as much as possible Realize that life is never perfect – it was not perfect before illness and will not be perfect after Use faith and spiritual strengths for support

35. Living With Hope (cont) See oneself as living with illness instead of dying from it Enjoy the simple things in life – it is often these that give life meaning and enjoyment Include loved ones in the experience by talking about fears, concerns and feelings Daily private time is a healthy practice Physical pain can be increased with social, emotional or spiritual pain

36. Palliative Care Services Nurses specializing in palliative care provide weekly home visits and more if need is indicated Hospice Department assists as needed and covers after hours calls and visits Indicated for patients with a life- limiting illness

37. Palliative Care Services Patient must be homebound and have a skilled need Hospice has partnered with SOMC Home Care for billing purposes Goal to keep patient out of the hospital Very similar to hospice services in providing pain and symptom management

38. Palliative Care Services Prognosis is not limited to 6 months Can provide curative, life sustaining care

39. Palliative Care – Nurse Practitioner Program Services provided in the patient’s home or homelike setting (SNF; Assisted Living) by a Nurse Practitioner Patients do not require a skilled need or homebound status Visits are based on medical necessity – per week, per month, etc.

40. Palliative Care – Practitioner Program Can be in addition for the Home Care program or can be independent, based upon patient need 24/7 access to on-call nursing services Does not replace physician – NP will collaborate with the patient’s physician on-going to determine appropriate interventions

41. Referrals: Hospice and Palliative Care (740) 353-2567 (24/7) Ext. 2651 (During business hours only)

42. Questions???