Hospice

Hospice is comfort-focused care where quality of life is the priority.

The goals are to alleviate physical pain and provide psychosocial and emotional support.  Our physician-led hospice team provides expert medical care aimed at minimizing physical pain with appropriate prescription medications, which will be delivered to patients’ homes free of charge. In addition, the team includes social workers, bereavement counselors, and chaplain/spiritual leaders who serve as valuable custodians of patient and family wishes. If we do our job well, patients remain comfortable in their home environment, maintain dignity, do not feel like a burden on their loved ones as our team provides valuable support to everyone close to the patient.

Hospice is 100% covered by Medicare, Medi-Cal, and all health insurance plans.  Here is what is included at no cost to patients:

  • A physician-led interdisciplinary team of nurses, social workers. chaplains, bereavement counselors, and volunteers
  • Home visits by any and all members of the interdisciplinary hospice team as needed
  • Medications related to the hospice diagnosis and medications which alleviate physical, psychosocial, and emotional pain
  • Delivery of medications to patient’s home, SNF, ALF, RCFE or wherever he/she is receiving hospice care
  • 24/7 nurse line and on-call support
  • Medical Equipment (ME) delivered to patient’s home
  • Supplies (such as bandages and catheters)
  • Bereavement services for loved ones for a minimum of 13 months after death

Even if you have Medicare Advantage or Part D Supplemental Drug Insurance, traditional Medicare will cover all costs associated with hospice (including drugs).

Here are some signs and symptoms to consider that it may be time to talk to a doctor and begin thinking about end-of-life choices and options:

• A life-limiting illness or terminal diagnosis
• Frequent hospitalizations/ER visits
• Frequent calls to doctor’s office
• Frequent falls
• Progressive weight loss
• Profound weakness/fatigue
• Frequent infections
• Continuous use of Oxygen
• Difficulty in swallowing
• Increased edema/swelling
• Uncontrolled or increased pain
• Difficulty in breathing
• Progressive renal insufficiency
• Uncontrolled nausea or vomiting
• In emotional, social or spiritual distress
• Progressive decline in health despite therapy
• Patient and family requests no further aggressive treatment
• Change in mental status
• General decline

Hospice interdisciplinary team includes:

  • Medical Director
  • Hospice Manager
  • Nurses
  • Home Health Aides
  • Social Worker
  • Bereavement Coordinator
  • Chaplain
  • Volunteers
  • Patient Advocates

Hospice patients may require differing intensities of care during the course of their disease. There are four levels of care: Routine Home Care, General Inpatient Care, Continuous Home Care, and In-patient Respite Care. The insurance benefit for hospice typically covers all aspects of the patient’s care related to the terminal illness, including all services delivered by the Interdisciplinary team, medication, medical equipment and supplies.

  • Routine Hospice Care is the most common level of hospice care. With this type of care, an individual has elected to receive hospice care at their residence,
    which can include a private residence, assisted living facility or nursing facility. Nearly ninety- seven percent of hospice care is provided at the routine
    home care level.
  • General Inpatient Care is provided for pain control or other acute symptom management that cannot feasibly be provided in any other setting. General Inpatient Care begins when other efforts to manage symptoms have been ineffective. General Inpatient Care can be provided in a Medicare certified hospital, hospice inpatient facility, or nursing facility that has a registered nursing available 24 hours a day to provide direct patient care.
  • Continuous Home Care is care provided for between 8 and 24 hours a day to manage pain and other acute medical symptoms. Continuous home care services must be predominately nursing care, supplemented with caregiver and hospice aide services and are intended to maintain the terminally ill patient at home during a pain or symptom crisis.
  • Inpatient Respite Care is available to provide temporary relief to the patient’s primary caregiver. Respite Care can be provided in a hospital, hospice facility, or a long term care facility that has sufficient 24 hour nursing personnel present on all shifts to guarantee that patient’s needs are met. Respite care is provided for a maximum of 5 consecutive days.
  • Inpatient Respite Care is available to provide temporary relief to the patient’s primary caregiver. Respite Care can be provided in a hospital, hospice facility, or a long term care facility that has sufficient 24 hour nursing personnel present on all shifts to guarantee that patient’s needs are met. Respite care is provided for a maximum of 5 consecutive days.

Hospice care can be provided in any of the following settings:

  • Private Residence
  • RCFE- Residential Care Facility for the Elderly (Board and Care)
  • Assisted Living Facility
  • Independent Living
  • SNF- Skilled Nursing Facility
  • Hospital

Why should I start thinking ahead regarding my treatment wishes at end-of-life?

  • 80% of people say they prefer to die at home, but only 20% actually do
  • 82% of people say it is important to put their end-of-life wishes in writing, but only 23% of people have actually done it.
  • 80% of people say if they are seriously ill they would like to speak with their doctor about end-of -life care, yet only 7% of people have actually had an end-of-life discussion with their doctor
  • 59% of families of patients were much more likely to rate hospice care as excellent when their family member received hospice care for more than three days.

Hospice Care

What is Advance Care Planning?

Collaborative PROCESS between health care providers, patients & and family (surrogate others) to make decisions about future health care concerns, even through periods of incapacity.

•  Thinking through one’s values and preferences
•  Talking about one’s values and preferences
•  Documenting them and sharing the information

How do I start the process of Advance Care Planning?

•  Select a spokesperson to speak as your agent, when you’re unable to
•  Consider your wishes for care based on your priorities, beliefs & values
•  Discuss wishes with loved ones, designated agent, physicians and medical team
•  Document and share copies of your decisions, with loved ones and health care providers
•  Periodically review and make changes to these documents, as conditions change

Complete an ADVANCE HEALTH CARE DIRECTIVE:

•  Document that allows you to designate a “surrogate” that can make health care decisions for you, when you are not able to speak for yourself.
•  An AHCD is NOT about death and dying
•  Tips:
o An AHCD does not have to be notarized, only witnessed by two individuals
o A state of California approved FORM is preferred

What is POLST?

• POLST = Physician Orders for Life-Sustaining Treatment
• A physician order recognized throughout the medical system
• Portable document that transfers with the patient
• Brightly colored, standardized form for entire state of CA
• For forms and more information about POLST, please click through to www.capolst.org

Why POLST?

• Patient Wishes often are not known
• POLST and AHCD are meant to go hand-in-hand
• The (AHCD) Advance Health Care Directive may not be accessible.
• Wishes may not be clearly defined.
• POLST allows treatment choices.
• POLST gives direction and allows health care professionals to know and honor your treatment wishes for care.

Hospice Care
Resources• POLST: www.capolst.org
• California Advance Directive: http://www.caringinfo.org/files/public/ad/California.pdf
• Will/ Trust
• Aging with Dignity/ Five Wishes: www.fivewishes.org
• California Coalition for Compassionate Care: www.coalitionccc.org
• California Health Care Foundation: www.chcf.org
• California State University of San Marcos: CSUSM Palliative Care Institute www.csupalliativecare.org
• Caring Connections: Planning Ahead: www.caringinfo.org
• Prepare for Your Care: www.prepareforyourcare.org
• The Conversation Project: www.theconversationproject.org
• GO WISH Cards: www.gowish.org

We focus on the whole person, addressing physical, emotional, spiritual, and relational needs.

 We have a responsibility not only to our patients, but also to those who love and care for them.

 

 The needs of our patients and their families are best met through the services of an interdisciplinary team.

 

 Our patients deserve state-of-the-art medical care delivered with thoughtful consideration of their personal beliefs and values.