HLTH 335 1st Edition Lecture 16 Hospice Brazos Valley In 2013 cared for 1066 patients Service area includes 17 counties 9000 square miles offices in Bryan Brenham and La Grange Only hospice inpatient unit in service area Is the only community owned non profit hospice in its service area Average patient length of stay is 55 days 2014 budget totals 9 2 million One of the largest rural hospices in Texas Objectives At the end of this presentation you will be able to Articulate a basic understanding of palliative and hospice care and its place in today s healthcare arena Identify the myths about hospice care that are detrimental to the treatment of chronic and terminal illness Articulate the role of hospice care in the treatment of patients who are chronically or terminally ill Where to you want to die 1 Home 2 Hospital 3 Assisted living facility 4 Nursing home 5 While on Facebook 6 At your deer lease 7 At Kyle Field Where Do People Die Hospital 50 Nursing Home 30 Home 20 Where do People WANT to die Home 1st Hospital 2nd Nursing Home Never If people wish to die at home why do most die in the hospital Forces exist in our health care delivery system together with the values related to health and illness that propel the physician patient family towards aggressive life prolonging care far longer than is medically appropriate such care typically is provided in the hospital environment up until shortly before death These notes represent a detailed interpretation of the professor s lecture GradeBuddy is best used as a supplement to your own notes not as a substitute 1 Physician Forces cont Uninformed about prognostic factors Uninformed about pain treatment e g how to assess pain use opioids Poor or no training in end of life communication skills Cultural insensitivity 2 Patient and Family Forces Difficulty accepting impending death Expectation of miracles Inability to give up hope Fear of talking about death Fear that giving up personal weakness Fear of the impact of a death at home Failure to discuss advance care plans 3 System Forces Increased number of hospital beds correlates to increased hospital deaths if you build it they will come Lack of organizational structure to support excellent end of life care in all care settings Financial disincentives exist that force care toward aggressive orientation Most Significant Force 1 Physician 2 Patient and Family 3 System Dying is an expected life cycle event Dying is just one of the many expected normal life cycle events Dying can be an opportunity for personal growth Dying can be an opportunity for family and community growth But is death a normal life cycle event Yes Normal in the very old Normal in patients who are chronically ill with declining function No Not normal in the young If medicine takes aim at death prevention rather than at health and relief of suffering if it regards every death as premature as a failure of today s medicine but avoidable by tomorrow s medicine then it is tacitly asserting that it s true goal is bodily immortality Physicians should try to keep their eyes on the main business restoring and correcting what can be corrected and restored always acknowledging that death will and must come that health is a mortal good and that as embodied beings we are fragile beings that must stop sooner or later medicine or no medicine End of Life Care Treats patients of all ages with life limiting or terminal illness Begins when the patient has decided not to have curative treatment or prolong life Has as its goal comfort and enhancing the quality of remaining life Typically has a pain management component Is directed by the physician and the patient Involves a primary care giver Why end of life care is important By 2030 20 of the U S population will be over 65 yrs of age Eventually most adults will have one or more chronic illnesses living with the illness for years before they die 95 of Medicare expenses occur in the last six months of a patient s life In the US in 2013 an estimated 45 of all deaths were hospice patients In the US in 2013 an estimated 1 65 million patients received hospice services Hospice care is provided by a team which includes the patient a primary caregiver and specially trained healthcare professionals Patient Patient s Primary Caregiver Physician Nurse Healthcare Aide Social Worker Chaplain Volunteer Bereavement Counselor Care is designed to treat the whole person and is provided wherever the patient lives home nursing home assisting living facility care may also be provided in an inpatient setting such as a hospital Services include all supplies medications and medical equipment as related to the terminal Diagnosis The goal of hospice care is to maintain the patient s independence allowing the patient to exercise important choices and guide his or her care Type of health care and medical treatment Advance directives Estate planning Reflect patient attitudes about death Influenced by advances in medical technology Contingent upon sound communication Bereavement Patient choices are reflected in a specialized plan of care designed to meet the unique individual needs of each patient Potential goals of care include Cure of disease Avoidance of premature death Maintenance or improvement of function Prolong life Relief of suffering Quality of life Maintaining control A good death Support of family and loved ones Hospice is about living with a terminal illness as fully and comfortably as possible Specialized health service provided to patients with life limiting illness a vital link in the chain of health care services Aggressive pain and symptom management always focuses on comfort and quality of life Compassionate comprehensive services delivered by hospice team to treat the whole person Support for family 24 hours a day Patients often live longer on hospice care A service paid for by Medicare Medicaid and most insurance companies Myths about hospice care Hospice is not About losing hope hospice care focuses on quality of life with each day filled with compassion About giving in to the disease About hand holding and doing nothing it is an active comprehensive treatment About hanging the morphine bag and comatose patients Religion based but does address the truth that dying is a spiritual exercise Just for the immediately dying Just for cancer patients Common Non Cancer Hospice Diagnoses Heart Disease HIV Pulmonary Disease ALS Stroke and Coma Liver Disease Alzheimer s Disease Renal Disease Failure to Thrive