End of Life Care Flashcards
end of life care
o Involves both palliative care and hospice care.
o The terms “palliative care” and “hospice care” are frequently used interchangeably, but they differ.
o Palliative care is not always hospice care.
o Hospice care always involves palliative care.
palliative care
o The goal is symptom relief, improvement of function, and improvement of quality of life.
o Both acute and chronic illnesses may require palliative care.
o The symptoms may be physical, mental, emotional, and/or spiritual.
o Non Hospice Palliative care routinely inform patients and families about hospice and other community based healthcare resources consistent with the patient’s and their families beliefs and values.
hospice care
o The patient has: less than 6 months to live.
o The patient’s goals of care clearly change: from “cure” to “comfort.”
o Treatments and medications are geared to the goal of comfort.
o Not set in stone, patients may leave and return to hospice care during EOL time.
attitudes about dying
o Medical o Societal o Cultural o Individual o Familial
fantasy death
o TO DIE AT HOME. o To die with loved ones at bedside. o To be peaceful. o To be old. o To die quickly and without suffering.
what really happens
o 60% of deaths occur in an acute care setting.
o 20% of deaths occur in a LTC setting.
o 5+% of deaths occur in “other” settings (i.e., accidents, suicides, homicides, other sudden death).
o The remainder of deaths (<20%) occur at home.
o 40+% of people who die in acute and LTC settings die in significant pain – the incidence of pain is greater in LTC.
o 60+% die without spiritual or psychological support.
o <7% of deaths occur in a hospice setting.
o >70% of people who die in acute and LTC settings are alone at the time of death.
o Less than 10% die with hospice support.
hospice eligibility
o Insurance requires a prognosis of < 6 months.
o For Medicare, and some other insurances, recertification can be done at the end of 6 months.
o Patients can sometimes move in and out of hospice care.
-CHF, COPD, Renal failure, cirrhosis/liver failure, dementia, stroke
CHF hospice eligibility
- Class IV failure
- EF <20%
- 2-3 admissions to acute care in one year.
COPD hospice eligibility
- O2 dependent,
- poor response to bronchodilators, tires after walking a few steps, resting PCO2 >50,
- O2 sat on room air <88,
- PO2 < 55 on O2,
- cor pulmonale, wt loss,
- HR >100, 2-3 acute admissions in one year.
Renal failure hospice eligibility
- creatinine >8.0
- off dialysis
cirrhosis/liver failure hospice eligibility
- mostly bed bound,
- albumin <2.5,
- INR >1.5,
- one of the following: encephalopathy, spontaneous bacterial peritonitis, refractory ascites, recurrent variceal bleed, hepatorenal syndrome.
dementia hospice eligibility
- bed bound
- mute (except for occasional vocalization)
- unable to ambulate
- aspiration pneumonia
- progressive wt loss
- and at least one of following occurring in the past year: pyelonephritis, sepsis, pressure ulcers, fever after antibiotics, dysphagia.
stroke hospice eligibility
- poor nutritional status
- albumin <2.5
- recurrent medical problems as with dementia.
hospice eligibility for medicare and most insurance
-DNR is not a requirement – but it is strongly encouraged. It is, however, a requirement of many agencies providing in home hospice
dying trajectories
o Concept of “dying trajectory” introduced by Glaser & Strauss in 1965.
o Refers to the changes in health status over time as the patient nears death.
o Graphically time is shown on the “X” axis and health is shown on the “Y” axis.
