Geriatrics: hospice Flashcards
4 considerations for end of life care
Life prolonging measures (or not)
Location of care
Goals of care
End-of-life care preferences
legal/ethical considerations for end-of-life care
- Access to Hospice Care: Justice/Fairness + Autonomy
- medicare payment
- withholding/withdrawal of med txt
medicare payment for hospice?
when prognosis gives 6 months or less to live
what is the “natural death act” ?
In Virginia, the hierarchy of decision makers
what is the heirarchy of surrogate decision makers in VA?
Documented POA Legal Guardian Spouse Children Parents Siblings Other living relatives Physician
what 5 things are included in Advanced-care-planning? (ACP)
Advance Directives Living Wills Durable Power of Attorney DNR Organ Donation
define ACP
Talking about your values and goals for care at the end of life
“recording your preferences, which could include written documents such as advance directives and medical orders”… what does this refer to ?
“advanced-care-planning”
advanced directives
documents that help outline future preferences for treatment.
durable power of attorney for health care
also known as a health care proxy
-a document that identifies a health care agent who is authorized to make medical decisions in the event that you cannot make them yourself
living will
written (or video) statement about the kinds of medical care you do or do not want under certain specific conditions (often “terminal illness”) if you are no longer able to express your wishes
ACP: what form is needed for a healthy adult, for chronic/progressive illness, and for last 12 months of life?
healthy adult: advanced directive
chronic illness: txt preferences form
last 12 months of life: POST form
medical orders are based what 3 things? why?
based on your current health status, values, and goals for care and help ensure that care preferences are honored.
” medical orders covering a range of topics likely to emerge in caring for a patient near the end of life” … what are these?
Physician or medical orders for life-sustaining treatment (POST)
what are DNR orders? (what do they cover? where are they honored?)
cover specific treatments that are written in a health care facility.
These orders do not necessarily cross care settings and may not be honored outside of a health care facility setting.
living will vs POST: who is it for?
living will: For every adult
POST: for end of life
Patient completes and reviews
living will vs POST: instructions for what? how many formate?
living will: instructions for future txt; many formats
POST: instructions for current txt; one format
living will vs POST: retrieval or interpretation required?
living will:yes and yes
POST: no (stays with the pt), no (clearly communicated)
living will vs POST: who completes it?
living will: patient
POST: provider
POST paradigm
End-User training for Providers and EMTs
Clear, specific language on an actionable form
Orders honored throughout the system
POST form: comfort care vs only DNR order
Patients with a POST form indicating Comfort Care were far less likely to receive unwanted hospitalizations and medical interventions than those who had only a DNR order
POST completion will improve end-of-life care where? what will it require?
throughout the system; requires communication
what is covered in hospice benefit?
services + equipment
medications
bereavement care for family for 13 months
qualifying criteria for hospice benefit coverage
Patient must have a life limiting illness that, if it were to run its usual course, may result in a prognosis of 6 months or less.
4 requirements of palliative care unit
- symptom management necessitating inpatient hospitalization
- complex psychosocial issues
- complex care planning
- death is imminent
general inpatient (GIP): hospice patients may be admitted for…
Short term general inpatient care
When deemed appropriate by the physician or the hospice interdisciplinary group (IDG)
3 ways care me be aimed for GIP for hospice pts?
- Pain control
- Acute or Chronic Symptom Management
- when care Cannot be feasibly provided in other settings.
imminent death
death is expected in 5-7 days
5 stages of grief
- shock and denial
- anger
- bargaining
- depression
- acceptance
