By Joelle Y. Jean, FNP
Due to its busy nature, providers in the Emergency Room (ER) may not immediately identify patients for hospice care. Approaching patients or family members about hospice can also be challenging-especially if they have specific questions. This hospice checklist can help guide providers on when they should consider a patient for hospice.
What is hospice?
Hospice is for patients who are at the end of life. Patients can have a terminal illness or declining health from a chronic illness. The hospice team can coordinate care with health care providers to manage and treat patients.
Benefits of hospice
Initiating hospice early in the disease process has many benefits for the patient and family members. Hospice is there to improve the quality of life and provide comfort for patients during their end of life. Benefits of hospice include:
Improved physical and psychological symptoms
Caregiver relief
Reduced hospitalizations
Lowered hospitalization costs
Reduced hospital deaths
Barriers to initiating hospice
Studies have shown that providers initiate hospice too late- patients die within weeks of entering hospice. There are barriers that cause ER providers to wait or not consider hospice. Some barriers include:
Not having the right resources
Breakdowns in patient-clinician communication
Failing to identify terminal stage of life
Geographical and socioeconomic barriers
Head-to-toe hospice checklist
Alzheimer’s disease and dementia
Patients in the late stages of Alzheimer’s disease or dementia are candidates for hospice. At this stage, they start to lose activities of daily living (ADLs) and cannot complete basic functions on their own. These functions include:
Bathing
Dressing
Eating
Swallowing
Other signs providers should consider patients with Alzheimer’s disease or dementia for hospice are:
Loss of the ability to walk (life expectancy is about a year)
Patients in their late stages of heart failure (HF) are candidates for hospice. Providers should consider hospice if the patient has:
Visited the ER two or more times in the past six months
A decline in ADLs
Severe HF symptoms such as dyspnea, angina, fatigue
Not responded to pharmacological and non-pharmacological interventions
Ineligible for surgery
Weight and muscle loss
NYHA class three/four heart failure
Lung disease and lung cancer
Patients with end-stage lung disease and lung cancer are hospice candidates. Providers should consider hospice if the patient:
Has frequent ER visits
Increased weight loss
Increased dyspnea at rest even with oxygen
Stage four non-small lung cancer
Liver disease
Patients with end-stage liver disease are candidates for hospice. Liver disease is the 12th leading cause of death in the United States. Patients with liver disease are often overlooked for hospice care. Providers should consider hospice for patients with end-stage liver disease if they are:
Ineligible for a liver transplant
Increased pain
Increased pruritus
Increased nausea
Depression and anxiety
A decline in cognition and weight
Cancers
ER providers can opt for hospice for patients with cancer if treatment is no longer working or there are no other treatment plans. Patients also at the end stage of their cancer can benefit from entering hospice early. Other signs a patient is ready for hospice are if the patient:
Has increased weakness
Significant weight loss
Pain control
In bed for most of the day
Sepsis
It’s not always easy to identify patients with sepsis who qualify for hospice. However, some patients meet the criteria. Providers should consider patients with sepsis for hospice if the patient:
Has impaired kidney failure
Not responding to pharmacological treatment
Require mechanical ventilation
Injury to the liver
Hyperlactemia
Hospice is available to patients who are at the end of their life. They can entire at any stage in their disease process. Initiating hospice early benefits the patient. Studies have shown that hospice improves mood, decreases medical interventions, and enhances the patient’s overall quality of life.By: Wilma Peterson, RN
According to the American Lung Association, Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death in the United States. Living with the symptoms of COPD, such as difficulty in breathing, can induce stress for both the patient and the family. Due to this, Doctors are beginning to call for earlier hospice referrals for these patients with COPD. If elected early, the benefit of hospice care can assist with symptom management, prevent unnecessary hospitalizations, and help patients achieve a better quality of life.
Patients with advanced COPD are eligible for hospice care, which is fully covered by Medicare, some private insurances, as well as assistance from Veterans Affairs. When hospice care is chosen early, patients have access to the appropriate care and medications, allowing for more restful periods and easier breathing. Identifying these factors early can relieve symptoms such as anxiety, panic, labored breathing, and intractable coughing that are uncontrolled with regular medications and traditional therapies.
Factors to consider when discussing the appropriateness of a hospice referral for a COPD patient include:
The patient has a projected life expectancy of 6 months or less
All therapies, including medications and rehabilitation, have been exhausted
The patient has frequent emergency room visits and hospitalizations due to exacerbation of COPD
At this point, the patient is considered to be in the advanced stages of COPD, and the discussion for hospice and end-of-life care should begin.
Eight benefits of early hospice referral for those with COPD
Electing the hospice benefit early allows for the expertise of a focused team of professionals:
Physician
Nurses
Social worker
Chaplain
Ancillary services
Hospice services are available 24/7/365. The hospice care team will provide medical, emotional, psychological, and spiritual support to the patient and family. Here are eight benefits of early hospice referral:
Early intervention. The earlier the hospice referral is made, the more time it allows the patient and their family to select the right hospice company and be a part of the care plan.
Managed care. A physician leads the hospice care team and can order the appropriate medications and therapies and cater to an individualized care plan for each patient.
Skilled Nurses. A registered nurse will meet with the patient and family, and can admit the same day. The nurse will also reconcile all medications, put together a plan that focuses on managing symptoms, and provide relief of pain and respiratory distress.
Hospice Aides. Health aides assist with normal daily activities:
Washing
Grooming
Dressing
Ambulating safely
Other household chores, as needed
Medical Social Worker. A social worker will support patients and families with accessing resources within the community, such as respite care, living arrangement and other services.
Chaplain. Clergy works with the patient and their family to support psychological and spiritual needs, assisting them through the end-of-life, grieving process or any other related needs.
Ancillary services. Other ancillary services like physical therapy and occupational therapy, strengthen muscles to assist with safety and allow for a sense of independence.
Respite Care. Allows time for self-care and rest, which can help with a change in attitude and mindset in caring for your loved one.
Living easier with hospice care
Early hospice referrals means early management of symptoms by:
Having the appropriate therapy and staff when needed
Avoiding the stress of emergency exacerbations and unnecessary hospital visits
Providing a more individualized approach to the patient and caregiver
Alleviating stress to allow time for future planning or ability to spend quality time
Don’t wait, make the referral to hospice early. An early hospice referral can provide extra support for both the caregiver and the patient. If you or a loved one is struggling with COPD, consider the benefit of hospice services.The holidays can be a challenging and bittersweet time for those with a seriously-ill loved one. Electing the hospice benefit may seem like one more item on your to do list, but hospice can ease the burdens of facing a life-limiting illness. If a loved one has unmanageable symptoms, they could end up spending their holiday in the hospital, away from family and friends.
Hospice of the Midwest helps families manage their loved one’s pain and symptoms so they can spend the holidays in the comfort of home–whether that means in their own home, in a loved one’s home, or in a skilled nursing facility or assisted living facility that they’ve made their home.
Hospice Care in the Comfort of Your Home
Whether your loved one is being cared for at home or in a facility, the additional layer of support that hospice can provide can make all the difference. Hospice care can help manage complex symptoms of pulmonary disease, cancer, dementia, Parkinson’s, heart disease, stroke, liver or kidney disease.
Our interdisciplinary approach, which includes care from a nurse, aide, social worker, chaplain, medical director, and the patient’s primary care physician, is designed to support patients and their families physically, psychologically, and spiritually. With the assistance of this personalized care team and the guidance of the patient’s primary physician, your family can have the support necessary to keep your loved one comfortable and supported without unnecessary hospital visits or doctor appointments.
Hospice of the Midwest’s team is local and available 24 hours a day, 7 days a week, 365 days a year to provide care for our patients and for admissions.
Hospice can also provide necessary durable medical equipment, such as a hospital bed; medications related to the patient’s primary hospice diagnosis; and incontinence products and nutritional supplements. By utilizing hospice services, families have more time to enjoy the most meaningful moments of the holidays — time spent together with family.
“Hospice of the Midwest has always been great with communication and are very pleasant to work with. We love teaming up with them to ensure our patients receive the best care possible.” – Amy, Director of Nursing at Windsor Manor in Grinnell Family & Caregiver Support this Holiday Season
With holidays comes stress, as time runs out to shop, run end-of-year errands, and attend special events. Combine that with caring for a seriously-ill loved one during these unprecedented times, and life can become overwhelming quickly.
Our hospice care extends beyond the patient. Hospice of the Midwest works closely with family members to assure they have the tools necessary to cope with stress or caregiver burnout surrounding what may be the final holiday with someone they love. In addition to scheduled visits, patients and their families will have access to a dedicated hospice nurse by phone who is available to answer your questions and dispatch a nurse to your home as needed.
Our team of chaplains and social workers collaborate to address patient and family members’ emotional, psychological and spiritual needs. They make certain our patients’ families have a plan for the holidays, so they can make the most of the holidays without piling up additional stress.
“I’m so glad I had hospice directly involved at the end of my mother’s life. People need to take advantage of hospice and be encouraged to use it – especially this holiday season.” – Bridget Tessler, Daughter of HOMW Patient
Caring for a loved one facing a terminal illness can be demanding, but it can also be incredibly fulfilling. Hospice of the Midwest can partner with you or your loved one’s facility to ensure everyone – patient and family alike – is supported and cared for this holiday season.
If you have a loved one with a life limiting illness, please contact us to learn more about how Hospice of the Midwest can help your family this holiday season, because home should be more than a holiday wish!Care at no cost to Veterans and their families.
Hospice of the Midwest collaborates with local VA agencies and programs to raise awareness about the benefit of hospice services for Veterans. As a Veteran, expenses for hospice-related services or enrolled veterans are covered in full.
We Honor Veterans Program
Hospice of the Midwest partners with the We Honor Veterans program to give veterans the best care possible. This program provides resources and training to meet the needs of our veteran patients and their families through respectful inquiry, compassionate listening, and grateful acknowledgement so that veterans can have a peaceful end-of-life experience.
VA Hospice Program Benefits
Hospice is a benefit that the VA offers to qualified Veterans who are in the final phase of their lives. This multi-disciplinary team approach helps Veterans live fully until they die. The VA also works very closely with community and home hospice agencies to provide care in the home. The VA hospice benefit includes:
Care available wherever you call home
No co-pay for hospice care
Medical equipment, medication and personal care supplies
Personalized pain and symptom management
Care coordinated with your doctors
Physical, occupational and other therapy services
Spiritual care and support
Volunteers with military experience (when available)
Ongoing grief counseling for patients and family
Veteran-To-Veteran Volunteer Program
Hospice of the Midwest’s Veteran-to-Veteran volunteer program pairs Veteran volunteers with hospice patients who are Veterans as well. Veteran volunteers have the ability to develop a unique connection with patients and their families through their common experiences and stories, establishing a strong relational bond.
How can Veteran Volunteers Help?
Reminisce or tell life stories
Educate and answer questions regarding Veteran benefits
Assist in pinning ceremonies, distribute certificates and help with other recognition events
Assist in replacing lost medals
For many people, the decision to receive hospice care is made following the diagnosis of a life-limiting illness. Even so, some families still question this decision. Here are some common Hospice qualifiers to help determine when it might be time to elect the hospice benefit.
Falls
Frequent physician, ET and/or Hospital visits
Weight loss and or BMI < 22
Decline aggressive therapy or is not a candidate
Wounds
EF < 20%
NYHA Class IV symptoms at rest
Little or no response to Bronchodilators
Serum < 2.5
Dysphagia and/or aspiration pneumonia
Shortness of breath and/or o2 sat of 88% or less
Frequent injections
Edema
UTIs
Upper respiratory infections, bronchitis or pneumonia
If you or a loved one are experiencing any of these symptoms and have questions about our services at Hospice of the Midwest, please contact one of our office locations near you to speak with a staff member about these Hospice qualifiers.
Hospice of the Midwest is here for you – 24/7/365.
Choosing Hospice is often a difficult decision. We help lead this conversation and can ease the anxiety of the transition from cure to comfort for patients who are appropriate for hospice care. If two or more of these potential indicators are present, hospice should be considered.
Common Hospice Diagnoses
End Stages of: Cancer, Heart Disease/CHF, Pulmonary Disease/COPD, Dementia/Alzheimer’s Disease, Neurological Disease/CVA, Renal Disease & Liver Disease.
If your loved one is requiring increased assistance with Activities of Daily Living (ADLs) such as bathing, dressing, grooming, oral care, toileting, transferring to their bed/chair, walking, eating, etc.; this may be an indicator that hospice should be considered.
Additional indicators include:
Muscle Loss/Weakening or Weakness
Multiple Falls
Multiple ER Visits/Hospitalizations
Recurrent/Multiple Infections
Altered Mental Status
Unintentional Mental Status
Unintentional Weight Loss
Difficulty at Mealtime
Increasing Shortness of Breath
Multiple Medication/Frequent Medication Changes
Sleeping Longer/Napping More
Skin Breakdown/Wounds
Other Diagnoses that Contribute to Decline
If you have questions about the hospice benefit or when to elect your benefit, please contact Hospice of the Midwest at 515-218-2143 (Johnston, IA) · 641-323-2047 (Grinnell, IA) · 641-332-3006 (Guthrie Center, IA) · 651-344-1040 (Woodbury, MN).One word… One word that’s the most solidifying word you will ever hear. A word that can often be misinterpreted.
One word… Hospice.
This means you are dying. Maybe not dying today, tomorrow or the next day – but it is a word not many want to hear. As a hospice liaison, helping people understand to not be afraid is part of what makes my job so rewarding. Watching potential patients and their family member begin to ease as I explain the role of hospice is an incredible feeling.
As a hospice liaison, I help ease all your previous notions about what we do and assure you that we are here to help.
Hospice doesn’t mean you will die tomorrow. It does not mean you will be taken off all your medications or stay home while waiting for the end. What it does mean is that you have a terminal illness and instead of continuing to seek aggressive treatment, it is better for you to be comfortable and have a quality of life with loved ones, however that may be defined by you.
It is shown that a hospice patient lives more comfortably when: a nurse visits to manage pain and symptoms, a home health aide provides personal care, a social worker assists with community resources and counseling, a chaplain offers spiritual support, volunteers play cards with and a physician oversees it all to ensure you are as comfortable as possible for however long that may be.
That one word… Hospice. Let’s look at it in a more positive way, focusing on the benefits we can offer a patient and their family.
So, I ask both professionals and patients – Why would you not want to live more comfortably with support from hospice?
-Tracy Wagoner, Hospice LiaisonPandemic Relief via legislation, CMS waivers, and enforcement discretion
Telehealth
Waived requirement to use volunteers
Waive non-core services (physical, occupational, and speech pathology) *hospice only
Waive on-site visits for hospice aide supervision
Telehealth and Telephonic Visits
CMS permits hospices to provide telehealth to a Medicare patient receiving routine home care during the emergency period, if it is feasible and appropriate to do so.
Face-to-face encounters for purposed of patient recertification for the Medicare hospice benefit can now be conducted via telehealth (must be 2-way audio-visual)
Must be physician-ordered and on the plan of care
In an effort to protect patients, some SNF, LTC, hospice, and other facilities are limiting the number of visits that Abode Healthcare staff may make to patients in their care. Some patients are even requesting fewer in-person visits to reduce their exposure to the outside world.
Abode Healthcare understands and joins in these protection measures by offering telehealth visits. In some cases where access has been limited or is desired, Abode staff are utilizing telehealth on a weekly or bi-weekly basis in order to maintain contact with high-risk patients.
In all cases, telehealth visits are meant to be supplementary to in-person patient visits. Telehealth visits should not replace in-person visits altogether.
Telehealth Tools
Our commitment, as always, is to serve our patients as best we can. Our clinical team has been trained in effective ways to utilize telehealth systems to streamline patient care through our own remote access system using the following tools:
Phone: Abode Healthcare staff may conduct remote visits with patients through phone calls.
Video: Abode Healthcare staff may conduct remote visits with patients through Doxy.me. (All F2F between NPs or MDs, DOs must be done through a 2-way type of technology. This is for both HH and Hospice)
me can be utilized via tablets or phone and has been selected by Abode due to the ease of use for both the clinician and the patient/family/caregiver as well as its ability to capture/validate that the tele visit occurred, and its security features.
Though telehealth is never our first choice, it is the right choice during this time. Abode Healthcare continues to partner with providers to preserve the health and wellbeing of all of our patients.
