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The Role of the Respiratory Therapist in Hospice/Palliative Care


... housekeepers, transportation, social work, pain ... Role of the Respiratory Therapist in Hospice/Palliative Care Role of the RT in Palliative Care Why ... – PowerPoint PPT presentation

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Title: The Role of the Respiratory Therapist in Hospice/Palliative Care

The Role of the Respiratory Therapist in
Hospice/Palliative Care
  • Tim Buckley, RRT, FAARC
  • Director Respiratory Services
  • Walgreens Home Care

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?

Why should we talk about RTs in Hospice Care?
  • Of the top ten causes of death, 3 are RT
  • 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

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
  • 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
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

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

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

Whats Missing?
Medicare Recognizes Respiratory Care as a Hospice
  • 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.

What are the possible roles for an RT in Hospice
  • Assessment and treatment of dyspnea
  • Management of secretions
  • Airway management
  • Aerosol therapy
  • Non-invasive ventilation
  • Invasive ventilation
  • Staff educator
  • Case manager

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
  • Nothing effects quality of life more

Dyspnea Assessment, Sorenson, Respiratory Care
November 2000
Treatment of Dyspnea
  • Drug therapy
  • Opiates
  • Anti anxiety
  • Anti depressants
  • Oxygen
  • Air
  • Alternative medicine techniques

Dyspnea Treatment, Manning, Respiratory Care,
November 2000
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
Other areas of expertise
  • Pulmonary Rehabilitation
  • Exercise techniques
  • Non invasive ventilation
  • Especially in chronic respiratory failure
  • Invasive Ventilation
  • Withdrawing support
  • Airway management

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

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
  • 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