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Working Together Providing Quality End of Life Care

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The disciplines involved may include nurses, psychosocial ... Homemaker Volunteer Therapy Dietician Bereavement Medicare Hospice finances The Medicare Hospice Home ... – PowerPoint PPT presentation

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Title: Working Together Providing Quality End of Life Care


1
Working Together Providing Quality End of Life
Care
Presented by Jan Nowak LBSW Brenda
Schoenherr Social Worker Program
Director Dowagiac Nursing Home RN, NHA, BBL, MBA
2
(No Transcript)
3
Interesting Statistic
  • Did you know that the studies are showing that
    10 to 20 of the residents in a Long Term Care
    setting, at any time, are appropriate for Hospice
    care?

4
Changes in the Environment
  • Decreasing Length of Stay
  • Increase in number of younger residents
  • Increase in complex/high tech admits
  • Increase in elderly care givers
  • Increase in working care givers

5
The Continuum of Care
  • ACUTE CARE
  • Focus is on active treatment/intervention to
    cure, alter or prevent disease and/or to prolong
    life.
  • May include palliative care as part of the
    continuum.
  • Delivered by multiple disciplines in various
    modes.

6
Curative/Disease Focus
  • Diagnosis of disease related symptoms
  • Curing of disease
  • Treatment of disease
  • Alleviation of symptoms

7
The Continuum of Care contd
  • PALLIATIVE CARE
  • Focus is on relief of suffering and improving the
    quality of life.
  • May be combined with curative therapies.
  • Delivered in an interdisciplinary manner.

8
Palliative Focus
  • Pt/family identify unique end-of-life goals
  • Assess how symptoms, issues are helping/
    hindering reaching goals
  • Interventions to assist in reaching end-of-life
    goals
  • Quality of life closure

9
Location of Death, 1997
www.chcr.brown.edu/dying/forresearcherssod.htm
10
Applicability of Palliative Care
Life Closure
Last Hours of Life
Therapy to Modify Disease
Palliative Care
Bereavement Care
Therapy to Relieve Suffering and/or
Improve Quality of Life
6 Mos
Death
Presentation/ Diagnosis
Illness
Advanced Life-threatening
Acute
Chronic
Hospice Care
Attribution Ferris FD, Balfour HM, Farley J,
Hardwick M, Lamontagne C, Lundy M, Syme A, West
P, 2001 Proposed Norms of Practice for Hospice
Palliative Care, Ottawa, ON Canadian Palliative
Care Association, 2001
11
Hospice care is always palliative. Palliative
care is NOT always Hospice.
12
Why Partner?
  • A partnership between the nursing facility and
    the hospice interdisciplinary team provides the
    best approach to palliative care and optimal
    end-of-life experiences for dying residents and
    their family members.

13
Benefits
  • A partnership allows for
  • Expertise by varied disciplines from both the
    hospice and nursing facility.
  • Collaborative care planning.
  • Resident and family involvement in
    decision-making.

14
Certification for Care
  • To qualify for hospice care a physician needs to
    certify that the resident has a life expectancy
    of 6 months or less if their illness runs its
    expected course.

15
The Medicare Hospice Levels of Care
  • There are 4 levels of care provided by Hospice.
  • 1. Respite. The resident is entitled to up to 5
    days of Respite care usually provided in our
    contracted Long Term Care facilities to give the
    family a rest period from the care of the
    resident
  • 2. Continuous Care. When the residents symptoms
    are out of control, Hospice will provide
    continuous care, 11 staffing. Examples of
    symptoms out of control include pain, severe
    anxiety, nausea/vomiting.

16
Level of Care, continued
  • 3. Inpatient. The hospice resident may be
    admitted to a hospital or in a Long Term Care
    facility for treatment or symptoms out of
    control. An RN must be on the floor providing
    care to meet regulatory compliance.
  • 4. Home Hospice Care. Hospice Home care visits
    are made to residents and caregivers to assess
    their needs. The facility is the residents home
    and the facility staff are also the primary
    caregivers.

17
Locations for Hospice Care
  • Care can be provided in
  • Home
  • Nursing Home
  • Hospice facilities
  • Adult foster care
  • Assisted living facilities
  • Hospital

18
Interdisciplinary team
  • RN
  • MSW
  • Physician
  • Medical Director
  • Chaplain
  • Hospice Health Aide
  • Volunteer
  • Therapy
  • Dietician
  • Bereavement

19
Medicare Hospice finances
  • The Medicare Hospice Care benefit does not pay
    for room and board charges.
  • Under the Medicare and Medicaid Hospice Care
    benefit the hospice does pay for
  • 1. Medications related to the terminal diagnosis
  • 2. Durable Medical Equipment
  • 3. O2
  • 4. Therapy services when in the plan of care

20
Medicare Hospice finances continued
  • For services to be covered that are related to
    the terminal illness they must be a part of the
    hospice plan of care

21
Coordination and Collaboration
  • The Hospice staff supplement the care plan with
    the additional problems, goals and interventions
    where applicable.

22
Coordination and Collaboration
  • The Hospice personnel should conference with a
    facility staff member to discuss the resident
    visit, any new orders, change in plan of care,
    and answer any questions or concerns. This also
    facilitates showing coordination in care.

23
Hospice Home Health Aide Requirements
  • Hospice Requirements
  • Long-Term Care Requirements

24
Orientation
25
Facility Staff Needs to Know
  • What is in the contract
  • Hospice Philosophy
  • Who to call when
  • When will hospice staff visit
  • How are standing orders managed
  • How the facility staff input is included in the
    Hospice IDG meeting

26
Hospice Staff Need to Know
  • What is in the contract
  • Facility layout
  • Facility chain of command
  • Nursing Home Federal and State regulations
  • Impact on annual survey

27
Hospice Staff Needs to Know, Continued
  • Where to document in the chart
  • When and where are the resident care conferences
    held

28
Change in Status
  • Hospice and NH staff must derive resident care
    decisions from the same core data
  • Rehabilitation/curative vs. palliative
  • Further changes anticipated team review
  • Change related to progression of terminal
    illness?
  • Was the change already anticipated and documented
    on MDS?

29
  • In an end-stage disease status, a full
    reassessment is optional, depending on a clinical
    determination of whether the resident would
    benefit from it. The facility is still
    responsible for providing necessary care and
    services to assist the resident to achieve
    his/her highest practicable well being. However,
    provided that the facility identifies and
    responds to problems and needs associated with
    the terminal condition, a comprehensive
    re-assessment is not necessarily indicated.
  • --Source Federal RAI manual, page 2-11

30
Need to know.
31
Hospice Jargon
  • Pre-Active
  • Actively Dying
  • Comfort Packs
  • Bereavement
  • LCD, LMRP, NHO Guidelines

32
Level of Coverage Determination
33
Questions and Answers
34
Resources
  • Michigan Hospice and Palliative Care
    WWW.MIHOSPICE.ORG
  • Ethics Committee
  • Your local Hospice provider
  • www.growthhouse.org
  • www.lastacts.org
  • www.capc.org

35
Resources
  • www.TNEEL.org
  • www.elnec.org
  • Means to a Better End A Report on Dying in
    America Today (Last Acts, November 2002)
  • Level of Coverage Determination (LCD)

36
The End
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