Hospice Flashcards
definition: a place of rest or shelter for the ill and wearly
hospice
What are the goals of hospice?
- QOL
- self-determined closure of life
- patient/family-care independence
- effective grieving and support for the family
How is hospice covered?
Medicare A and Private insurance
What are the requirements for hospice?
physician certification of a life-limiting illness and prognosis of less than 6 months to live
(true/false) Hospice care cannot exceed 6 months.
False (it can)
Can a person graduate from or discontinue hospice and then return at a later time in life?
Yes
Where do most patients pass away while receiving hospice?
Their place of residene
How many Americans receive hospice each year?
1.7 million
Majority of people receiving hospice are > ____ y/o
85 y/o (white females are most common)
What are the top diagnoses in hospice?
- cancer
- dementia
- heart disease
- lung disease
What are the four levels of hospice care?
- routine
- respite
- inpatient
- continuous
Hospice level:
- traditional hospice in patient home or facility
- intermittent services by the multi-disciplinary team
routine level
Hospice level:
- break for families when patient lives at home
- will bring the patient into SNF or a hospice house for short periods of time
- rest for the family
Respite level
Hospice level:
- hospice inpatient unit
- short stay
- acute symptom mgmt
- often at very end of life if patient is having severe pain and can not be managed
- needs extensive IV pain medication
Inpatient level
Hospice level:
- 24 hours in home or faciity
- combination of SN, HHA, LPN, and MSW
- for short periods of time to manage periods of significant disease exacerbation
continuous level
definition:
Legal Document that contains information regarding what care you want at end of life
- Emergency persons may not follow because it is not a physician order
- Need to have a copy with patient and in Chart
advanced directive
(true/false) advanced directives are a physician order.
FALSE
What are the two components of an advanced directive?
- living will
- POA
definition:
-Legal document that expresses an individual’s care wishes
- Can guide care at end of life but can be overridden by healthcare providers and power of attorney
Outlines life-sustaining interventions such as Ventilation, Feeding tubes, Dialysis
living will
definition: person legally assigned to act and make decisions for someone financially and/or medically
POA
definition:
Documents what medical care you want at end of life or during an emergency that can be changed any time by you and your physician
- Will be honored by medical facilities
- Meant for individuals with serious illness or at the end of their life
POLST (physician orders for life-sustaining treatment)
(true/false) POLST documents are not a physician order
FALSE (it is)
POLST documents are (medical/legal) documents.
Medical
(true/false) POLST documents are available in every state.
False
Are POLST documents available in PA?
yes
(true/false) The 5 wishes can act as a living will completed by the patient AND family.
True
definition: multidisciplinary and holistic assessment and management of physical, psychosocial and spiritual symptoms, with the goal of alleviating suffering
palliative care
What is the goal of palliative care?
pain and symptom management
Palliative care (is/is not) paid for by hospice benefit
is not
(true/false) Palliation of symptoms is part of hospice but the program entitles “palliative care” is different.
true
Who covers palliative care program costs?
Medicare A or B (depending on location)
–> some private insurances (EX: highmark includes this as a member benefit)
Where is palliative care provided?
- hospital
- outpatient facility
- home health
- nursing homes
What is considered as a bridge to hospice for patients?
Palliative care
Who makes up the hospice team?
Physician
RN
MSW
Therapy
HHA
Spiritual and Bereavement support
Volunteers
Who makes up a palliative care team?
Medical Model
Lead by physician or NP
What is the description of cancer trajectory for functional decline?
Steady decline over time w/ aggressive intervention and then has a sharp decline
What is the description of organ failure trajectory for functional decline?
Long term limitation with short severe periods of exacerbations followed by recovery to a lesser extent
What is the description of frailty/dementia trajectory for functional decline?
Slow steady decline with intermittent social and medical complications triggering more decline
definition: Palliative Care/Hospice documentation of patient decline over time that includes:
- Ambulation
- Evidence of the disease
- Self care
- Food Intake
- Level of Consciousness
Palliative Performance Scale (PPS)
What is the most common assessment tool in hospice that can bbe used with ALL patients at ALL stages?
Palliative Performance Scale (PPS)
(true/false) You can move in multipe directions on the PPS scale
true
(true/false) you can move in multiple directions on the Functional Assessment Scale (FAST)
False
definition: Assessment scale that was developed in 1984 to help identify Alzheimer’s/dementia patients at end of life:
Seven Stages of development:
- Normal without decline
- Normal with mild memory loss
- Early stage dementia
- Mild dementia
- Moderate dementia
- Moderately severe dementia
- Severe dementia
Functional Assessment Scale (FAST)
definition: Examines patient symptoms
- Valuable in determining effectiveness of interventions
- Nine symptoms assessed on scale of 0-10
edmonton symptom assessment scale (ESAS)
definition: Reliable and valid tool for assessing the impact of care giving that can be helpful for goal setting especially in case management
brief and easy to use
Measures strain in 5 major domains:
Financial
Physical
Psychological
Social
Personal
caregiver strain index
(true/false) The end of life disease trajectory for functional decline is predictable for several diagnoses
True
_____ tools play a role in managing patients at the end of life
Evidence based tools
The ____ model provides a model of intervention based on disease trajectory.
Briggs Palliative Care Model
