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 a variety 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.

Levels of care of Medicare hospice regulations

Routine home care Continuous home care Respite care Inpatient care

Routine home care

The most common level of care and the heart of hospice care Care begins with an admission process, which includes and assessment and evaluation of the patients status and appropriateness for hospice care During the initial visit, the focus is on discovering the concerns and issues that are troubling the patient and the family and in helping them unerstand what hospice care is and how it can help them.

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 direct care for the patient

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 to prevent hospitalization for management of acute symptoms It may also be used when the burden of caregiving for families is greater than their resources There are no limits to the number of hours or days allowed at this level, but care must be primarily skilled nursing for at least 8 hours out of 24 to qualify. provides an invaluable resource for helping patients to stay at home and die at home

Respite Care
Supports the patients family and caregivers They need time away from the intensity of caring for terminally ill individual Hospices in their own facilities or contracted beds in nursing homes or hospitals provide respite care for 5 day periods Respite care must be provided in a medicare-certified facility

Inpatient care
Short term admission to a Medicare certified facility for medical problems In general, any patient whose care is so complex or demanding that the family can no longer continue to provide home care is a candidate for inpatient care At least 80% of all patient care must be home care days, and no more than 20% of days can be spent in the combination of respite and regular inpatient care

Triggers for Inpatient Palliative Care Admissions

Imminent death under specific conditions Bleeding active and potential Sepsis Seizures Impending delirium tremens Uncontrolled pain Any uncontrolled symptom CNS dysfunstion delirium, coma, dementia Fractures of weight bearing bones Management of complex medications Acute cardiac symptoms MI, arrhythmias Complex treatment schedule requiring frequent dressing changes or procedures that require the time, skill and observations of a professional nurse Terminal agitation

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

Additional Non-Medicare Levels of Care

Not included in the Medicare hospice benefit are three separate levels of specialized care:
Residential care Day care Extended caregiver programs/services

Residential care
Is provided in the hospice/palliative inpatient settings for patients who require supportive care related to safety needs, weakness, or the inability to perform selfcare. Also provides a way to offer better continuity for those patients who are no longer appropriate for regular inpatient care status. Is provided in hospice facilities or in contracted beds in hospitals or nursing homes. In either case, the hospice is responsible for ensuring that care and services meet hospice standards.

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 specific health care problems. Patients are transported to the day care site by family or by the hospice. There are planned activities, meals, and observation and assistance as needed. Severely ill or debilitated patients should not use this portion of the gram.

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 where the physical demands for caregiving are beyond the strength of the caregiver. It is also a way to supplement care when residential care beds are not immediately available.

It is possible to use extended caregiver programs, where extra help in the home is offered to supplement the familys care for patients whose temporary needs cannot easily or appropriately be satisfied through regular home-care or inpatient services. This is an optional service some hospices provide when they are able to fund the care through special fund-raising projects, community support, or foundation grants. Although extended caregiver service is not a mandated level of care, it is important to remember that other required levels of care must be available to hospice patients.

Service Settings
Home Facility-Based Care Common Service Sites Hospital Long-Term Care Facility Hospice Facilities Specialized Residences

Service Settings
Hospice care is defined not only by services and
levels 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

Home
simply defines as a persons place of residence Hospice home care is being provide in the following settings
Adult foster care homes Congregate living and group homes AIDS housing Hospice residences Tents Homeless shelters Jails Nursing homes And many other kind of personal residencies

Facility-Based Care
This may be a more significant responsibility for the safety and comport of the patients home because care is being provided 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 regular inpatient 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

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 care for 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 between nursing 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.

Hospice Facilities
There was no reimbursement or licensure for hospice care. The first hospice facilities were licensed as specialty hospital hospices, nursing homes or extended care facilities and the level of care they could offer was limited to regular inpatient care. It applied specifically to those facilities, were inappropriate for hospice care. The cost of meeting those requirements increased the cost to hospices for providing inpatient care. The reimbursement level for inpatient care was much less than the actual cost, and hospices were continually forced to employ fundraising events in order to keep the facilities operating.

There is typically no reimbursement for the room and board cost of residential care. Enactment of the Medicare hospice benefit influenced licensure laws and created a reimbursement source for hospice care. The hospices could design cost-effective settings to provide acute, residential and respite care and justify licensure of the facility as a hospice. It allows for expeditious transfer of patients from one level of care to another.

Specialized Residences
Certain populations of patients with terminal illness are spurring the development of specialized hospice/ palliative care settings. These include patients with the diagnosis of AIDS, Alzheimers dementia, and all pediatric terminal illness. Although nearly 10,000 children die of conditions such as cancer each year, fewer than 10% of the 3,100 hospice program provide end-of-life care and fewer are geared specifically toward kids.

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

THANK YOU!!!
Group 2
Calimon, Czarina Feye Demeterio, Micah Clarysse Dugenio, Neriza Gamis, John Alvin Pecson, Carl Allen Perez, Ernmalene Zoilo, Melanie