Hospice

Background

Hospice: aims to provide aggressive palliative care for pts at the end of their life, usually when life-prolonging treatment options have stopped.

Eligibility: ≤ 6-month life expectancy and goals are comfort.
Ensure patient is hospice minded (does not want to be readmitted, comfortable with foregoing routine blood work and scans).
Consider in patients with 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

Inpatient: 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: 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, 2-3x/wk at most
Medication for comfort.
Durable medical equipment for comfort and safety including oxygen.
Up to 13 months of bereavement counseling for caregivers after the death.
Respite care for 5 days, usually in a nursing home.
Inpatient hospice for symptom control for up to 7 days.

Veterans can continue to receive some treatments for the primary condition (e.g. palliative radiation or chemotherapy) and still receive hospice services.
All veterans on hospice 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.”