Case Study 2 Instructions: Please read through the case study below and consider the questions that follow.
You are talking to your clinical colleagues about end-of-life care for a patient. Someone states that hospice is the same as palliative care and that only private insurance pays for hospice care.
1. 1. You know this statement is not accurate, and you clarify to your colleagues that a. palliative care is a subset of hospice care. b. hospice is a subset of palliative care and can be paid for by private health insurance, veteran’s benefits, the patient’s own income or family support, charitable donations, Medicaid, or from the Medicare hospice benefit. c. hospice can only be paid for by private health insurance. d. palliative care is the same hospice care but for those in a hospital setting. Explanation: Hospice and palliative care are not the same. Palliative care is the overarching care of those with serous or advanced illness, in which hospice is a subset. Hospice is not only paid for by private insurance. Other sources of payment for hospice services are veteran’s benefits, self-pay, charity, Medicaid, or the Medicare Hospice Benefit.
2. Any patient can qualify for hospice care as long as they have all of the following EXCEPT: a. an advanced illness. b. certification of terminal illness by a physician.
c. a family to care for them. d. 6 months or less to live.
Explanation: Only patients who have been diagnosed with an advanced or life-limiting illness and determined by a physician to have 6 months or less to live can qualify for hospice care. Having a family is not part of the hospice certification process.
Geriatric palliative care
• Physical component: Coping with bodily changes and any significant suffering • Cognitive component: Thinking about adapting to what is and leaving behind what was • Behavioral component: Conveying wishes to others and personally acting upon those wishes based on personal values • Spiritual component: Interpreting life’s purpose, unraveling its mystery, and leaving a legacy that helps explain it all As individuals face dying, they may attempt to find meaning in their losses, their lives, their illness, and most importantly, in their own deaths by asking themselves what it means to be near the end of life, or by exploring what it means to no longer exist. 30
Stage-Based
Palliative care in the geriatric population is a collaborative and interdisciplinary approach focused on improving and maintaining quality of life for the patient’s remaining time. Patients with a primary diagnosis of cancer (32%) had the greatest number of days on palliative care, followed by primary diagnoses of circulatory/ heart disease (13.2%) and pulmonary disease (11.3%). 27 In addition to these diagnoses, dementia, including Alzheimer’s disease, vascular dementia, and dementia with Lewy Bodies, has been steadily increasing. 28 Regardless of etiology, pain is the most common complaint (50%) of palliative care patients. 28 Finding Meaning In 1969, Viktor Frankl argued that the main goal in a person’s life is to actively create and find meaning and value in life. This reflective process at the end of life includes emotional, physical, cognitive, behavioral, and spiritual exploration, and it helps many to find understanding and positive transformation. 29 • Emotional component: Exploring one’s feelings about a diagnosis with a terminal prognosis
The stage-based approach to coping with dying is the most familiar among healthcare providers. This groundbreaking work by Elisabeth Kübler-Ross 31 outlined emotional stages of the dying process and includes five stages of grieving, or accepting death: denial, anger, bargaining, depression, and acceptance. 31 What this model can teach clinicians is that the underlying philosophy of the stage-based model is not to manipulate and move those with a life-threatening disease through transitions and milestones as death approaches; stages do not occur in a fixed sequence or timeline. 32
Task-Based
Theoretical models
While dealing with each phase that brings the patient closer to death, there are certain tasks that need to be accomplished while living with life-threatening illness, which have been bodily needs and minimizing physical distress, such as by controlling pain and constipation. psychological security, autonomy, and richness in living. • Psychological tasks maximize divided into four areas of taskwork. 33 • Physical tasks involve managing
In addition to finding meaning, a variety of theoretical perspectives can help guide the way in which clinicians provide support to those coping with death and dying. These theories can be applied from the time of diagnosis to the time of death. Theoretical models of the dying process help clinicians intervene appropriately and offer the best quality of life for these patients. Theoretical models of the dying process include stage-based, awareness- based, task-based, phase-based, landmarks- based, and spirituality-based models.
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