Hospice and Palliative Care: Help Throughout Life s Journey. John P. Langlois MD CarePartners Hospice and Palliative Care

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1 Hospice and Palliative Care: Help Throughout Life s Journey John P. Langlois MD CarePartners Hospice and Palliative Care

2 Goals Define Palliative Care and Hospice. Describe and clarify the differences and similarities between Hospice and Palliative Care Identify types of services available for each program. Describe how to access and utilize these services.

3 It s About Life and Living

4 The D Word A Part of Life

5 LIFE Beginnings and Endings

6 A Case Description

7 Defining Hospice and Palliative Care Hospice Came First Hospice is a Part of Palliative Care For Persons with Life Limiting Illness Usually a Prognosis of Six Months or Less

8 World Health Organization Definition of Palliative Care Palliative care is an approach that improves the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.

9 Palliative care: provides relief from pain and other distressing symptoms

10 Palliative care: affirms life and regards dying as a normal process

11 Palliative care: intends neither to hasten or postpone death

12 Palliative care: integrates the psychological and spiritual aspects of patient care

13 Palliative care: offers a support system to help patients live as actively as possible until death

14 Palliative care: offers a support system to help the family cope during the patients illness and in their own bereavement

15 Palliative care: uses a team approach to address the needs of patients and their families, including bereavement counseling, if indicated

16 Palliative care: will enhance quality of life, and may also positively influence the course of illness

17 Palliative care: is applicable early in the course of illness, in conjunction with other therapies that are intended to prolong life, such as chemotherapy or radiation therapy, and includes those investigations needed to better understand and manage distressing clinical complications.

18 So How Does it Work Palliative Care: Who: Persons with Serious Illness. Why: Symptom Management Goals of Care/Medical Decision Making Where: Hospital Nursing Home Home

19 So How Does it Work Palliative Care: What: The Team... Physician or Nurse Practitioner/PA Nurse Social Worker Chaplain How: Referral from Your Physician Paid from Insurance just like a Dr. Visit

20 Palliative Care Results: Reduce Costs On average, palliative care consultation is associated with reductions of $1,700 per admission for live discharges and reductions of $4,900 per admission for patients who died in the hospital. This means savings of more than $1.3 million for a 300-bed community hospital Source: Morrison RS, Penrod JD, Cassel JB, et al. Cost savings associated with U.S. hospital palliative care consultation programs. Arch Intern Med Sep 8;168(16):

21 Results: Improved Clinical Outcomes Reductions in symptoms, high family satisfaction with overall care and greater emotional support, as compared with usual care. Palliative care interventions in the ICU have consistently demonstrated reduced length of stay and reduced hospital cost. Helps patients complete treatments, including rehabilitation and chemotherapy. Increases the rate of hospice referral for patients whose disease is nonresponsive to curative intervention or who determine that the burdens of treatment outweigh their benefits.

22 Results: Improved Clinical Outcomes 151 patients with incurable metastatic lung cancer Randomly assigned to cancer treatment with or without Palliative Care. PC patients: Less depression, higher QOL. Less cancer treatment in last 2 weeks of life and more hospice referrals. Lived 11.6 months vs. 8.9 months. Quality and Quantity of Life NEJM, 363(8) Aug pp

23 Results: Providing the Care that Patients Want Patients want vigorous treatment of their pain and other symptoms. Patients want relief from worry, anxiety and depression. Patients and families want close communication about their care over time. Patients want well-coordinated care and transitions. Patients want support for family caregivers. Patients want a sense of safety in the health care system.

24 Who: So How Does it Work Hospice: Persons with Life-Limiting Illness Prognosis likely less than six months Not just Cancer Dementia COPD Congestive Heart Failure ALS/MS and other neuro-degenerative conditions Liver disease Kidney disease and more

25 Where So How Does it Work Hospice: Home Nursing Home Inpatient Hospice Solace Center Hospice is not a place... It is a system of care.

26 So How Does it Work Hospice: What: The Team... Nurse Visits 1-3 time per week Social Worker Regularly and as needed Chaplain If desired CNA - If desired/needed Music Therapy If desired/available Volunteers If desired Hospice Doctor Home Visits If ordered Bereavement Services If needed

27 What Else: So How Does it Work Hospice: Medications Related to Hospice Diagnosis Supplies and Dressings Medical Equipment Wheel chair Walker Hospital Bed Oxygen Commode Chair\ Other Treatment:eg Palliative Radiation

28 How: So How Does it Work Hospice: A referral from you Doctor A visit from Hospice Admissions Nurse Hospice is paid a daily rate Covers all of the above except MD Visits. MD Visits still paid by insurance You may revoke Hospice at any time. Patients can and do Graduate

29 Why: So How Does it Work Hospice

30 Hospice: Results Patients may life longer with Hospice than with conventional care. Families report positive experiences and better coping after death of loved one. Hospice is cost effective care.

31 It s a Good Idea to be Ready

32 We are not all this guy

33 Hospice Death is a Part of Life Hospice is About Living Quality of Life Respect and Dignity Control of Symptoms Relief from Pain: Physical, Emotional, Spiritual To Acheive This Takes Time and a Team

34 Palliative Care Most of Medicine s Focus: Diagnosis and Treatment Palliative Medicine s Focus: Relief of Symptoms Support for Decision Making Hospice is a Part of Palliative Care Focused on the End of Life

35 To Live and to Die with Dignity...

36

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