Hospice and Palliative Care Flashcards
Hospice came from the term ________ meaning _________________
hospitality; a place of rest or shelter for ill and weary travelers
History of Hospice: 1948
Dame Cicely Saunders first applied the name to dying patients
History of Hospice: 1963
Saunders visits US and promotes Hospice
History of Hospice: 1969
Elizabeth Kubler-Ross published “On Death and Dying”
History of Hospice: 1972
Kubler-Ross testifies at the senate special committee on aging
History of Hospice: 1974
First legislation for hospice proposed but not enacted
History of Hospice: 1982
Medicare Hospice Benefit added to the Tax Equity Fiscal Responsibility Act of 1982 (4 year sunset)
History of Hospice: 1986
Medicare Hospice Benefit became permanent
What is Hospice?
Compassionate care model for life-limiting (terminal) illness
What is included in hospice?
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
Goals of Hospice
Enhance QOL, Patient-centered, patient-determined EOL planning, Patient/family self-care independence, and support for the family
How does one qualify for Hospice?
Benefit of Medicare A and private insurances; Physician certification: life-limiting illness, not expected to live > 6 months
Hospice care can exceed __________ months
6
Patients can ________________ or ____________ hospice and return later
Graduate from; discontinue
There is a daily rate for all care related to the _____________
life-limiting diagnosis
Members of the hospice team
Volunteers, physicians, spiritual counselors, social workers, bereavement counselors, home health aides, therapists, nurses, pt, and family
Who is always at the center of the hospice team?
Pts and their family
Hospice can occur in what settings?
Home/residence, Hospital, skilled nursing facility, assisted living facility, and inpatient hospice facility
How many Americans receive Hospice each year?
1.7 million
Slightly more ________ than _______ receive hospice, with a majority being over the age of _____________ and a majority _______% being ___________________
women, men; 85; 80, white/Caucasian
What are the 4 most common diagnoses in Hospice?
Cancer, dementia, heart disease, and lung disease
What are the 4 levels of Hospice care?
Routine, Respite, Inpatient, and Continuous
Routine hospice care
Traditional hospice, in a home or facility; Intermittent services by the multidisciplinary team
Respite Hospice care
Break for families when patient lives at home, bring patient into facility for short periods of time to allow rest for the family
Inpatient hospice care
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
Continuous Hospice Care
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
End of Life Planning: documents
advanced directive: living will and power of attorney (POA), Physician Orders for Life-sustaining treatment (POLST), and 5 wishes
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: _______________
care you want at end of life, refuse to follow it; living will and power of attorney
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 ________________
care wishes; overridden; life-sustaining interventions, ventilation, feeding tubes, and dialysis
Power of attorney
person legally assigned to act and make decisions for someone: financial, medical, or both
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.
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
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 ____________________
patient and family; how you want to be cared for during your last days; those things that are important to them
What are the five wishes
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
Palliative care is defined by the World Health Organization as ___________________________
multidisciplinary and holistic assessment and management of physical, psychosocial and spiritual symptoms, with the goal of alleviating suffering
Palliative care often sits outside of hospice. It’s goal is __________________ and the patient is often still involved in ________________
pain and symptom management; active treatment
Palliative care programs _____________ paid for by Hospice Benefit
are NOT
______________ is part of Hospice, but the program entitled _________________ is different
Palliation of symptoms; palliative care
The Palliative Care Team
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
Palliative care reimbursement is included in _______________ depending on the location
Medicare A or B
Medicare A reimburses palliative care in what locations?
home health and the hospital
Medicare B reimburses palliative care in what locations?
Outpatient
Palliative care is provided in _________________ by a palliative care team that is often led by ____________________ and it is also provided by some insurance benefits
hospital, outpatient, home health, or SNF; physician or nurse practitioner
Primary goal of palliative care?
pain and symptom management
Why receive palliative care?
collaborate with other physicians to ensure optimal symptom control, and it’s often the bridge to hospice
Hospice vs Palliative care
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
Disease Trajectory 1
Prolonged stability usually associated with aggressive intervention and then sharp decline
Cancer is which disease trajectory
1
Disease Trajectory 2
Long term limitation, short severe exacerbations followed by recovery to a lesser extent
Organ Failure is which disease trajectory
2
Disease Trajectory 3
Slow steady decline with intermittent medical complications triggering more functional decline
Dementia is which disease trajectory
3
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 _____________________
medical model; efficient, high-quality; pushed to quantify their services
The Functional assessment scale (FAST) was developed to ____________________
help identify pts with dementia at end of life
How many stages of development are there in the FAST scale and what are they?
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
The FAST scale moves in ____________ direction
only 1
Edmonton Symptom Assessment Scale
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
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: ____________________________________
Premature institutionalization; goal setting and case management; financial, physical, psychological, social, and personal
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.
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
Palliative care model
Rehab-light, case management, skilled maintenance, rehabilitation in reverse, and supportive care
Rehab Light
When exacerbated symptoms are controlled and individual has potential to improve; Gentle endurance and strengthening program; Functional improvement expected but often not exceeding baseline
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
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
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 ___________
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
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: _______________
rapid decline in functional status; changes in functional activity, caregiver education, equipment modifications; Maintenance of QOL activities with modifications
Supportive care: PT to enhance __________________; Goal: ____________________
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
Hospice is a relatively new benefit for ____________
Medicare
The hospice benefit is a ____________ benefit that supports ________________
comprehensive; patients and families
Palliative care __________ hospice care
is not
The EOL disease trajectory for functional decline is relatively _______________ for several diagnoses
predictable
______________ play a role in managing patients at the end of life
evidence based tools
The _________________ provides a model of intervention based on the disease trajectory
Briggs Palliative Care Model
