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The Role of the Respiratory Therapist in Hospice/Palliative Care

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Title: 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?
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