HOSPICE 102. The Impact of Readiness & Teamwork. Sally Mattingly, R.N., CHPN Carrefour Associates. Management Company for Crossroads Hospice

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1 The Impact of Readiness & Teamwork Sally Mattingly, R.N., CHPN Carrefour Associates Management Company for Crossroads Hospice September 2009

2 Sooner is better. While most primary care physicians recognize the many benefits of hospice care, they are faced with a lack of readiness on the part of the patient and family 1. Earlier hospice referrals are important as they provide patient and family the opportunity to establish a relationship with the hospice team, and get the most benefit from hospice care, while reducing stress on the patient, family, and healthcare system alike. The average length of hospice care provided in 1994 was 26 days, dropping to just 19 days in The average length in 2004 improved, increasing to 57 days with a median length of 22 days 3. Today, these numbers still remain low despite the fact that an earlier introduction to hospice care is beneficial, in many ways, for all parties involved.

3 The most important members of the team. Hospice providers understand that few people are ready for death. This is why much of the focus of a hospice care team is in helping to prepare patients and families emotionally, and spiritually, for this inevitable event wherever they are in the process. Hospice surrounds the patient and family with a team experienced in providing end-of-life care. This team consists of professionals from multiple disciplines who not only address the physical distress associated with dying; they address all needs associated with dying. The goal is to create a safe and comfortable patient death by assisting the patient with self-determined life closure while helping the family deal with the loss of a loved one. Hospice care is patient-centered, patient-directed care because the needs of the patient and family drive the activities of the hospice team. The patient and family are the primary, and most important, members of the hospice team.

4 Roles and responsibilities of the team. Primary Care Physician As the primary care physician, you are responsible for identifying the patient s need for hospice and making the referral for hospice services. You are encouraged to remain involved as a member of the patient care team, and to actively participate in the hospice plan of care. Your role is an important one as the patient and family value your relationship and consider you a trusted care provider. This creates a better transition to hospice, and overall experience, for the patient and family. Hospice Medical Director The hospice medical director provides an oversight of patient care and support to the hospice team. The hospice medical director attends an interdisciplinary team conference to discuss the plan of care by assisting in establishing goals, and providing active participation in decisions regarding patient care. The hospice medical director is also available to consult with the primary care physician regarding patient care issues as needed.

5 Registered Nurse Case Manager The registered nurse case manager coordinates the plan of care with the primary care physician and hospice medical director through initial and ongoing nursing assessments. The nurse visits the patient two or three times a week, or as needed, to ensure all distressing symptoms are effectively palliated and that patient and family needs are being met. The RN provides supervision of all care provided by the licensed practical nurse and home health aide, and coordinates care with the other members of the hospice team to ensure patient and family spiritual and psychosocial needs are met. Social Worker The hospice social worker provides initial and ongoing psychosocial assessments of the patient and establishes a psychosocial plan of care. The social worker normally sees the patient once or twice a month to provide emotional support and ensure patient and family psychosocial needs are being met. The patient/family or any member of the hospice interdisciplinary group (IDG) can request additional psychosocial visits as needed. The social worker can provide assistance to the patient and family such as helping the patient with a DNR, assisting the patient and family in finding financial or community resources, and making arrangements for nursing home placement or transfer to inpatient care facility. The hospice social worker can also provide counseling to the patient or family in times of crisis.

6 Chaplain The hospice chaplain provides initial and ongoing spiritual assessments of the patient and family and provides interventions as needed. The chaplain visits once or twice per month or more often if requested by the patient, family or a member of the IDG. The hospice chaplain coordinates care with the patient s community spiritual care provider. The care provided by the hospice chaplain can address religious issues, however the focus of care is more spiritual, in nature, than religious. Spiritual care is aimed at addressing the existential issues commonly experienced in the dying process. Care by the hospice chaplain is non-denominational; no attempts are ever made at proselytization. The chaplain can, if requested by the patient and family, officiate at the funeral. Bereavement Counselor The bereavement counselor not only supports and guides the family through the bereavement period after the death of the patient, but can also help the patient deal with the grief associated with declining health and the eventuality of death. The bereavement counselor assesses the grief risk of the family and can provide bereavement services to the family beginning upon admission and up to a year, or longer, after death. The terminally ill patient usually finds great comfort in knowing that their family will continue to receive the support of hospice after they are gone.

7 Home Health Aide The home health aide assists the patient and family with personal care needs and light housekeeping. They also teach family members the correct and safe method for providing personal care to the patient. The services of the aide, when required, are highly valued by the patient and family. The home health aide supplements the care provided by the nurse case manager. Their role is invaluable in the comfort of the patient. Hospice Volunteer The hospice volunteer provides companionship and support to the patient and family. All hospice volunteers are required to attend volunteer training at the hospice and must follow a volunteer plan of care. The volunteers frequently perform needed errands and light housekeeping for the patient and family. 5% of all hospice care hours are required by Medicare to be provided by the hospice volunteer.

8 Taking comfort in hospice. There are many aspects of hospice care that impact the quality of life a patient and family experience with a terminal illness. Early hospice intervention is the best way to help your patients and their families deal with one of life s most stressful events. The more you can help them understand what the teamwork of hospice can do for them, the more comfortable they will be during the end-of-life process. To find a reputable hospice in your area, contact your local hospice and palliative care organization or you can contact Crossroads Hospice by calling or visiting 1 Hospice and Primary Care Physicians: Attitudes, Knowledge, and Barriers Karen Ogle M.D. American Journal of Hospice and Palliative Medicine Vol.20, No. 1, pp (2003) 2 Palliative and End of Life Care: Clinical Practice Guidelines 2nd Ed, Kuebler, Kim K.; Peg Esper, Deborah E Heidrich, PG 29, Elseiver Health Sciences, ISBN (2006). 3 Unplugged: Reclaiming Our Right to Die in America Colby, William H., pg 210, Amacom Divison American Mgmt Assn. ISBN ,(2007). Georgia Kansas Missouri Ohio Oklahoma Pennsylvania Tennessee

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