SCAN
NCH
July/August 2013

Accessing hospice care can help both patients and families at the end of life

As a physician, you are familiar with your patient's goals and know when a hospice referral would best meet your patient's needs. In general, patients must meet the following eligibility criteria to be appropriate for hospice care:

  • Adults with a prognosis of six months or less if the disease runs its normal course. Hospice can continue beyond six months as long as the patient continues to meet eligibility criteria.
  • Prognosis is certified by the patient's primary care physician as well as the hospice medical director.
  • Patient and family desire supportive care as opposed to curative treatment.

In the hospital setting, "admission for inpatient hospice care should follow a similar thought process in terms of eligibility criteria," explains Alan Smookler, MD, assistant medical director at Midwest CareCenter and medical director of the Palliative Care Services program at NCH. "Additionally, specific needs must be met, including symptom management or skilled nursing care, which cannot be provided in another setting."

The length of stay in an inpatient hospice facility is considered short-term and requires daily assessment by the hospice and medical team to determine continued eligibility. Once symptoms are managed, the disease plateaus, or skilled nursing assessment/care is no longer required, the patient will be transferred to another level of care, such as to the home or to a nursing home. Should conditions change and the patient become appropriate for hospice, then readmission into the hospice inpatient facility is an option once again.

Dr. Smookler emphasizes that the Midwest CareCenter hospice team is available to assist NCH physicians in explaining the options available to patients and families so they make informed decisions that resonate with their comfort level. After the hospice order is placed, a Midwest CareCenter hospice nurse will evaluate the patient for eligibility and level of hospice care needed.

The hospice team will handle all details related to the transition to the next site of care, and communicate with the patient, family, NCH care team members, and referring physician throughout the transition. The hospice team will explain the process of transitioning the patient from the acute care setting to the NCH Hospice Suite, a block of eight private rooms in the hospital where hospice care and support can be provided. The suite is located on the 9E level of the hospital's Arlington Heights campus.

The Hospice Suite staff is specially trained in hospice, pain and symptom management, and other care issues related to the end of life. The patient's care team will assess and treat acute and chronic symptoms that cannot be easily managed in another setting. Care is available 24 hours a day, seven days a week and patients, as well as families, can access a full complement of psychological and spiritual support services, including grief, music, and Jewish care services.

Admissions to the Hospice Suite can be made from the NCH inpatient acute care setting, the NCH emergency room, or directly from home. Patients who are discharged from the Hospice Suite can be transferred to other sites of care, including home, a long-term care facility or another hospice.

Midwest Palliative & Hospice CareCenter opened its Hospice Suite at Northwest Community Hospital in 2012 and hundreds of individuals and their families have benefited from the acute level of hospice care. Midwest CareCenter received national recognition recently with the Hospice Honors award as a top 100 inpatient hospice facilities in 2012, the only hospice program in Illinois to receive this designation. For more information or to take a tour of the Hospice Suite, feel free to stop or call us at (847) 467-7423.

SIDEBAR

Hospice Admission Information

Indications for admission into inpatient hospice care:

  • Onset or worsening of symptoms that require frequent evaluation by the physician or nurse where the goal is to focus on comfort and the relief of distress at end of life. Examples include:
    • Uncontrolled pain, delirium, or respiratory distress
    • Intractable nausea/vomiting
    • New onset or uncontrolled seizures
    • Severe sepsis
    • Uncontrolled bleeding
    • Imminent death where the family is unable to cope and where care requires ongoing and frequent skilled nursing intervention
  • Chronic symptom management that cannot feasibly be provided in another setting. Examples include:
    • Complicated wound or skin care problems, such as
      • Surgical or nonsurgical wounds that are infected, hemorrhagic, or fungating
      • Multiple draining mucocutaneous fistulas
      • Weeping anasarca requiring frequent attention
    • Severe, non-fixated fractures, such as a pathologic hip fracture
    • Severe incapacitating myoclonus or muscle pains/spasms
  • Acute psychological or psychosocial problems. Examples include:
    • Severe depression, including suicidal ideation in patient or family member providing care
    • Breakdown in home support systems precluding ability to provide needed care in home setting, such as
      • Caregiver becoming physically or mentally incapable of providing care in the home
      • Patient living alone has abrupt physical/mental decline and can no longer care for self
    • Unsafe home environment due to
      • Suspected or proven abuse or neglect, drug diversion or other issues
Indications for ongoing inpatient hospice care:
  • New or ongoing symptoms that require ongoing visits by the physician or by skilled nursing assessment
  • Transition planning for symptom management needs
    • Family requiring extensive teaching, such as on medication administration or medical procedures
    • Home care planning/preparation for patient with pain/symptom management
    • Hospice is working with family to provide conditions for safe discharge
Indications for discharge from inpatient hospice care:
  • Reason for admission stabilized
  • Re-established family support system
  • Appropriate discharge plan has been developed
  • Transfer to another level of care
Conditions NOT appropriate for inpatient hospice care:
  • Caregiver respite. If the caregiver needs a break, the hospice team will assist in making arrangements for the patient to go to a nursing home for respite care.
  • Continuous care until death. When symptoms are managed, psychosocial or psychological problems have been addressed, and the patient no longer requires frequent physician or skilled nursing assessments, the patient will be transferred to a different level of care, either to the home or to a nursing home

Frequently Asked Questions

Q: Can I admit a patient into the NCH Hospice Suite from home, a nursing home, or from the emergency department? A: Yes. If already in hospice, the patient can be transferred into the Hospice Suite as long as eligibility criteria are met. If the patient is not already in hospice, a hospice representative will meet with the patient and family wherever they are to complete the admission process prior to transfer into the Hospice Suite.

Q: Can I be the attending physician for my patient in the Hospice Suite? A: Yes. You would bill using inpatient hospital codes. If the patient is in Medicare then you would also need to use the GV or GW modifier. If you choose not to be the attending then the hospice physician will assume responsibility. Patients and families tend to be reassured of their decisions, however, when their physician continues to monitor their conditions and visit them while in hospice care.

Q: Can a patient admitted into the Hospice Suite stay there until death? A: Only if the patient meets eligibility for ongoing inpatient hospice care, as noted above.