Hospice: aims to provide aggressive palliative care for pts at the end of their life, usually when life-prolonging treatment options have stopped
Eligibility: less than or equal to 6-month life expectancy and goals are comfort o Ensure patient is hospice minded (does not want to be readmitted, comfortable with foregoing routine blood work and scans)
Ensure therapies can be covered by hospice (i.e. frequent blood transfusions, pulmonary HTN meds, dialysis)
Consider: palliative performance scale (PPS) rating of <50-60%, dependence in 3 of 6 ADL’s, alteration in nutritional status, or documented deterioration in 4-6 months
Levels of Care
General inpt care: Pts must require skilled nursing care that could not be provided at home (IV medications, suction, high flow O2,) No cost to the pt under this level of care.
Home hospice pts are discharged to their "home,” which could be a long-term care facility, assisted living facility, or their house.
What is covered?
Personnel:
Hospice RN visits at least weekly and as needed; crisis on-call visits available 24/7
SW, Chaplain, Hospice MD oversight
CNAs: usually 1 hr, 2-3/wk at most
Medication for comfort
Durable medical equipment for comfort and safety including oxygen
Up to 13 months of bereavement for caregivers after the death
Respite care for 5 days, usually in a nursing home
Inpt hospice at hospice facility or at certain hospitals for symptom control for up to 7 days
Hospice can be offered to pts without insurance
VA Specifics for Hospice
Main difference compared to VUMC is pt is allowed concurrent care
This means vets can continue to receive some treatments for the primary condition (e.g. palliative radiation or chemotherapy) and still receive hospice services
Additionally, all veterans that go on hospice should have any needed nursing home stay (at a contracted SNF) covered by the VA regardless of service connection
VA Palliative Care team will help with these referrals
One (1) F Status at the VA
Designates “treating specialty” as NA-HOSPICE. Reduces costs for families, helps quality metrics. Use this if pt qualifies and agrees to hospice care
Write Delayed Transfer Orders: Admit to NA-HOSPICE and Specialty as “Hospice for Acute Care”
Write a nursing text order to “Change Pt to 1-F Status”
