Hospice and Support Services

Flashcards covering hospice vs palliative care, admission criteria, care teams, reimbursement, bereavement, and grief concepts from the video notes.

What is hospice?

A model of care for terminally ill patients in the final phase of illness, focusing on alleviating pain and improving quality of life, with emphasis on palliative care rather than curative treatment.

What is palliative care?

A multidisciplinary approach to relieve suffering in all stages of disease, not limited to end-of-life, aiming to improve quality of life, prevent and relieve suffering, and manage symptoms; can begin at diagnosis and with treatment; pain management is key.

Where is hospice care typically provided?

Home-based; the majority of hospice programs care for patients at home, though some have inpatient units in hospitals, rehabilitation facilities, or skilled nursing facilities.

What is respite care in hospice?

A rest period for the primary caregiver, during which another caregiver cares for the patient; may involve moving the patient to a hospice unit for short periods.

What are the hospice admission criteria?

Clinician must order hospice and sign the death certificate; life expectancy <6 months; patient consents to admission; patient agrees not to continue life-sustaining equipment if a life-threatening event occurs (but comfort-focused treatments, such as palliative chemotherapy, may be chosen).

Do patients have to be actively dying to receive hospice care?

No. Patients must show functional decline with an estimated prognosis of 6 months or less and may elect to stop services.

Can hospice care be extended if a patient lives longer than 6 months?

Yes. The patient may be discharged or hospice care can be extended through recertification if the physician deems the patient still terminally ill with life expectancy ≤6 months (about 21% live longer than 6 months).

Give examples of terminal conditions eligible for hospice.

Metastatic cancers (lung, colon), end-stage COPD, end-stage CHF (Class III/IV), end-stage liver disease without transplant, HIV/AIDS with comorbidities and ARV refusal, ESRD with dialysis cessation, ALS, Parkinson's, stroke, coma, end-stage dementia (e.g., Alzheimer's).

When should hospice consultation be considered?

Earlier discussions are beneficial to improve symptom care, pain relief, and emotional support; average stay can be up to 25 days; clarify that hospice is not cessation of all care; arrange evaluation when ready and qualifying.

Who makes up the hospice team?

Attending physician/clinician, hospice physician, RN as primary case manager, home health aides, social worker/grief counselor, clergy; PT/OT for comfort as needed; other members may include pharmacists, volunteers, and alternative therapy specialists.

What is bereavement care in hospice?

Both patient and family are offered bereavement care; a hospice counselor provides initial and ongoing grief counseling; after death, bereavement support lasts about 13 months under Medicare; specialized support for children is available.

What are Medicare Hospice Benefits criteria?

Medicare Part A covers hospice for citizens 65+ (or certain younger individuals with long-term disability/ESRD); enrollment in a Medicare-approved facility; both hospice and attending physician certify life expectancy <6 months; patient cannot be on life-sustaining equipment during hospice.

What other reimbursement methods cover hospice care?

Medicaid, long-term care insurance, and most private health insurance; some hospice programs provide care for uninsured individuals; know local hospice resources.

What is a common misconception about hospice and death preparation?

That hospice equates to cessation of all care; clarify that hospice focuses on comfort and support for patient and family, not abandonment of care.

What is the difference in goals and treatment between palliative care and hospice?

Palliative care aims to relieve suffering at all disease stages and may use life-prolonging medications and equipment; hospice serves terminally ill patients (<6 months) and focuses on comfort, with no life-prolonging treatments.

What are the Five Stages of Grief and Dying according to Kübler-Ross?

Denial and isolation, Anger, Bargaining, Depression, Acceptance; not all patients experience every stage or in the same order.

What is the average length of hospice stay mentioned?

Up to 25 days.

Who signs the death certificate in hospice admission?

The clinician (attending physician/clinician) must sign the death certificate.

Are PT/OT/SLP available in hospice care?

Yes, for palliation and comfort; they may continue if beneficial and not aimed at curative/restorative goals.

What does ‘functional decline’ mean in hospice eligibility?

A decline in the patient’s ability to perform daily activities, contributing to an estimated prognosis of 6 months or less.

What is home-based residential care in hospice?

Hospice care delivered primarily in the patient’s home, with some inpatient units or facilities available as needed.