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Signs of Appropriateness for Hospice Evalutaion
While these guidelines are certainly not all inclusive,
they are meant to serve as a starting point for evaluating the need for hospice care.
You may request consultation with a Homeside Hospice staff member
to discuss any questions that arise as a result of these guidelines
in determining the appropriate time for a hospice referral.
- Sudden or progressive weight loss
- Decline in function, with increased need for assistance with activities of daily living
- Decrease in level of orientation or consciousness
- Increased pain and decreased ability to control pain
- Progression of disease process to the level that “heroic” measures
are being considered to sustain life, such as feeding tubes or intravenous fluids
- Inability or unwillingness to take foods by mouth
- Cancer diagnosis
- Family or patient expresses wishes for palliative measures only.
- Family or patient requests that the patient be a Do Not Resuscitate (DNR), Do Not Intubate (DNI),
or Do Not Hospitalize (DNH) (although not necessary)
- Increased disease symptoms in non-cancer diagnosis,
such as increase in episodes of CHF in end-stage cardiac patient,
with decreased response to medical interventions
When is hospice care appropriate? Routine or inpatient level?
While these guidelines are certainly not all inclusive,
they are meant to serve as a starting point for evaluating the need for hospice care
in a patient.
Keep in mind that with ROUTINE hospice care,
if the patient is going to a skilled nursing facility the room and board
IS NOT covered by hospice and must be covered either by Medicaid
or paid privately by the patient/family.
For INPATIENT level of care, room and board
IS paid for by hospice and there is no cost to the patient/family.
Routine Hospice Care – level of care provided
to all eligible patients, regardless of whether they reside at home or
in a skilled nursing facility, and regardless of insurance or ability to pay for services.
Receives full range of hospice services including nurse/case management,
psychosocial evaluation and follow-up, spiritual support, home health aide assistance,
volunteer services, and bereavement care for 13 months following death of patient.
Some of the eligibility criteria include:
- Life-limiting illness with a prognosis of <6 months
- Declining functional status
- Frequent hospitalizations due to multiple infections
- Frequent trips to the emergency room
- Weight loss of >10% in the last 4 to 6 months
- Serum Albumin < 2.5 gm/dl
- Patient/family have elected palliative care and are not seeking curative treatment
- Documented clinical disease progression
- Generalized failure to thrive and decline in health status
Inpatient Hospice Care – a higher level
of care required for treatment necessary for pain control or acute or chronic symptom
management that cannot feasibly be provided in other settings.
Some of the eligibility criteria include:
- Sudden onset or new manifestation of pain
- Ongoing pain management when this management necessitates frequent adjustments in the dose of analgesia requiring constant monitoring
- Alternative modalities of pain control that cannot be managed in another setting
- Intractable nausea, vomiting, or other major gastrointestinal symptoms
- Respiratory distress
- Severe decubiti or other skin lesions/wounds
- Any other physical symptom that is unmanageable in an alternative setting
- Psychosocial problems and uncontrolled symptoms that can create significant psychosocial pathology in the patient or family, including behavioral or cognitive abnormalities that do not appear to have a neurologic or organic etiology
- Acute breakdown or disruption in family dynamics, preventing family members from functioning as adequate caregivers for reasons that can be either physical or emotional (i.e. family unwilling or unable to provide needed care to patient)
Why Hospice In An Assisted Living Facility?
Utilizing hospice in an assisted living facility provides an additional level of care
and support both to the resident and to the facility.
It can provide the resident with the additional level of support needed
to remain at the facility rather than being transferred to an alternative care setting.
Some of the added benefits include:
- Hospice nurse available 24 hours a day,
7 days a week for visits for patient assessment, change in condition, medication changes
or to pronounce the patient upon expiration
- Home health aide visits daily, at times that best meet the resident’s needs,
to provide support with activities of daily living or companionship
- Educational program conducted that are appropriate both to facility staff and
to residents
- Hospice provides additional staff, including home health aide, social worker, nurse,
chaplain, in order to allow the resident to remain in place rather than need transfer
to an alternative care setting
- Symptom management provided by nursing staff trained and experienced
in pain management, under the supervision of the hospice medical director
- Support for the family system; knowing a loved one has a life-limiting illness
can be overwhelming for families,
and hospice provides support through our social work and spiritual care staff
to meet their unique needs
- There is never a cost to the patient,
their family or the facility for hospice services;
it is covered by Medicare, Medicaid and most private insurances,
and no patient is denied hospice services because of lack of insurance or lack of ability
to pay
The Partnership of Hospice and Assisted Living Facilities
How Hospice Helps in the Assisted Living Setting
- Allows peace of mind in knowing that highly trained nurses in palliative care are assessing patients' needs and managing their symptoms at home
- Hospice provides necessary documentation to meet licensure requirements such as Plan of Care
- When disease progresses and patients require more assistance and demands from facility staff increases, the hospice team is available to supplement their care
- Continuity of care provided by a designated interdisciplinary team for each assisted living facility
- Plan of care is individualized for each patient in accordance with the regulations identified by Medicare
- Medications related to the hospice disease process are provided by a local pharmacy through Hospice
- Supplies are provided by the members of the hospice team responsible for personal physical care, such as briefs/diapers, wound care supplies, and gloves
- Participation by the Primary Care Physician is always encouraged. Assistance from the hospice medical director is also available.
- Bereavement/memorial services are available to patients' families, other residents and facility staff
- Hospice staff is available to provide training to facility staff regarding disease process and progression, identification of symptoms and how to manage them with and without medication
Consideration For Referring A Patient To Hospice Begins When:
- There is a significant decline in resident's physical or mental health status
- Patient requires frequent visits to the MD's office or the Emergency Room
- Patient's level of mobility has declined requiring frequent intervention by facility staff
- Patient is losing weight which is not intentional
- Patient is becoming weaker and requires more assistance with activities of daily living
- Disease is progressing at a rapid rate or a new diagnosis has been identified
- Resident has recently chosen to stop aggressive treatment options
How Does Hospice Help the Patient?
- Hospice assists the patient and the family through the end-of-life process, by providing medical, nursing, psychosocial, spiritual and volunteer services
- Provides education, support, and relief of care for the patient to assist the family in their goals for patient comfort, symptom management, advanced directives/ planning
- Hospice develops an individualized Plan of Care for each patient. This Plan of Care is then implemented by an interdisciplinary team approach. Services provided by team members may be increased or decreased at any time based on the needs of the patient and/or family/caregiver
- Persons receiving hospice services often times experience a relief of financial burden. Hospice provides medications related to the hospice disease, supplies and medical equipment necessary to provide comfort and ease of care giving
- There is never a cost to the patient, their family or the facility for hospice services; it is covered by Medicare, Medicaid and most private insurances, and no patient is denied hospice services because of lack of insurance or lack of ability to pay
- Hospice services are available 24 hours a day, 7 days a week to assist with any questions or urgent needs, and to help manage any changes in condition
- Hospice provides bereavement and support services to families and the community after the loss of loved ones.
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