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QIO HHQI Weekly Update :: December 3, 2007   

TIP OF THE WEEK

Hospice, palliative, and end-of-life care

When patients first learn that they have a potentially life-limiting illness, their focus is often on curing the disease. However, as an initial plan of care is developed, there are opportunities to discuss the benefits of advance care planning and the differences between curative and palliative care. (National Hospice and Palliative Care Organization [NHPCO])

HOSPICE CARE DEFINED

Hospice care provides end of life care to patients when the goal of treatments shifts from cure to comfort, often in the last six months of life.

PALLIATIVE CARE DEFINED

The World Health Organization defines palliative care as “The active total care of patients whose disease is not responsive to curative treatment.” The goal of palliative care is to achieve the best quality of life for patients and their families.

Palliative care extends the principles of hospice care to a broader population that could benefit from receiving this type of care earlier in their illness or disease process. No specific therapy is excluded from consideration. Palliative care, ideally, would segue into hospice care as the illness progresses. (NHPCO)

WHEN TO BEGIN CONSIDERING END-OF-LIFE CARE

In the lifecycle of a life-limiting illness, there is a point where it becomes apparent that continued treatments are not likely to offer a cure for the patient. If your patient has a chronic illness with repeated hospitalizations and is experiencing a decline in health status, ask yourself: “Would you be surprised if this patient died in the next six to 12 months?” If the answer is no, it may be time to begin the transition away from curative treatment and emphasize palliative care.

The home care nurse is in a unique position to help patients and families transition from curative care to palliative care. Explain what palliative care is (care focused on alleviating symptoms) and help the patient become familiar and comfortable with this type of care. (Caring Connections is a program of the NHPCO)

Patients are often not ready for traditional hospice care because they:

  • Expect to live longer than hospice guidelines suggest
  • Wish to pursue active treatment
  • Have an illness whose course is difficult to predict
  • May still wish to receive lifesaving measures

Questions to help clinicians begin or continue dialogue with the patient:

  • Are you comfortable?
  • Do you feel that any of your treatments are causing you more harm than good?
  • Do you feel like you have good quality of life right now?
  • If we could do one thing other than cure your illness to bring you a better quality of life, what would it be?

ADDITIONAL RESOURCES

RESOURCE SPOTLIGHT

The Agent’s Role in End-of-Life Care (PDF - 39 KB)
The person we designate to make decisions and speak for us in our dying days, called a health care agent, may have no idea how complicated and difficult the role may ultimately be. Indeed, much research—including a study funded by the Robert Wood Johnson Foundation—suggests that this is the case. Download this two-page guide for working with or being a good agent.

 

IN THE NEWS

HOLIDAYS AND AGING: SOME TIPS FROM GERIATRIC SPECIALISTS

November 28, 2007 -- University of California, San Diego Health Sciences -- The joys, charms, chaos and confusion of family life during the holidays can be very positive or highly stressful, with older family members who are frail or ill particularly susceptible to negative consequences if emotional, mental or physical health needs are not taken into account. Specialists in senior medicine at the University of California, San Diego (UCSD) School of Medicine offer some simple tips to help ensure that elderly family members with underlying health issues enjoy the season. Read more >>

MEDICARE CHIEF IS 'SECRET SHOPPER' OF INSURERS

November 27, 2007 -- MSNBS -- To get a better feel for the marketing practices of private insurers, Kerry Weems, Administrator for the Centers for Medicare & Medicaid Services (CMS), ordered senior CMS staff to surreptitiously attend agents' presentations to seniors and the disabled. They call it the "secret shopper program." Read more >>

MANAGING THE CHRONIC CARE OF PATIENTS IS NOT BEING CAPTURED IN TODAY’S REIMBURSEMENT SYSTEM

November 19, 2007 -- Mount Sinai Medical Center -- Full-time physicians spend an average of one full day a week providing services for patients that are not reimbursed by Medicare, according to a new study conducted by Jeffrey Farber, MD, Assistant Professor of Geriatrics at The Mount Sinai Medical Center, and published today in the journal Annals of Internal Medicine.

The study results could potentially prod insurance companies and Medicare to catch up to physicians’ current levels of productivity by reimbursing them for the care that is increasingly taking place outside of formal office visits. Read more >>

 

COMING ATTRACTIONS

OASIS UPDATE 2008 – TELECONFERENCE WITH CORRINE STEVENSON, OEC

December 5, 2007, 10:00 a.m. OR 2:30 p.m.
Duration: 1hr        Cost: Free
Dial in: 1.866.814.8483


OHIO HOME HEALTH COMMUNITY OF PRACTICE

CALLS SUSPENDED: The home health community of practice calls are cancelled for the month of December. Please call 1.800.385.5080 to request additional assistance. Have a happy and safe holiday season.

   

 

The Tip of the Week Archive is available on the Ohio KePRO Web Site.