Presentation: Providing Hospice Care in a Skilled or Long-Term Care Nursing Facility

National Hospice and Palliative Care Organization, 2009 All Rights Reserved
Providing Hospice
Care in a Skilled or
Long-Term Care
Nursing Facility
Education program

Objectives
• Review the philosophy of hospice care
and discuss what hospice care provides.
• Talk about comfort care as a hospice
care goal.
• Discuss principles of death and dying
and individual response to death.
• Review hospice patient rights at end of
life.
• Discuss the hospice – facility
partnership.

Hospice and Facility Regulations
• On June 5, 2008, the Centers for Medicare and
Medicaid Services (CMS) published new
regulations for hospice care.
• The regulatory language includes guidance for
hospice care for a patient who resides in a
facility. (418.112: Condition of participation :
Hospices that provide hospice care to residents
of a facility).
• CMS Facility regulations effective August 26,
2013 [483.75 (t)(3)(v)]

Mission and Vision of Alive Hospice
Our Mission
We provide loving care to people with life-threatening illnesses, support
to their families, and service to the community in a spirit of enriching lives.
Our Vision
• To be recognized as expert providers of hospice care, palliative care,
management of advanced disease and grief support and to be the
agency of choice for the provision of these services.
• To be recognized as innovators and leaders in all aspects of end of life
resources.
• To influence the perceptions within the community and among medical
professionals so that the end of life is accepted as a meaningful
component of the human experience.

What is hospice care?
• Care at Alive Hospice focuses on improving the
quality of life for persons and their families faced
with a life-limiting illness.
• The primary goals of hospice care are to provide
comfort, relieve physical, emotional, and spiritual
suffering, and promote the dignity of terminally ill
persons.
• Hospice care neither prolongs nor hastens the
dying process.
• Care is palliative (not curative) to control
pain and symptoms associated with the
terminal illness.

What is hospice care?
• Alive Hospice treats the whole person, not just the disease.
• It focuses on the needs of both the patient and the family.
• Care is provided by an interdisciplinary team including the
physician, nurse, social worker, chaplain, nursing assistant,
and volunteers.
• Hospice addresses patient and family needs such as:
– Pain and symptom management
– Emotional, psychosocial, and spiritual support
– Help with funeral planning and arrangements
– Bereavement for family/ caregivers after the patient’s
death

Basic Principles of Hospice Care
At Alive Hospice, we:
• Affirm life
• Regard dying as normal process
• Neither hasten nor postpone death
• Relieve pain and other symptoms
• Integrate medical, psychological, and spiritual
aspects of care
• Offer a support system to patients and
families

Where is hospice care provided?
• Hospice care is a philosophy or approach to
care rather than a place.
• Care may be provided in a person’s home,
nursing home, hospital, or independent facility
devoted to end-of-life care.
• Hospice was originally designed to be a non-
institutional benefit. However, it is possible to
receive Medicare covered hospice care while
residing in a nursing facility.

Attitudes Towards Death and Dying
• Each person has his or her own view of death
and attitude towards it
• Society as the main influencer has a huge
impact on people’s perception of death
• The attitudes of the society towards death have
been changing over the time
• Fear has always been one of the most common
attitudes towards death
• Attitudes towards death change over the lifetime
of the person

Attitudes Towards Death and Dying
• American society tends to deny the reality of
death.
– Previous experiences with death
– Circumstances of death
– Some medical professionals view death as a
failure
• Cultural factors can significantly influence
patients’ reactions to their illness and the dying
process.
• There are many different religions and belief
systems across the world. Each holds an
individual view of death and mourning.

When is Hospice Care Appropriate?
• A referral to hospice is appropriate when the
patient and family have opted for palliative
treatment rather than curative treatment for life-
limiting or “terminal” illness.
• Medicare guidelines further require that the
physician has determined that life expectancy is
six months or less if the disease follows its
normal course.

Hospice Care Diagnoses
• Hospice care is not just for patients dying of
cancer
• Other hospice diagnoses include:
– End stage heart disease
– End stage pulmonary disease
– End stage renal disease
– End stage liver disease
– Dementia due to Alzheimer’s Disease and Related
Disorders
– Neurological disorders
– HIV disease
– Stroke & Coma

Patient Rights Under Hospice
• Patient rights is a regulation for hospice providers under
the 2008 Medicare Hospice Conditions of Participation.
• Hospice providers must review the notice of patient rights
with patients/ family/ representatives at the time of
hospice admission and obtain a signature that they
received their notice of these rights.

Hospice Core Services
• Hospice core services will be routinely provided
by Alive hospice, and will not be delegated to the
facility.
• Hospice core services include:
– Physician services
– Nursing services
– Social work services
– Counseling services
• Bereavement and spiritual
• Dietary

Who Are the Members of the Alive Hospice Team?
• The Alive Hospice team is an
interdisciplinary team (IDT) and together we
coordinate the patient’s plan of care.
• Members of the hospice team include:
– Patient and family/ caregiver
– Patient’s primary physician
– Hospice physician
– Nurse
– Social worker
– Chaplain
– Hospice aide
– Volunteers
– Bereavement counselor
– Additional team members may include dietician,
occupational or physical therapist, pharmacist
– YOU!

End of Life Symptoms
• Most patients and families who are living with a
life-threatening illness can expect to experience
multiple physical symptoms
• Some of these symptoms are related to the
primary illness, others are related to adverse
effects of medications or therapy or related
conditions.
• Hospice care manages a patient’s symptoms to
promote comfort and quality of life.

Common End of Life Symptoms
• Pain
– Physical
– Emotional
– Spiritual
• Shortness of breath
• Nausea / vomiting
• Anorexia / Cachexia
• Weakness/ fatigue
• Constipation
• Delirium

Bereavement After Patient Death
• Alive Hospice offers bereavement services to
family and loved ones for a minimum of 12
months following the death of a patient.
• Services can be:
– Phone contact
– Short-term counseling
– Assessment of need and referrals to community
resources
– Support groups
– Educational forums
– Written information on the grief process
– Memorial services

Bereavement Services are available to:
• Resident’s roommate
• Family members
• Staff caregiver who experiences grief from the
loss of the patient

Partnership for Patients
• The provision of high
quality coordinated end
of life care is a win-win
scenario for:
– A patient and their
family
– A nursing facility and
their staff
– A hospice and their staff
Patient &
family
Hospice
& staff
Facility
& staff

The Alive Hospice–Facility Partnership
• The nursing facility staff become part of the interdisciplinary
team when a facility resident elects hospice care.
• Important for each provider to recognize each other’s
knowledge and remain open to two-way learning.
─ Nursing facility staff are skilled in meeting the clinical and
psychosocial, and spiritual needs of their residents.
─ Hospice staff are skilled at meeting the special clinical, psychosocial,
and spiritual needs at end of life.
• Combined expertise allows the nursing facility and hospice
to deliver the most comprehensive care patient/ family
possible.

The Alive Hospice–Facility Partnership
• Successful partnerships between a hospice
provider and a nursing facility include:
– Acknowledgement and respect for each other’s
regulations
– Developing an excellent communication process
– Consistent coordination of care by the hospice and the
nursing facility
– Identification of care plan in both the nursing facility
and the hospice medical record
• Consistent communication, coordination,
and documentation are keys for success!

Payment for Hospice Care
• There is a Medicare hospice benefit for Medicare
part A beneficiaries
• All but one state (Oklahoma) have a Medicaid
hospice benefit
• Many commercial insurances also cover hospice
care as well
• Most hospices are committed to caring for all
patients, regardless of an individual’s ability
to pay

Hospice Service Periods
• The patient’s primary physician and hospice
team evaluate the patient’s eligibility for hospice
care on a regular basis.
• The first and second certification periods are 90
days; subsequent periods are 60 days.
• If a patient no longer meets criteria for hospice
care, they may be discharged from hospice and
readmitted at a later date.

Need More Information?

“Hope, Dignity, Love…It must be hospice”

References
• The National Hospice and Palliative Care Organization.
– www.nhpco.org
• EndLink - Resource for End of Life Care Education (Northwestern
University)
– http://endoflife.northwestern.edu/index.cfm
• Centers for Medicare and Medicaid Services -42 CFR Part 418,
Medicare and Medicaid Programs: Hospice Conditions of Participation;
Final Rule ( Pgs. 32216-32217)
– http://edocket.access.gpo.gov/2008/pdf/08-1305.pdf
• Attitudes Towards Death and Dying, Jeff Stats, APR, 2007.
– http://www.articlesbase.com/college-and-university-articles/attitudes-
towards-death-and-dying-139943.html

Alive Hospice

Presentation: Providing Hospice Care in a Skilled or Long-Term Care Nursing Facility

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