Hospice and Palliative Care PDF

1/28/25 Hospice and Palliative Care Alex DeRadke, DO Assistant Professor Geriatric Medicine 1 Objectives Identify factors that play a role in estimating life expectancy....

1/28/25 Hospice and Palliative Care Alex DeRadke, DO Assistant Professor Geriatric Medicine 1 Objectives Identify factors that play a role in estimating life expectancy. Module 4 Identify resources to assist the health care team with prognostication for older adults. Module 4 Compare and contrast palliative vs curative care. Module 4 List the benefits of and barriers to Hospice care. Describe how Hospice is funded. Module 4 Understand how to refer patients to hospice and criteria for admission to Hospice. Module 4 Discuss the various roles of members of an inter-professional team that provide palliative or end-of-life care for patients. Module 4 Evaluate the concepts of prognostication. Module 4 Apply the components of prognostication that providers use in end-of-life care. Module 4 Evaluate how prognostication helps patients, caregivers, and providers. Module 4 2 Definitions Hospice care: is a comprehensive care system for patients expected to live ≤6 months; its sole focus of care is on comfort and relief of suffering for individuals at life’s end. Palliative care: Interdisciplinary care that aims to relieve suffering, improve quality of life, optimize function, and assist with decision making for patients with advanced illness and their families 3 1  1/28/25 Goals of Care Palliative Care: Alleviate out of control symptoms (pain or existential). This can be in conjunction with curative care or comfort care Hospice Care: Comfort at the end of life. Not curative 4 Hospice Criteria Less than 6 months or less to live agreed upon by two providers (usually referring provider and hospice director) Some hospices require that patient is no longer seeking life prolonging interventions (some don’t and VA does not) Have to have clinical information and documentation that backs this up Can use Medicare LCD guidelines which have disease specific criteria for Hospice 5 Hospice Settings Home Ideal for most patients so they can stay at home with loved ones as the disease progresses Medical team comes to the patient in their home Facility Assisted living or nursing home care Usually family are unable to manage symptoms at home but don’t need inpatient care Inpatient Symptoms require inpatient treatment as they are too out of control Patient has terminal diagnosis while inpatient and doesn’t seem safe to transfer home 6 2  1/28/25 Palliative Settings Outpatient Clinic based practice Referred by other specialties/primary care for discussions about end of life or uncontrolled symptoms (pain, nausea, constipation, etc) Conversations stretched over multiple clinic visits Inpatient Hospital based practice See patients while admitted for other diagnosis Conversations usually center around current circumstances and will have further discussions after discharge in outpatient setting if appropriate 7 Hospice Team Physician (at least one to serve as medical director) APPs Nurses Aide (CNAs to help with bathing, dressing, ADLs, etc) SW Volunteer (all hospices must have volunteers) Bereavement specialist Chaplin (who can be bereavement specialist but not always) 8 Palliative Team Physicians/APPs Nurses MA’s Usually have SW Sometimes have chaplains associated with outpatient but definitely do with inpatient 9 3  1/28/25 Hospice: Medicare Benefit For patients with an expected prognosis of 6 months or less if the disease follows its usual course, certified by 2 licensed physicians. Patients may revoke their hospice benefit at any time. Prognostication is challenging and accuracy increases with experience Patients must be recertified hospice-eligible every few months. If no longer judged to have a remaining life expectancy of