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7/31/2019 Hospice and Palliatiave Care Settings
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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