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PT Selected Topics > Hospice and Palliative Care > Flashcards

Hospice and Palliative Care Flashcards

1
Q

Hospice came from the term ________ meaning _________________

A

hospitality; a place of rest or shelter for ill and weary travelers

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2
Q

History of Hospice: 1948

A

Dame Cicely Saunders first applied the name to dying patients

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3
Q

History of Hospice: 1963

A

Saunders visits US and promotes Hospice

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4
Q

History of Hospice: 1969

A

Elizabeth Kubler-Ross published “On Death and Dying”

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5
Q

History of Hospice: 1972

A

Kubler-Ross testifies at the senate special committee on aging

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6
Q

History of Hospice: 1974

A

First legislation for hospice proposed but not enacted

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7
Q

History of Hospice: 1982

A

Medicare Hospice Benefit added to the Tax Equity Fiscal Responsibility Act of 1982 (4 year sunset)

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8
Q

History of Hospice: 1986

A

Medicare Hospice Benefit became permanent

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9
Q

What is Hospice?

A

Compassionate care model for life-limiting (terminal) illness

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10
Q

What is included in hospice?

A

Medical care, pain management, Emotional, spiritual, and other support, it’s customized to persons needs, and provides support to the family of the individual with the life-limiting illness

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11
Q

Goals of Hospice

A

Enhance QOL, Patient-centered, patient-determined EOL planning, Patient/family self-care independence, and support for the family

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12
Q

How does one qualify for Hospice?

A

Benefit of Medicare A and private insurances; Physician certification: life-limiting illness, not expected to live > 6 months

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13
Q

Hospice care can exceed __________ months

A

6

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14
Q

Patients can ________________ or ____________ hospice and return later

A

Graduate from; discontinue

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15
Q

There is a daily rate for all care related to the _____________

A

life-limiting diagnosis

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16
Q

Members of the hospice team

A

Volunteers, physicians, spiritual counselors, social workers, bereavement counselors, home health aides, therapists, nurses, pt, and family

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17
Q

Who is always at the center of the hospice team?

A

Pts and their family

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18
Q

Hospice can occur in what settings?

A

Home/residence, Hospital, skilled nursing facility, assisted living facility, and inpatient hospice facility

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19
Q

How many Americans receive Hospice each year?

A

1.7 million

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20
Q

Slightly more ________ than _______ receive hospice, with a majority being over the age of _____________ and a majority _______% being ___________________

A

women, men; 85; 80, white/Caucasian

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21
Q

What are the 4 most common diagnoses in Hospice?

A

Cancer, dementia, heart disease, and lung disease

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22
Q

What are the 4 levels of Hospice care?

A

Routine, Respite, Inpatient, and Continuous

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23
Q

Routine hospice care

A

Traditional hospice, in a home or facility; Intermittent services by the multidisciplinary team

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24
Q

Respite Hospice care

A

Break for families when patient lives at home, bring patient into facility for short periods of time to allow rest for the family

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25
Q

Inpatient hospice care

A

Inpatient hospice unit; Short stay - a couple of days; Acute symptoms management; often at very end of life if patient is having severe pain and can not be managed at home and needs extensive IV medications

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26
Q

Continuous Hospice Care

A

24 hour care in the home or facility; combination of SN, HHA, LPN, and MSW; for short periods to manage periods of significant disease exacerbation

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27
Q

End of Life Planning: documents

A

advanced directive: living will and power of attorney (POA), Physician Orders for Life-sustaining treatment (POLST), and 5 wishes

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28
Q

Advanced directives are a legal document about _____________, is NOT a physician order, needs to be a copy with patient and in their chart, doctors and other health providers can ________________________, and it has two components: _______________

A

care you want at end of life, refuse to follow it; living will and power of attorney

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29
Q

Living Will is a legal document about ______________. It can guide care at the end of life but can be ____________ by healthcare providers and power of attorney. It also includes statements about _____________ such as ________________

A

care wishes; overridden; life-sustaining interventions, ventilation, feeding tubes, and dialysis

30
Q

Power of attorney

A

person legally assigned to act and make decisions for someone: financial, medical, or both

31
Q

The POLST (Physician Orders for Life-Sustaining Treatment) documents _________________________, emergency personnel will follow it because it is a physician order, it can be changed any time by ____________________, it’s a ___________ document, not a _____________ document and will be honored by medical facilities. It is meant for individuals with ______________ or at ___________________; it’s not available in every state, but PA does have it.

A

what medical care you want at end of life or during an emergency; you and your physician; medical, legal; serious illness, end of their life

32
Q

The 5 wishes is a document completed by _____________. It can act as a living will, which means it can be overridden. It establishes _________________ and helps patients identify ____________________

A

patient and family; how you want to be cared for during your last days; those things that are important to them

33
Q

What are the five wishes

A

1 - My wish for the person I want to make decisions for me (POA)
2 - My wish for what kind of medical treatment do I want or don’t want (advanced directive)
3 - My wish for how comfortable I want to be
4 - My wish for how I want people to treat me
5 - My wish for what I want loved ones to know

34
Q

Palliative care is defined by the World Health Organization as ___________________________

A

multidisciplinary and holistic assessment and management of physical, psychosocial and spiritual symptoms, with the goal of alleviating suffering

35
Q

Palliative care often sits outside of hospice. It’s goal is __________________ and the patient is often still involved in ________________

A

pain and symptom management; active treatment

36
Q

Palliative care programs _____________ paid for by Hospice Benefit

A

are NOT

37
Q

______________ is part of Hospice, but the program entitled _________________ is different

A

Palliation of symptoms; palliative care

38
Q

The Palliative Care Team

A

Specially trained and certified physicians and nurse practitioners; Other medical specialties (PT, OT, SLP, RT, social workers, clinical nurses), and sometimes spiritual support is offered but not required as in hospice

39
Q

Palliative care reimbursement is included in _______________ depending on the location

A

Medicare A or B

40
Q

Medicare A reimburses palliative care in what locations?

A

home health and the hospital

41
Q

Medicare B reimburses palliative care in what locations?

A

Outpatient

42
Q

Palliative care is provided in _________________ by a palliative care team that is often led by ____________________ and it is also provided by some insurance benefits

A

hospital, outpatient, home health, or SNF; physician or nurse practitioner

43
Q

Primary goal of palliative care?

A

pain and symptom management

44
Q

Why receive palliative care?

A

collaborate with other physicians to ensure optimal symptom control, and it’s often the bridge to hospice

45
Q

Hospice vs Palliative care

A

Hospice: Medicare benefit - stands alone, end of life care, home, SNF, ALF, or hospice facility, and Hospice team consists of: physician, RN, MSW, Therapy, HHA, spiritual and bereavement support, and volunteers
Palliative: Insurance or part of Medicare A and B depending on location, Pain and symptoms management through entire disease process, and palliative team: Medical model and lead by physician or NP

46
Q

Disease Trajectory 1

A

Prolonged stability usually associated with aggressive intervention and then sharp decline

47
Q

Cancer is which disease trajectory

A

1

48
Q

Disease Trajectory 2

A

Long term limitation, short severe exacerbations followed by recovery to a lesser extent

49
Q

Organ Failure is which disease trajectory

A

2

50
Q

Disease Trajectory 3

A

Slow steady decline with intermittent medical complications triggering more functional decline

51
Q

Dementia is which disease trajectory

A

3

52
Q

Hospice traditionally has stayed away form objective evidence based tools in their practice setting as hospice is not focused on _____________________, but as CMS moved toward a focus of ___________ care, hospice programs were _____________________

A

medical model; efficient, high-quality; pushed to quantify their services

53
Q

The Functional assessment scale (FAST) was developed to ____________________

A

help identify pts with dementia at end of life

54
Q

How many stages of development are there in the FAST scale and what are they?

A

7; 1 Normal without decline, 2 normal with mild memory loss, 3 early-stage dementia, 4 mild dementia, 5 moderate dementia, 6 moderately severe dementia, and 7 severe dementia

55
Q

The FAST scale moves in ____________ direction

A

only 1

56
Q

Edmonton Symptom Assessment Scale

A

Assesses 9 pt symptoms on a numeric rating scale to determine the effectiveness of interventions, which are pain, fatigue, nausea, shortness of breath, depression, anxiety, sleep, appetite, well-being, and other patient specific problems

57
Q

Caregiver Strain Index is reliable/valid for assessing the impact of caregiving. Caregiver strain is associated with _____________. The index is helpful for _______________________, and is brief and easy to use. It measures strain in 5 domains which are: ____________________________________

A

Premature institutionalization; goal setting and case management; financial, physical, psychological, social, and personal

58
Q

The Role of Physical Therapy in Hospice and Palliative Care: Throughout the continuum of life, physical therapists are experts in _____________________ for the patient/client and caregivers. Physical therapists and physical therapist assistants, as part of the interdisciplinary team, are well equipped to ________________ for, individuals in hospice or palliative care.

A

diagnosing and treating movement dysfunction, ergonomics, and managing pain to optimize quality of life and function; meet the needs of, and maximize quality of life

59
Q

Palliative care model

A

Rehab-light, case management, skilled maintenance, rehabilitation in reverse, and supportive care

60
Q

Rehab Light

A

When exacerbated symptoms are controlled and individual has potential to improve; Gentle endurance and strengthening program; Functional improvement expected but often not exceeding baseline

61
Q

Case management: Individual has a ____________; Caregivers and family are currently managing care of the individual but requires _______________________; PT visits as needed to re-evaluate safe function and provide ___________________; Goal is ___________________; Often necessary due to levels of stress related to caregiving at EOL

A

complex condition +/- multiple co-morbidities; intermittent education and cueing to manage safely; ongoing family education and equipment recommendations; patient and family safety and maintenance of quality of life

62
Q

Skilled maintenance: Like Case Management where the individual has a ________________; Difference is that the individual REQUIRES the ______________; No longer caregiver training, is skilled intervention; Visit frequency based on the required visits to maintain the ___________

A

complex condition with multiple co-morbidities and is not expected to improve; specific skills of a PT to safely perform functional mobility; functional level for patient’s quality of life

63
Q

Rehabilitation in Reverse: Often follows case management and/or maintenance; Applies to individuals who have a _____________; Re-evaluation of status at every visit with recommendations for _______________; Goal of care: _______________

A

rapid decline in functional status; changes in functional activity, caregiver education, equipment modifications; Maintenance of QOL activities with modifications

64
Q

Supportive care: PT to enhance __________________; Goal: ____________________

A

comfort and quality at end of life; education and demonstration of techniques for the family and caregiver to provide on-going support to the individual

65
Q

Hospice is a relatively new benefit for ____________

A

Medicare

66
Q

The hospice benefit is a ____________ benefit that supports ________________

A

comprehensive; patients and families

67
Q

Palliative care __________ hospice care

A

is not

68
Q

The EOL disease trajectory for functional decline is relatively _______________ for several diagnoses

A

predictable

69
Q

______________ play a role in managing patients at the end of life

A

evidence based tools

70
Q

The _________________ provides a model of intervention based on the disease trajectory

A

Briggs Palliative Care Model

PT Selected Topics (7 decks)

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