HOSPICE: OPTIMIZING PALLIATIVE CARE FOR PATIENTS WITH ESRD Judith A. Skretny, M.A. The Center for Hospice - PowerPoint PPT Presentation

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HOSPICE: OPTIMIZING PALLIATIVE CARE FOR PATIENTS WITH ESRD Judith A. Skretny, M.A. The Center for Hospice

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Title: HOSPICE: OPTIMIZING PALLIATIVE CARE FOR PATIENTS WITH ESRD Judith A. Skretny, M.A. The Center for Hospice


1
HOSPICE OPTIMIZING PALLIATIVE CARE FOR
PATIENTS WITH ESRDJudith A. Skretny, M.A.The
Center for Hospice Palliative CareBuffalo, New
York
2
  • We have been challenged by the RWJF ESRD Workgroup

3
  • The Challenge
  • Collaboration
  • Education
  • New and Innovative Models of Care

4
What is Hospice?
  • Is it similar to or different from Palliative
    Care?

5
Hospice
  • A Philosophy
  • A Program
  • A Facility
  • A Benefit

6
Hospice Philosophy
  • Palliative care for terminally ill patients and
    their families
  • Control of distressing physical symptoms,
    psychological and spiritual support, and
    bereavement care
  • Interdisciplinary team of professionals and
    volunteers

7
Primary Hospice Services
  • Physical symptom control-pain, nausea, dyspnea,
    etc.
  • HHA services-bathing, dressing, feeding
  • Psychosocial counseling-patient and family
  • Spiritual support-patient and family
  • Completion of advance directives, wills, funeral
    planning
  • Volunteers
  • Bereavement services

8
The Interdisciplinary Team
  • Hospice medical director
  • Skilled nursing
  • Social work
  • Pastoral care
  • Home health aides
  • Volunteers
  • Bereavement programs

9
Where Can Hospice Services Can Be Received?
  • Home
  • Hospital
  • Nursing Home
  • In-Patient Units

10
The Hospice Benefit Includes
  • All drugs related to terminal illness
  • All durable medical equipment
  • Therapies OT, PT, music, massage, dietary
  • Other services as approved in plan of care
    radiation, chemoRx, TPN, Tx, hydration, surgery
  • Hospice receives approx. 106/day to provide
    these services

11
Eligibility for Hospice Care
  • MD certified prognosis lt6 mos. If disease pursues
    its usual course
  • Any terminal diagnosis is appropriate
  • Treatment goals are palliative rather than
    curative
  • No therapy excluded pro forma
  • No DNR required

12
Medicare Hospice Benefit
  • Elect Hospice benefit for terminal illness, sign
    off Medicare A (hospital)
  • PMD may remain primary, bills Part B
  • Benefit periods/90/90/60.days
  • Patient recertified as hospice eligible at
    beginning of each benefit period unlimited
    recertifications
  • Patient may revoke at any time

13
Myths Hospice doesnt admit patients who
  • Dont have cancer
  • Dont have a DNR
  • Are receiving tube feedings or TPN or IVs
  • Are receiving chemotherapy or radiation therapy
  • Need palliative surgery
  • Dont have a primary caregiver

14
Unfortunate Reality
  • Patients with ESRD who continue to receive
    dialysis cannot access their hospice benefit.

15
Hospice
  • Interdisiciplinary, compassionate, competent
    end-of-life care that aims to relieve suffering
    and promote QOL for patients and their families

16
Palliative Care and Hospice
  • A hospice program provides palliative care and
    supportive services to terminally ill patients,
    their families and significant others throughout
    the course of the illness and into bereavement.

17
Hospice is the pre-eminent practitioner
of palliative care
18
HOSPICE PALLIATIVE CAREPALLIATIVE CARE gt
HOSPICE
19
Palliative Care
  • No specific therapy is excluded from
    consideration. The test of palliative treatment
    lies in the agreementthat the expected outcome
    is relief from distressing symptoms, easing of
    pain, and improvement in quality of life.
  • The decision to intervene is based on the
    treatments ability to meet the stated goals,
    rather than its effect on the underlying disease.

20
Barriers to Hospice Referrals
  • Death Denying Society giving up, hope
  • Medicine is a death defying profession
  • Lack of training/information
  • Difficulty re prognostication
  • Belief that Hospice is for the last days of life

21
Opportunities for Collaboration
  • Hospices and Dialysis Units are Natural Partners
    in Providing
  • End-of-life education for staff, patients,
    families
  • Advance care planning seminars for patients and
    families
  • Seminars for staff, patients and families on
    anticipatory grief, spirituality

22
Hospices can assist dialysis units by providing
  • Training in having difficult conversations
  • Support groups for staff of dialysis units
  • Information on how to discuss Hospice as part of
    care planning
  • Direction on developing bereavement services

23
Hospices can assist the medical community by
providing
  • Rotation opportunities for nephrologists
  • Medical student education
  • University affiliated training for social
    workers, PT, OT, nurses, potential nephrology
    specialists

24
When the decision has been made to stop dialysis
  • Hospices and Dialysis Units can create a seamless
    referral process into Hospice that ensures the
  • Same physician will follow the patient
  • The process of admission is simple
  • Possible scenarios are anticipated and discussed
  • i.e. dyspnea, seizures
  • The patient and family are supported
    psychologically and spiritually
  • Children in the family will receive support from
    child life specialists

25
Innovative Programs
  • VNA Hospice of Cooley-Dickinson
  • Northampton, MA

26
Self-Determined Life Closure
  • The Death of Ivan Ilyich Tolstoy
  • What tormented Ivan Ilyich most was the
    deception, the liethat he was not dying but was
    simply ill, and that he only need keep quiet and
    undergo treatment and then something very good
    would result.
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