1. BECOMING COMFORTABLE with HOSPICE

2. Hospice Goals: Understand hospice comfortably Able to discuss hospice with the patient & family Know when and how to refer

3. Hospice Medicare Benefit (established in 1983) “Caring not curing” Right to die pain-free, with dignity and family support Saves money and improves care quality 2/3 of hospice patients die at place of residence Needs 2 physicians that determine less than 6 months to live probable

4. Hospice The Hospice TEAM Median length of service 2013 = 18.5 days Average length of service 2013 = 72.6 days About 50% die/discharged within 14 days Only 11.5% past 180 days Includes all aspects of patient care including drugs, medical equipment and supplies Affordable Care Act will decrease payments by 7.4% over 10 years

5. Hospice Choose palliative care of symptom management rather than curative treatment – no extreme measures Helps people live as well as they can for as long as they can

6. Hospice General Guidelines: Patient/family choose comfort care Multiple co-morbidities Frequent hospitalizations Progressive weight loss Deteriorating mental abilities Recurrent infections Overall function decline/dependent ADL’s

7. Hospice Qualifying Diagnoses: Cancer End-stage Cardiac disease End-stage Pulmonary disease Alzheimer’s disease A.F.T.T. Stroke/coma End-stage Liver disease End-stage Renal disease ALS/Neurologic disease HIV/AIDS

8. References General Hospice Guidelines National Hospice and Palliative Care Organizations Copyright 1996 Medical Guidelines for Determining Prognosis in Selected Non-Cancer Diseases – 2 nd Edition Centers for Medicare and Medicaid Services (CMS) Intermediary 2007 Local Coverage Determinations (LCD’s) NYHA Functional Classification The Criteria Committee of the New York Heart Association Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9 th ed. Boston, Mass: Little, Brown & Co; 1994:253-256.

9. References Palliative Performance Scale (PPS) Anderson, Fern et al. (1996) Palliative Performance Scale (PPS) A New Tool, Journal of Palliative Care 12(1), 5-11 Functional Assessment Staging (FAST) Scale National Hospice and Palliative Care Organization Copyright 1996 Medical Guidelines for Determining Prognosis in Selected Non-Cancer Diseases – 2 nd Edition

10. Victor J. Sobolewski III, D.O. visitingdoc@wi.rr.com (262) 949-1893