Hospice Care Vs Palliative Care - Mhha

Palliative vs HospiceSMHospice Care vsPalliative CareEasing the burden of illness,Improving quality of lifeSeasons Hospice and Palliative CareCheryl Ledesma, FNP-BCJacklyn Griffin, ACNP-BCMichelle Briggs, FNP-BCObjectivesSMAfter completing this course the learnerwill be able to: Define Palliative Care Explain how Palliative Care differsfrom Hospice List common conditions and symptomstreated by Palliative CarePalliative Care DefinedSM Palliative care is an approach that improvesthe quality of life of patients and theirfamilies facing the problem associated withlife-threatening illness, through theprevention and relief of suffering by meansof early identification and impeccableassessment and treatment of pain and otherproblems, physical, psychosocial andspiritual.1

Palliative vs HospicePalliative care:SM Provides relief from pain and otherdistressing symptoms; Affirms life and regards dying as anormal process; Intends neither to hasten or postponedeath; Integrates the psychological andspiritual aspects of patient care;SM Offers a support system to help patientslive as actively as possible until death; Offers a support system to help thefamily cope during the patients illnessand in their own bereavement; Uses a team approach to address theneeds of patients and their families,including bereavement counseling, ifindicated;SM Will enhance quality of life, and mayalso positively influence the course ofillness; Is applicable early in the course ofillness, in conjunction with othertherapies that are intended to prolonglife, such as chemotherapy or radiationtherapy, and includes thoseinvestigations needed to betterunderstand and manage distressingclinical complications.2

Palliative vs HospiceSMPalliative Care andHospice DifferencesSMPalliative CareHospiceComparable to a house callpractice or a subspecialist (suchas cardiology or pulmonology)Medicare benefit programConsults / visits provided byMD or NP for symptommanagement related to anadvanced illnessServices provided by interdisciplinaryteam including physicians, nurses,social workers, chaplains, musictherapists, home health aides,volunteers, etc.Visits occur anywhere fromevery day to once per monthbased on clinical needs.Visits occur usually twice per week bynurse, and twice per week by homehealth aide. Physicians visit PRN.Continued next slidePalliative Care andHospice DifferencesSMPalliative CareHospiceNo requirement for prognosis ofless than 6 monthsRequired to have a prognosis of 6months or lessServices are consultation based.Curative measures can bemaintained (chemo, radiation,surgeries, dialysis, etc.)Services are comprehensive and includeDME, medications related to terminaldiagnosis, 24 hour supportPatient can be accessing homehealth or skilled nursing daysPatients forego skilled rehab, homehealth and curative treatmentsContinued next slide3

Palliative vs HospicePalliative Care andHospice DifferencesSMPalliative CareHospiceBilled through Medicare Part BBilled through Medicare Part APalliative specialist receivesMedicare, Medicaid and privateinsurance reimbursementdepending on billing code (CPTand ICD-10)Hospice receives a per diem rate fromMedicare depending on the level ofcare (4 levels)Patient is responsible for copaybased on consultation rateInsurance reimburses case-by-case,carve out for certain treatments, suchas TPNPalliative CareSM Can be provided along with other therapiesintended to prolong life, such aschemotherapy or radiation therapy Includes those tests or investigationsneeded to better understand and managedistressing clinical complications Important to note: patient can have a lifeexpectancy of more than 6 months but stillhave a chronic and ultimately terminalillnessSMChronic Illnesses Addressed byPalliative Care include: CancerCongestive heart failureChronic kidney diseaseChronic pulmonary diseaseDementia (unspecified andAlzheimer-type)Liver diseaseCerebrovascular disease/CVAParkinson’s diseaseHIV/AIDS4

Palliative vs HospicePalliative Care vs HospiceSM Elderly female with past medical history of endstage COPD status post multiplehospitalizations Goals of care included maximal independence,peaceful end of life, refer to hospice onceskilled days have been exhausted Symptoms included debility and dyspnea Advanced directives needed to be addressedand updatedWould this patient be more appropriate for palliative care or hospicecare?Palliative Care vs HospiceSM 63 year old women who was diagnosedwith lung cancer Not aware that she was “stage 4” until anew oncologist took on her case Wanted to continue radiation therapy eventhough she was very weak and in a lot ofpain She had goals to get “affairs in order” Difficulty eating due to dyspneaWould this patient be more appropriate for palliative care or hospicecare?Palliative Care vs HospiceSM 101 year old female with dementia andGrade I congestive heart failure on palliativecare service for over one year Stable until September 2016 when shesustained a couple of falls and beganintermittent wandering at night November 2016 suffered a right femurfracture and underwent an ORIF Post- operatively suffered from increasedlethargy, albumin dropped below 2 Decrease in functionalityWould this patient be more appropriate for palliative care or hospicecare?5

Palliative vs HospicePotential Palliative ConditionsSM “The Usual Suspects” – progressive life-limitingillness Incurable cancer Progressive, advanced organ failure (heart, lung,kidney, liver) Advanced neurodegenerative illness (ALS,Alzheimer’s Disease) Sudden fatal medical condition Acute stroke Withholding or withdrawing life-sustaininginterventions (ventilation, dialysis, pressors,food/fluids ) Trauma – eg. head injury Ischemic limbs, gut Post-cardiac arrest ischemic encephalopathy etc SMSymptoms often managed byPalliative Care: SMPainDyspneaNausea and VomitingCachexia and tionRestlessness and agitationSleep disordersFatiguePositive Impact of PalliativeCare Involvement 91 year old female diagnosed with CHF, renalfailure and COPD 20-25 % ejection fraction Oxygen dependent 4L NC, desat without NCO2 Hospitalized for edema of lower extremities Returned to facility with a LifeVest Family/resident were told that LifeVest wouldimprove heart function6

Palliative vs HospicePositive Impact of PalliativeCare InvolvementSM 89 year old women diagnosed with dementia Having syncopal episodes at Memory Care Unit Palliative Care NP found out that episodes wereoccurring primarily in the morning Palliative Care NP collaborated with attendingMD to change long acting beta blocker frombeing given in the evening to being given in themorning (with parameters) No further syncopal epidsodes Avoided injury, hospitalization, workup andoverall improved quality of life.Positive Impact of PalliativeCare InvolvementSM 55 year old female with early onset ofAlzheimers with behavioral issues. Pastmedical history of bipolar disorder, posttraumatic stress disorder and obsessivecompulsive disorder Goals of care are psychological comfort(improved behaviors and compliance) Symptom of increased agitation Weight loss Full codePotential Palliative Care InterventionsSMPalliativeSupport Emotional Spiritual ctionsHypercalcemiaControl of PainDyspneaNauseaVomitingGenerallyNot PalliativeTube FeedingHighlyburdensomeInterventionsDialysis7

Palliative vs HospiceSMAdvanced Care Planning/Goals ofCare Health care proxy/surrogate decision maker Establishing wishes in the event of seriousillness or acute event Clarifying code status Family meetings Communication/Documentation of patientwishes to the rest of the health care team.SMPalliative Care TriggersSM You would not be surprised if theresident/patient died within 12-18 months You’re aware the resident/patient has 3 ormore chronic illnesses and is on multiplemedications You’ve noticed the residents/patients goalsof care re inconsistent, he/she lacks anadvanced directive, or there’s disagreementamong family members about the plan ofcare8

Palliative vs HospicePalliative Care TriggersSM You’ve had to send the resident/patient to thehospital at least twice in the last 6 months You’ve had trouble controlling theresident’s/patient’s physical or psychologicalsymptoms You’ve noticed the resident/patient isbecoming more difficult to feed, is losingweight, or has a declining functional statusSMOverall Benefit of Palliative CareConsultations Reduced symptom burden ofchronic/terminal illness Early integration of palliative care mayprevent the use of aggressive care inoutpatient settings Identifies goals of care and advocates forpatient wishes Cost avoidance Increase in quality of lifeReferencesSM Alexander, K., Goldberg, J., & Korc-Grodzicki, B.(2016). Palliative care and symptom managementin older patients with cancer. Clinics in GeriatricMedicine, 32, 45-62. Bushor, L., & Rowser, M. (2015, August).Symptom management of adult chronic illness inthe outpatient setting. Journal of Hospice &Palliative Medicine, 17, 285-290. Buss, M. K., Rock, L. K., & McCarthy, E. P.(2017, February). Understanding hospice andpalliative care: A guide for primary care providers.Mayo Clinic Proceedings, 92, 280-286.9

Palliative vs HospiceReferencesSM Dahlin, C., Coyne, P. J., & Ferrell, B. R. (Eds.).(2016). Advanced practice palliative nursing. NewYork, NY: Oxford University Press. 6. Miller, S.C., Lima, J. C., Intrator, O., Martin, E., Bull, J., &Hanson, L. C. (2016, September 19). PalliativeCare Consultations in Nursing Homes andReductions in acute care use and potentiallyburdensome end-of-life transitions. Journal of theAmerican Geriatrics Society, 64, 2280-2287. World Health Organization (WHO) Definition ofPalliative Care. (2017). Retrieved n/en/Contact InformationSM Jacklyn Griffin- jaGriffin@seasons.org Cheryl Ledesma- cledesma@seasons.org Michelle Briggs- mbriggs@sesasons.org10

Palliative vs Hospice 1 SM Hospice Care vs Palliative Care Easing the burden of illness, Improving quality of life Seasons Hospice and Palliative Care Cheryl Ledesma, FNP-BC Jacklyn Griffin, ACNP-BC Michelle Briggs, FNP-BC SM Objectives