10: Palliative and Hospice Care

Question 1

Hospice falls under what section of government healthcare?

Answer 1

Medicare Part A

Question 2

What level of HF qualifies for hospice?

Answer 2

NYHA Class 4

Question 3

T/F A palliative care approach decreases length of hospital stay, including the ICU/CCU, and eases the transition between care settings for patients. This results in increased patient and family satisfaction and compliance with hospital standards (JCAHO). Integrative and consultant services have been used with success.

Answer 3

True

Question 4

Stems from the word “hospitality.” Beginning in medieval times, monks offered shelter to weary or ill travelers.

Answer 4

Hospice

Question 5

5 cues that could prompt a referral to palliative care.

Answer 5

1. Unacceptable level of pain or other symptom or distress.
2. Uncontrolled psychosocial or spiritual issues.
3. Frequent visits to the emergency department for the same diagnosis.
4. More than one hospitalization for the same diagnosis in the last 30 days.
5. Team/resident/family needs help with complex decision making and determination of goals of care.

Question 6

Aims to relieve suffering and improve quality of life for patients with advanced illness or chronic disease, and their families.

Answer 6

Palliative Care

Question 7

When did hospice come to the US?

Answer 7

1974. The first hospice in the United States opens: The Connecticut Hospice.

Question 8

Hospice eligibility (3).

Answer 8

1. Two physicians must certify.
2. <6 months to live in normal course of disease.
3. Patient must elect hospice.

Question 9

How long are hospice benefits under Medicare?

Answer 9

Benefit periods are two 90-day periods, followed by unlimited number of 60-day periods.

Question 10

Who helped establish the first US hospice in Connecticut?

Answer 10

Dame Cicely Saunders. She was a nurse, then social worker, then physician.

Question 11

8 components of palliative care.

Answer 11

1. Pain management
2. Symptom management
3. Goals of care
4. Quality of life
5. Family is the unit of care
6. Spiritual/cultural considerations
7. Bereavement
8. Communication is key

Question 12

To ease pain without curing.

Answer 12

Palliative

Question 13

When did the medical board begin offering hospice and palliative care as a specialty?

Answer 13

2006

Question 14

When was the term hospice first utilized in the medical field?

Answer 14

1967. Dr. Cicely Saunders applied the term to specialized care for dying patients at St. Christopher’s Hospice in London.

Question 15

What is the goal of palliative care?

Answer 15

The goal of palliative care is achievement of the best possible quality of life for patients and their families.

Question 16

T/F Palliative care helps postpone death.

Answer 16

False. It affirms life and regards death as a normal process. Palliative care neither hastens nor postpones death.

Question 17

T/F Hospice and palliative care are synonymous concepts.

Answer 17

False. Palliative care extends the principles of hospice to a broader population that could benefit from this type of care earlier in their illness. Hospice is restricted to those with a certain amount of time left. Palliative care can be appropriate at any point along a disease trajectory. The goal is the relief of distressing symptoms and maximizing quality of life.

Question 18

When did palliative care begin?

Answer 18

1988. The American Academy of Hospice Physicians was formed.