The Role of the Respiratory Therapist in Hospice/Palliative Care

1
The Role of the Respiratory Therapist in
Hospice/Palliative Care

• Tim Buckley, RRT, FAARC
• Director Respiratory Services
• Walgreens Home Care

2
Role of the RT in Palliative Care

• Why is this something that we should talk about?
• How does a Medicare Hospice work?
• Is there a role for respiratory therapists in the
  care of Hospice patients?
• What are some potential advantages of using RTs
  in the care of Hospice patients?

3
Why should we talk about RTs in Hospice Care?

• Of the top ten causes of death, 3 are RT
  diagnoses
• COPD
• Pneumonia
• Lung Cancer
• RTs are expert in the assessment and treatment of
  dyspnea in all care settings
• RTs are expert in the management of secretions in
  all care settings

4
Hospice Care

• Active total care of patients whose disease is
  not responsive to curative treatment
• Control of pain, of other symptoms
• Psychological, social and spiritual support is
  paramount
• The goal of hospice care is the best quality of
  life for patients and their families

Principles in Palliative Care An Overview Joseph
Fins, Respiratory Care, November 2000
5
Medicare Hospice Model

• Patients with a terminal diagnosis and a
  prognosis of 6 months or less are eligible
• CMS pays the Hospice a per diem for each patient
  enrolled for the time they are enrolled
• Hospice is responsible for all of the care
  related to the hospice diagnosis
• If the patient survives 6 months, they can be
  re-certified for hospice care

6
Hospice Economics

• Hospice census is critical to success
• All services are cost reported to set per diem
  rates
• All charges for allowed expenses are cost
  reported
• The best financial situation is long term
  patients who uses minimal services

7
Hospice Structure

• Medical Director admits all of the patients
• Nurses case manage each patient be developing a
  care plan that serves as the prescription
• Typically nurses, CNAs, housekeepers,
  transportation, social work, pain management,
  counseling, and spiritual care are provided.
• Equipment is also provided and can be cost
  reported

Whats Missing?
8
Medicare Recognizes Respiratory Care as a Hospice
Benefit

• In 2005, in response to a question from the AARC,
  CMS stated that Respiratory Care is a covered
  hospice benefit
• This allows respiratory care services to be cost
  reported and included in the per diem payment for
  hospice services.

9
What are the possible roles for an RT in Hospice
care?

• Assessment and treatment of dyspnea
• Management of secretions
• Airway management
• Aerosol therapy
• Non-invasive ventilation
• Invasive ventilation
• Staff educator
• Case manager

10
Assessment of Dyspnea

• In the last weeks of life 90 of COPD patients,
  90 of lung cancer patients, up to 70 of
  Hospice patients experience dyspnea
• Dyspnea does not always correlate well with
  traditional diagnostic evaluation
• Dyspnea manifests itself differently in different
  patients
• Nothing effects quality of life more

Dyspnea Assessment, Sorenson, Respiratory Care
November 2000
11
Treatment of Dyspnea

• Drug therapy
• Opiates
• Anti anxiety
• Anti depressants
• Oxygen
• Air
• Alternative medicine techniques

Dyspnea Treatment, Manning, Respiratory Care,
November 2000
12
Managing Secretions

• Assessment is key to how to treat
• Is it saliva or sputum?
• Positioning,nutrition hydration all play roles
• Therapeutic interventions
• Suctioning
• Drug therapy

Managing Secretions in Dying Patients, Sorenson,
Respiratory Care, November 2000
13
Other areas of expertise

• Pulmonary Rehabilitation
• Exercise techniques
• Non invasive ventilation
• Especially in chronic respiratory failure
• Invasive Ventilation
• Withdrawing support
• Airway management

14
Advantages of using RTs in Hospice Care

• RTs are experts in the diseases
• RTs are experts in the treatment of dyspnea
• RTs are great educators of the patient family
  as well as staff members
• RTs are more cost effective than RNs
• Having an RT may help to recruit patients
  earlier in the course of the disease
• RTs can move the focus from the equipment to the
  patient.

15
What do we need to do?

• Educate RTs about palliative care
• It effects us all in every practice setting
• RT need to know more about pharmacy of palliative
  care
• Educate Hospices about RTs
• What do we do well?
• How we can be more cost effective
• Develop evidence based techniques for dyspnea
  assessment and management

16
Questions?