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 TexasObjectives:-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 beforedeath. 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, alwaysacknowledging 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 healthcare 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 companiesMyths 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