Hospice: An

Alternative
Linda A. Filipczak RN, BSN,
MBA
Michigan Regional
Administrator
21st Century Oncology
 Disclosures
• I have nothing to disclose
 Objectives
• Discuss the concepts of Hospice
• Describe the role of Hospice in the Oncology
patients care
• Discuss how Hospice assists with the
patients Quality of Life
Historically Hospice was…..

„ 1967 first Hospice

London
„ Shelter for
„ Weary travelers
„ Ill travelers
 Hospice …
„ Terminally ill with < 6 months to live
„ Provides Professionals

„ Patient’s physical needs assessed

„ Patients emotional needs assessed

 Hospice Goals
„ Provide assistance with QOL
„ Provide Comfort Measures

„ Provide Emotional Support

„ Provide Spiritual Support

„ Provide Pain Management

„ Provide Psychosocial Support

 In 2007 Carlson and etal…..
„ Review of services Hospice patients and
families receive
„ Medication Management
„ Respite Care
„ Varies between Hospices
 Hospice Team
„ Medical Director
„ Personnel Physician of the patient
„ Registered Nurses
„ Social Worker
„ Chaplain
„ HHA
„ Volunteers
 2007-2008 CMS
Reimbursement Rates…...
$135.11
(increased by 3.3%)
 Hospice is not …
just for Cancer Patients
 Admitting Diagnosis
„ Cancer
„ End Stage Renal Disease
„ Failure to Thrive
„ End Stage Dementia
„ Aids
„ End Stage Liver Disease
„ End Stage Lung Disease – COPD , Emphysema
„ End Stage Neurologic Disease – ALS, MS
„ End Stage Heart Disease – CVA, CHF, CAD
 General Admitting Guidelines
„ Life limiting conditions
„ Karnofsky < 70
„ Progression of disease
„ Need for frequent hospitalization
„ Dependence in most ADL’s
„ Weight loss > 10% over past 6 months
„ Serum albumin < 2.5 g
„ Cholesterol < 156 mg or Hct < 41mg
Who can make a referral
to Hospice?
„ Physicians
„ Nurses
„ Patients
„ Family Members
 Admission
„ Patient Assessment
„ Medications
„ Home Environment
„ Support Systems
„ DNR
„ POA
„ Home Medical
Equipment
 Pain Medications
„ Morphine
„ IV, PCA, Oral, Rectally
„ MS Contin
„ Roxanol or MSIR
„ Oramorph SR
„ Fentanyl
„ Transdermal: Duragesic Patch
„ Actiq Fentanyl Lozenges (lollipops)
„ Lorazepam or Ativan
„ Methadone
„ Dilaudid
„ Tylenol #3, Percocet, Percodan, Demerol
 Pain Assessment
„ Location
„ Quality
„ Intensity
„ Onset
„ Duration
„ Alleviating Factors
„ History of present
illness
„ Frequency
„ Co-Morbid Conditions
„ 24 Dose history of
analgesics
Respite Care

„ 5 day rest
„ For the patient
„ For the family
Revocation or Discharge ?
Bereavement

„ Support continues
„ Funeral Homes Visitation
„ Sympathy Cards
„ Support Groups
„ Hospice Memorial
 Hospice Patients
can
show improvement
 Hospice
DOES NOT
expedite the dying process
 NHPCO

National Hospice and Palliative Care

Organization
Palliative Care
World Hospice & Palliative Care Day
October 6, 2007
In-Patient Hospice Unit
v.s.
Hospice at Home
2007 O’Kelly and Kauffman…..

„ Music Therapy
„ Sensitive Use of music
therapy
„ 5 UK Hospices
 The Dying Process
An individual process
 2007 Herman Study…..
Degree that the Hospice Patients
Spiritual needs are met near end of
life…
„ 62 female & 38 male
„ Mean age…67 years old
„ 74% dying of cancer
„ Women in nursing home or in-patient hospice with lower
level education…higher number of unmet spiritual needs
„ CONCLUSION: Spiritual activities important to patients
who are near end of life. Variety of unmet spiritual needs
 A Review of ones life….
(Jenko & etal…
etal…Hospice & Palliative Care June 2007)

„ Recalling past events

„ Recalling memories
„ Defines ones lifc with respect to meaning
„ Our true identity…
„ Who we are…
„ Why we are here…
„ Striving for emotional resolution
„ Every person has a story
„ Everyone
Children and Cancer……..
Gone From My Sight
The Dying Experience
Barbara Karnes, 1986
1 – 3 Months prior to
Death
Withdraw from the world…less
communication
Decrease in Eating habits
1 – 2 weeks prior to death
„ Disorientation
„ Agitation
„ Talking with the unseen
„ Confusion
„ Picking at clothes
„ Physical Changes
„ Decrease in BP
„ Changes in Pulse
„ Body Temperature fluctuates
„ Increased perspiration
„ Skin color changes
„ Respirations Irregular
„ Congestion
„ Not eating – taking small amounts of fluids
1 – 2 Days to hours prior to death
„ Surge of energy
„ Restlessness or no activity
„ Breathing patterns become slower and irregular
„ Congestions
„ Eyes: glassy, tearing, semi-open
„ Hands and Feet become purplish
„ Person becomes unresponsive
„ Pulse weak
„ Decreased urine output
„ May be incontinent of urine or feces
Oncology patients rely on the relationship
they develop with their health care
professionals during their cancer journey

These relationships are built upon a sacred

trust!