○ Minor comfort care procedures, such as paracentesis, i.e., removing fluid from the abdominal cavity. 21 Volunteer services Hospice volunteers are used in day-to-day administrative and/or direct patient-care roles. Volunteers are an essential part of the interdisciplinary team and endure rigorous training to participate in hospice programs. Their role is to assist in various tasks, including caregiver support, patient companionship, legacy writing, and administrative duties. Bereavement services As indicated previously, both hospice and palliative care programs offer support to bereaved family members as they anticipate the patient’s death. However, hospice programs that are Medicare certified are required to also offer bereavement care to the family for 13 months after the death. These bereavement services may include monthly phone calls to the family members, acknowledgements of anniversaries, receptions honoring those on hospice services, and resources for support groups. 22 Hospice medicare benefit Sources of payment for hospice care include private health insurance, veteran’s benefits, the patient’s own income or family support, charitable donations, Medicaid, or Medicare. Medicare patients have a specific Hospice Medicare Benefit (HMB) that reimburses the hospice on a per diem basis. The hospice provides clinical support from the interdisciplinary team, as well as durable medical equipment and coverage of medications associated with the terminal illness. Approximately 85 percent of hospice reimbursement/payment comes from the HMB. 20 The HMB does not cover curative treatments or medications, care from specialists not approved by the hospice provider, or room and board for hospice care provided in a patient’s home or another facility, such as a nursing home. 20 These strict limitations contribute to provider hesitancy in referring patients to hospice. 12 In addition, hospice items and services under the HMB require that items and services be provided by Medicare- approved hospice programs made up of an interdisciplinary team, including members of specific disciplines. These team members, representing specific interdisciplinary team to provide suggestions and collaborate with the patient, family, attending physician, and hospice team. ● Nurses coordinate patients’ care and assess and manage symptoms. They provide patient and family education, collaborate with the physician and other team members, initiate and administer treatments, provide physical care, and offer emotional support. ● Home health aides are certified Nurses Assistants who provide personal care, support, and light housekeeping for the patient and family. disciplines, fulfill different functions 20 : ● The medical director works with the
Universal ethical principles apply in situations of referral to palliative care and hospice. Advanced directives and shared decision-making support patient autonomy. Beneficence and non-maleficence guide many of the decision points in palliative and hospice care where the focus is on relieving suffering and promoting quality of life. 16 Patients can be referred to hospice while remaining full code, leading to ethical concerns about balancing patient autonomy and avoiding harm. 17 End-of-life decision-making can be especially difficult and ethically challenging for patients with dementia. While decision aids are available to help caregivers make decisions, more research is needed to further develop these tools for use in different ethnic populations. 18 However, while the conversations can be very difficult, the ethical principle of fidelity calls for clinicians to be clear, There are four levels of hospice care, defined by Medicare, which correspond to both acuity level and payment structure: Routine home care, continuous (aka crisis) home care, respite care, and general inpatient care. 19 1. Routine home care : The level of care that most patients could receive at home. This level of care consists of interdisciplinary care delivered on an intermittent basis at the patient’s home, and it may include skilled nursing facilities (SNFs), group homes, and assisted living facilities. 20 2. Continuous home care : Used when patients have symptom management needs that require temporary 24-hour support. 20 This level of care, also known as crisis care, assists patients who may require a higher level of nursing care but desire to stay at home. 20 3. Respite care : Caregivers are allowed a period of rest while patients are cared for by an interdisciplinary team in a facility. In respite care, patients are allowed 5 days of care while on direct, and truthful about prognosis. 16 Levels of hospice care and services hospice services. Respites are pre-planned stays in facilities (e.g., inpatient units or SNFs) which can occur under the following circumstances: ○ Caregivers who may be suffering from physical or emotional exhaustion from taking care of a patient around the clock. ○ Caregivers who would like to attend a family event such as a graduation, wedding, or funeral. ○ Caregivers who become ill and cannot take care of the patient. 20 ● General inpatient care : When the patient develops uncontrolled acute symptoms or a medical issue which cannot be resolved in the home or with continuous care, general inpatient care must be provided by the hospice. These acute symptoms include issues such as: ○ Uncontrolled pain and/or agitation; ○ Uncontrolled seizures; ○ Uncontrolled nausea and vomiting; ○ Unmanageable dyspnea, i.e., shortness of breath; ○ Complex wound care; and/or
Book Code: MI24CMEB
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