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7 Geriatrics > L8 Hospice > Flashcards

L8 Hospice Flashcards

1
Q

Palliative Care

A

meant to improve the QOL of pts who have serious disease, an approach to care that addresses the person as a whole, not their disease

goal is to prevent, treat, as early as possible, symptoms and side effects of disease and its tx in addition to any related problems

anyone can receive it regardless of age or stage of disease

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2
Q

Palliative Care should be

A

quality of life care, occurring with disease directed care

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3
Q

Primary Roles of Palliative Care Team

A
  1. Identify the individuals’ goals for care
  2. symptom management
  3. advanced care planning
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4
Q

Palliative care helps to

A
  • decrease the cost of end of life care
  • better QOL and less regret for family
  • decreases amount of grief family experiences
  • less depression, fewer tests, fewer invasive tx
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5
Q

Hospice Care

A
  • type of palliative care
  • goal is to improve QOL through multidisciplinary care
  • can receive medical treatment but it is for s/s management, not curative
  • offered at end of disease proces
  • must have terminal prognosis with 6 mo or less to live
  • payment is through a specialized benefit
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6
Q

Palliative Care vs Hospice

A
  • goal is to improve QOL in combo with primary medical tx for disease
  • goal is to improve QOL through multidisciplinary care
  • can still receive curative tx
  • can be offered at disease diagnosis
  • not time limited
  • also called supportive care and symptom management
  • payment through traditional methods
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7
Q

Comfort Care

A
  • common term used in hospitals, hospice provided in hospitals
  • expensive way to deliver hospice care but done when pt doesn’t have a place to discharge to
  • not the same as palliative care, lacks rehab
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8
Q

Palliative Care Payment

A
  • private health insurance usually covers it
  • medicare and medicaid pay for some kinds
  • Medicare B = outpatient medical services
  • Medicare A = inpatient, IPR, SNF
  • Medicaid = varies by state, OR does cover
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9
Q

Payment for Hospice Care

A
  • medicare = paid as a daily rate through Part A. Covers rate of $199 for ALL services. Decreases to $157 after 60 days
  • medicaid covers hospice, depends on state. OR does cover
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10
Q

Impairments addressed in palliative care

A
  • Physical = pain, nausea, SOB, fatigue
  • Emotional and Coping
  • Spiritual
  • Caregiver Needs
  • Practical needs = financial, insurance, employment
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11
Q

How to tell if pt is transitioning to hospice care

A
  • provider documents this in chart
  • patient tells you that they are ready
  • family members says they are ready
  • you observe pt medically declining
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12
Q

Types of Advanced Directives

A

Durable power or attorney
Living Will

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13
Q

Durable power of attorney for health care

A

lets you name one or more people to serve as your health care agent or proxy, giving them power to make medical decisions for you if you are not able to do so yourself

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14
Q

Living Will

A

lets patient specify what type of care or treatments they wish to receive and list the circumstances in which they’d like them to be used

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15
Q

Creating Advance DIrectives

A
  • Obtain a copy of an advance directive form
  • Contact physician, state agency, or download
  • do not need an attorney
  • you do need one notary public or two wtinesses to sign the form
  • copies of AD need to be given to health care proxy, doctor, and hospital
  • can be updated at any time
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16
Q

Without an AD

A
  • medical decisions might be made by others, if you can’t make them yourself
  • order in OR goes spouse, majority of adult children, parents, siblings
  • unmarried partner cannot make decisions unless they have been named as proxy
17
Q

Will an advance directive guarantee your wishes are followed?

A
  • legally recognized but not legally binding
  • may not be followed in complex medical situation, goes against provider’s conscience, institution’s policy, or health care standards
18
Q

Other examples of advance care planning forms

A
  • DNR
  • DN intubate
  • DN hospitalize
  • out of hospital DNR
  • physician orders for life sustaining tx and medical orders for LST. Created for serious progressive illness and is a medical order. PINK paper
19
Q

Conversation Project

A
  • 90% of people say that talking with loved ones about end of life is important, but only 27% have done it
  • 60% want to make sure family is not burdened after their death, but 56% have not communicated
  • 82% say it’s important to put wishes in writing, 23% have done it
20
Q

Changes in Palliative Care from Traditional

A
  • balance function and participation w/comfort and preserving some strength
  • more willing to accept refusal or physical variability
  • focus on pain control with modified ADLs
  • emotion based interactions
  • procure DME to anticipate decline
  • not pushing patients close to end of tolerance level
21
Q

Prioritization in PT Goals

A
  1. Safety
  2. Optimize QOL
  3. Mobility

no pain is a GAIN for palliative patients

21
Q

Is PT appropriate during hospice care?

A

YES

  • primary goals are related to safety and QOL
  • rehab clinicians are not identified as core interdisciplinary team members in medicare
  • PT, OT, SLP services must be available when provided
  • you as PT may need to advocate to the hospice of your role
22
Q

Do pts need to make functional progress to receive rehab services?

A
  • skilled therapy is NOT require to produce improvement in function
  • stable, maintenance, or declining is ok, and will not be denied payment
  • need to document the benefit from skilled therapy
23
Q

Skilled maintenance

A
  • required when person with an advancing illness would functionally decline at more rapid rate without clinician’s unique skills and services
  • key tasks required to manage the pts condition are too complex or unsafe for unskilled caregivers to perform
  • clinician visits can be delivered intermittently and coordinate amongst HCP
  • emphasize PT interventions to slow the person’s debility, optimize ADLs, and QOL
24
Q

Skilled maintenance billing

A
  • private insurance companies may NOT cover skilled maintenance therapy
  • billing medicare part B, tradition PT codes are relevant
  • billing in home health setting, use billing code “services performed by qualified PT in home health setting, for at least 15 min”
25
Q

Access and Timelines of PC rehab services

A
  • proactive screening and referral
  • referrals are to be prioritized for these patients, to reduce hospital readmissions, and assures successful D/C
26
Q

When should PT initiate a PC consult?

A
  • PTs develop close relationships with pts with terminal diseases
  • PTs often see the patients more frequently than other HCP and may identify S/S, repeated hospitalizations, difficulty coping, suffering spiritual distress, co-morbidities, unplanned weight loss
27
Q

Spirituality

A

dynamic dimension of human life that relates to the way persons experience, express and/or seek meaning, purpose and transcendence, the way they connect to the moment to self, others, nature, significant, sacred

7 Geriatrics (9 decks)

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