hospice and palliatiave care settings

7/31/2019 Hospice and Palliatiave Care Settings

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Hospice / Palliative Care

Includes a distinct, comprehensive cluster of

services for terminally ill individuals and

their families, which are provided for

continuum of intensity (levels of care) in avariety of settings

All hospice and palliative care includes

access to and availability of appropriate and

necessary services to meet the identified

needs and choices for care made by the

patient and the family.


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Levels of care of Medicare

hospice regulations

Routine home care

Continuous home care

Respite care

Inpatient care


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Routine home care

The most common level of care and the heartof hospice care

Care begins with an admission process,which includes and assessment andevaluation of the patients status andappropriateness for hospice care

During the initial visit, the focus is ondiscovering the concerns and issues that aretroubling the patient and the family and inhelping them unerstand what hospice care isand how it can help them.


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Care during the first few visits is

directed toward relieving specific

problems such as pain, symptoms of

the disease or anxiety

There is usually significant

involvement of the family or primary

care support persons providing directcare for the patient


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Continuous Home Care

Expanded level of care in the home It allows up to 24 hours a day of skilled nursing

to ease patients through period of crisis and toprevent hospitalization for management ofacute symptoms

It may also be used when the burden ofcaregiving for families is greater than theirresources

There are no limits to the number of hours or

days allowed at this level, but care must beprimarily skilled nursing for at least 8 hours outof 24 to qualify.

provides an invaluable resource for helpingpatients to stay at home and die at home


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Respite Care

Supports the patients family andcaregivers

They need time away from theintensity of caring for terminally illindividual

Hospices in their own facilities orcontracted beds in nursing homes orhospitals provide respite care for 5 -

day periodsRespite care must be provided in a

medicare-certified facility


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Triggers for InpatientPalliative Care Admissions

Imminent death under specific conditions

Bleeding active and potential

Sepsis

Seizures

Impending delirium tremens Uncontrolled pain

Any uncontrolled symptom

CNS dysfunstiondelirium, coma, dementia

Fractures of weight bearing bones

Management of complex medications Acute cardiac symptomsMI, arrhythmias

Complex treatment schedule requiring frequentdressing changes or procedures that require the time,skill and observations of a professional nurse

Terminal agitation


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In 2000, according to the National

Hospice and Palliative Care

Organization, 96% of the days of

hospice care service were routine

care, 3% of the days were inpatient,

0.3% was respite care, and 0.3% was

continuous home care


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Additional Non-MedicareLevels of Care

Not included in the Medicare

hospice benefit are three separate

levels of specialized care:Residential care

Day care

Extended caregiver programs/services


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Residential careIs provided in the hospice/palliative

inpatient settings for patients who requiresupportive care related to safety needs,weakness, or the inability to perform self-care.

Also provides a way to offer bettercontinuity for those patients who are nolonger appropriate for regular inpatient carestatus.

Is provided in hospice facilities or in

contracted beds in hospitals or nursinghomes. In either case, the hospice isresponsible for ensuring that care andservices meet hospice standards.


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Day care

Designed to provide relief to caregiver

and diverse activities for the patient.It is similar to other adult day care

programs for patients with specifichealth care problems.

Patients are transported to the day caresite by family or by the hospice.

There are planned activities, meals, andobservation and assistance as needed.Severely ill or debilitated patientsshould not use this portion of the gram.


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Extended caregiver programs/services

A.K.A in-home respite care.

Is a new level of care that is growing in

popularity in hospice programs

Is needed and used by working families,

frail caregivers, and in situations wherethe physical demands for caregiving are

beyond the strength of the caregiver.

It is also a way to supplement care whenresidential care beds are not immediately

available.


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It is possible to use extended caregiverprograms, where extra help in the home is

offered to supplement the familys care forpatients whose temporary needs cannot easilyor appropriately be satisfied through regularhome-care or inpatient services. This is anoptional service some hospices provide when

they are able to fund the care through specialfund-raising projects, community support, orfoundation grants.

Although extended caregiver service is not a

mandated level of care, it is important toremember that other required levels of caremust be available to hospice patients.


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Service Settings

Home

Facility-Based Care

Common Service Sites Hospital

Long-Term Care Facility

Hospice Facilities

Specialized Residences


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Service Settings

Hospice care is defined not only by services andlevels of care provided, but also by the settings in

which these services are delivered.

care in the patients personal residence is always

considered routine home care or continuous

home care.

levels of care provide by the hospice:

routine home care

continuous home care

residential care day care

respite care

inpatient care


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Home

simply defines as a persons place ofresidence

Hospice home care is being provide in the

following settings

Adult foster care homesCongregate living and group homes

AIDS housing

Hospice residences

Tents

Homeless shelters

Jails

Nursing homes

And many other kind of personal residencies


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Facility-Based Care This may be a more significant responsibility for the safety

and comport of the patients home because care is beingprovided by paid caretakers rather than family.

the services must be of the y and same quality and volume to

ensure comport and safety

Common Service Site Hospital

hospital settings are the most common site for regularinpatient care, and the most frequent method providing that

care is a scatter bad approach

a less common model is dedicated unit. This is contracted

arrangement with the hospital in which a specific unit or

number of beds are reserved for hospice patient


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Long-Term Care Facility Nursing homes are use as sites for regular inpatient care, respite care, and

routine home care. Reimbursement and the ability to offer expanded carefor residents are inducements to the nursing home to contract with the

hospice. The favorable surrounding, lower cost of contracting for regular

inpatient and respite care, and ability to increase their patient census are

benefits for the hospice.

The differences between long-term care regulations and hospice

regulations require careful negotiation and ongoing cooperation betweennursing home and hospice staff. The nursing home must be Medicare

certified, and the hospice requirement that a registered nurse be on the

premises and available to provide hands-on care 24 hours a day can create

a problem for the nursing facility.

It is a growing trend for hospices to provide care in extended care

facilities. Dedicated beds or dedicated units for regular inpatient and

respite care are a familiar part of hospice inpatient care. Routine home

care offered in nursing homes is a more recent and growing part of hospice

care. It requires the same level and mix of services provided to other

hospice home care patients, and it can be an equally valuable resource to

terminally ill patients in nursing homes.


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Hospice Facilities There was no reimbursement or licensure for

hospice care.

The first hospice facilities were licensed asspecialty hospital hospices, nursing homes orextended care facilities and the level of care theycould offer was limited to regular inpatient care.

It applied specifically to those facilities, wereinappropriate for hospice care.

The cost of meeting those requirementsincreased the cost to hospices for providing

inpatient care. The reimbursement level for inpatient care was

much less than the actual cost, and hospiceswere continually forced to employ fundraisingevents in order to keep the facilities operating.


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There is typically no reimbursement forthe room and board cost of residential

care.Enactment of the Medicare hospice

benefit influenced licensure laws andcreated a reimbursement source for

hospice care.The hospices could design cost-effective

settings to provide acute, residential andrespite care and justify licensure of thefacility as a hospice.

It allows for expeditious transfer ofpatients from one level of care toanother.


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Specialized Residences

Certain populations of patients withterminal illness are spurring thedevelopment of specialized hospice/palliative care settings. These include

patients with the diagnosis of AIDS,Alzheimers dementia, and all pediatricterminal illness.

Although nearly 10,000 children die of

conditions such as cancer each year,fewer than 10% of the 3,100 hospiceprogram provide end-of-life care andfewer are geared specifically toward

kids.


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Advocacy for holistic hospice services,

tailored to the needs of an individuals

diagnosis and age-specific

developmental skills and

requirements, is increasing.

The settings include:

Community-based homes

Residences owned by hospices

Designated inpatient wards


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THANK YOU!!!

Group 2Calimon, Czarina Feye

Demeterio, Micah Clarysse

Dugenio, NerizaGamis, John AlvinPecson, Carl AllenPerez, Ernmalene

Zoilo, Melanie

hospice and palliatiave care settings

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