When talking to physicians and case managers recently about determining prognosis on potential hospice patients, Noemi Sanchez, senior representative for VITAS Innovative Hospice Care® of Broward County, would ask them to consider their overall caseload and point out the patients who probably would not survive through spring of 2007. These are the patients, she told them, who would benefit from a hospice referral to VITAS today.
- Effective pain and symptom management
- Care delivered wherever a patient resides
- An interdisciplinary team caring for patient and family
- Medications, equipment and supplies related to the terminal diagnosis provided at no cost to patient or family and delivered directly to the patients home
- 24-hour care when a patient needs an inpatient level of service but wishes to remain at home
- Telecare(sm) servicesinstead of frantic after-hour calls to 911; VITAS Telecare is a virtual emergency room, staffed to answer questions or dispatch a nurse 5 p.m.8 a.m.
- Ongoing education for patient and family, so they know what to expect throughout the progression of the disease
- Psychosocial support for patient and family, including grief and loss counseling
Another common hospice misconception Noemi dispels is that patients must have a DNR in order to be referred to hospice. This is not true. Hospitals that understand hospice know it can:
- Reduce Average Length of Stay
- Reduce mortality rates
- Reduce average cost per case for terminally ill patients.
- Educate case managers and hospital staff about clinical criteria for hospice appropriateness
- Avoid unnecessary hospitalizations
- Assist discharge planning by coordinating delivery and providing all medications, equipment and supplies
- Provide important statistics regarding individualized hospice utilization by facility or physician, enabling hospitals to monitor and control length of stay and dollars spent on patients who are terminally ill
- Educate ER physicians and staff in identifying patients making the shift from chronic to terminal disease, thereby reducing ER crowding and freeing staff to care for patients who are critically ill or injured.
“We are a resource,” concurs Holli Hallmark, VITAS senior director of clinical services development. “Every day we work with case managers or discharge managers so they can plan ahead. We get people home sooner with the right equipment and we leave beds for patients requiring aggressive treatment.”
Finally, how can hospice help physicians? Noemi says:- We reduce calls to the physicians office from patients and their families.
- We encourage physicians to follow their patients to provide continuity of care, and we answer questions regarding billing Medicare Part B for those services.
- We answer questions about whether patients meet clinical criteria for hospice referral.
- We educate physicians on prognosticating survival, discussing advanced directives and “breaking bad news.”
- We answer frequently asked questions regarding nutrition, hydration and innovative ways to approach pain and symptom management.
When speaking about patients who cannot be cured by medical treatment, Noemi tells physicians, “You never have to say, There is nothing more that I can do.”
She suggests telling your most challenging patients and familiestodaythat “There is a great benefit available to you called palliative care. It provides everything needed to manage your symptoms and keep you comfortable. Palliative care focuses on the quality of your life, and this is the care I believe is best for you at this time.”
