HCN00 – HOSPICE NURSING LECTURE
patients (adults and children) and their families who
HOSPICE CARE NURSING
Introduction to Hospice and Palliative care
Hospice
➢ Medieval Latin hospitium
➢ “Hospitality, lodgings, monastic guesthouse, shelter
maintained by a religious order for the poor and
infirm.”
➢ Latin word “hospit, hospes” means guest
➢ + “ium” means function or occupation
➢ A program designed to provide palliative care and
emotional support to the terminally ill in a home or
homelike setting so that quality of life is maintained
and family members may be active participants in care
(Webster),
➢ Specialized type of care is given to people who are
terminally ill.
➢ It focuses on providing compassionate care while
maximizing a person's quality of life.
➢ Hospice care can be initiated when an individual has a
diagnosis of a life-limiting or terminal illness with a
prognosis of 6 months or less.
➢ The patient must no longer be seeking curative
treatment.
➢ Two physicians certify the patient's prognosis.
➢ Hospice care involves holistic care, which requires
focusing on not just the physical aspects of comfort,
but also the psychological, psychosocial, and spiritual
aspects of care and comfort for the patient and family
➢ Compassionate comfort care (as opposed to curative
care) for people facing a terminal illness with a
prognosis of six months or less, based on their
physician's estimate if the disease runs its course as
expected.
➢ An interdisciplinary group of team members
physicians, nurses, aides, social workers, counselors,
chaplains, volunteers, therapists, and pharmacists.
➢ For the next year following the patient's death,
bereavement counselors and volunteers work with
family members of all ages to provide support and
comfort, especially during many of the important
"firsts," such as the deceased patient's birthday,
wedding anniversary, holidays, and so on.
Palliative
➢ Compassionate comfort care that provides relief from
the symptoms and physical and mental stress of a
serious or life- limiting illness.
➢ Palliative care can be pursued at diagnosis, during
curative treatment and follow-up, and at the end of
life.
➢ It prevents and relieves suffering through the early
identification, correct assessment, and treatment of
pain and other problems, whether physical,
psychosocial, or spiritual.
➢ An approach that improves the quality of life of
are facing problems associated with life-threatening
illness.
➢ This type of care is focused on providing relief from
the symptoms and stress of the illness.
➢ The goal is to improve quality of life for both the
patient and the family.
➢ Palliative care is provided by a specially-trained team
of doctors, nurses, and other specialists who work
together with a patient's other doctors to provide an
extra layer of support.
➢ Palliative care is based on the needs of the patient, not
on the patient's prognosis. It is appropriate at any age
and any stage in a serious illness, and it can be
provided along with curative treatment
Difference between Hospice and Palliative Care
➢ HOSPICE CARE
• for terminally ill and dying patients
• bereavement services are provided up to 1 year
after death
• care is primarily delivered at patient's home
• patient chooses to forgo curative treatment
• covered by Hospice Medicare Benefit
• life expectancy is 6 months or less
➢ PALLIATIVE CARE
• aimed promoting comfort for seriously ill whether
terminal or not
• bereavement services are not always provided
• care maybe in acute care, long-term care, homes
or other settings provided either curative or end-
of-life treatments
• may or may not be covered by Medicare or other
health insurance life expectancy is not a factor.
History of Hospice Care
➢ 1989
• Concept of Hospice and Palliative Care was
integrated into the Family
• Health Care Program of the Department of Family
and Community Medicine (DFCM) of the
University of the Philippines -Philippine General
Hospital (UP- PGH).
• The focus of service then was Home Care.
➢ 1991
• First Hospice Home Care Program was established
by the Philippine Cancer Society (PCS) - Mamita
Pardo de Tavera (President and DSwd secretary)
and Dr. Catherine L. Krings as Program Director
who eventually became the Coordinator for the
Hospice Care Program of DFCM in UP-PGH.
➢ 1994 to Early 2000s
• Dr. Josefina Magno - a Filipino Oncologist who
was one of the pioneers of the Hospice Movement
in the US, and one of the founders of the American
Academy of Hospice and Palliative Medicine.
 • He strengthens the national hospice care
movement and the establishment of Hospital-
Based Hospice Care Programs such as Makati
Medical Center (1994) and the University of Santo
Tomas Hospice Program (1997).
➢ Community Based Hospices including Foundations
and Disease-Specific Programs incorporating the
model of Hospice and Palliative Care also commenced
during this period:
• Madre de Amor Hospice in Laguna
• Ayala Alabang Hospice in Muntinlupa
• Kythe Foundation (East Avenue Medical Center)
• Canossian Sisters of Charity in Bukidnon &
Cagayan de Oro
• Starfish Program in San Lazaro Medical Center
• PALCARE Volunteer Group
• Center for Health Improvement and Life
Improvement Development (Childhaus)
➢ 2002
• Establishment of the First Hospice and Palliative
Medicine Program in UP-PGH. This was headed by
Dr. Catherine L. Krings. This was followed by Dr.
Agnes Bausa-Claudio (2004-2006), Dr. Rachel
Rosario (2006-2009) and Dr. Manuel F. Medina
(2010 - 2019). 2004
• The Phillippine Cancer Society convened and
launched the National Hospice and Palliative Care
Council of the Philippines (Hospice Philippines).
➢ 2007
• The 7th Asia Pacific Hospice Conference was held
in the Philippines. This was sponsored by the
Phillippine Cancer
• Society and hosted by the National Hospice and
Palliative Care Council of the Philippines.
➢ 2012
• Southern Philippines Medical Center in Davao
offered the 2nd Sub-Specialty Fellowship Training
Program with Dr. Rojim Sorrosa as section head.
➢ 2015
• The Philippine Society of Hospice and Palliative
Medicine (PSHPM) was established and
recognized as a Sub-Specialty Society under the
Philippine Academy of Family Physicians.
• The founding President then was Dr. Josefina
Isidro-Lapena (2015-2017), followed by Dr.
Rumalie Corvera (2017-2019).
• The Philippines Department of Health (DOH)
ordered the National Policy on Palliative and
Hospice Care (AO 2015-0052) which aimed to sets
overall policy directions and identify the roles and
functions of DOH and partner agencies in the
provision and hospice care in hospitals, health
facilities and communities.
➢ 2018-2019
• Initiated the Specialty Examination for the Board
Certification of Palliative Specialists.
• Organization of the 1st and 2nd Annual PSHPM
National
• Convention, held in Manila and Davao
respectively.
• It was during the year 2019 when two substantial
Bills were enacted into Law the first of which is
Republic Act 11215 the National
• Integrated Cancer Control Act (NICCA), and
Republic Act 11223 - Universal Health Care Law.
• The combined efforts of the Philippine Cancer
Society and the Philippine Society of Hospice and
Palliative Medicine were instrumental in including
the provision of Hospice and Palliative Care
Services in the Universal Health Care.
• The society participated in various stakeholder
meetings, Implementing Rules and Regulations, on
these bills.
➢ 2020
• With the current threat of the COVID-19
Pandemic, the Society in partnership with Hospice
Philippines, the Philippine Society of Public Health
Physicians (PSPHP) and the Ruth Foundation
released three Guidance Documents for Palliative
Care.
• These guidance documents include
o (1) Care for Palliative and Bedridden Patients
in Communities on Enhanced Community
Quarantine
o (2) Guidance for Palliative Hospice and
Bereavement Care for COVID-19 and other
patients facing Life-Threatening Illnesses in
Hospitals and
o (3) Triage Decisions, Shared Decision Making
and Advanced Care Planning for Covid-19
Situation: A Guidance Document for Levels 2
and 3 Health Care Facilities.
• Department of Health (DOH) - Department Order
2020-1431 which aims for the development of the
Manual of Operations, Procedures and Standards
and Training Modules with Phase One
Implementation of the National Palliative and
Hospice Care Program due to the Republic Act
11215 and Republic Act. 11223. Together with
other stakeholders the Society is currently a
member and plays one of the lead roles in the
newly created Technical Advisory Group for this
project. (PSHPM 2020.)
Concepts, Principles, Theories in Hospice Care
➢ Concepts
• vehicles of thought that involve images. Are words
that describe objects, properties, or events & are
basic components of theory.
• Types:
o Empirical concepts
o Inferential concepts
o Abstract concept
➢ Principles
 • 1. Care providers with different professional
backgrounds work as a team to address physical,
social, emotional, and spiritual needs.
• 2. Focus on respecting the expressed wishes and
goals of the individual and family.
➢ Theory
• A theory: is a set of concepts and propositions that
provide an orderly way to view phenomena.
• It is a belief, policy, or procedure followed as the
basis of action, (Webster new collegiate
dictionary.
• Shared theory
• Unitary caring model (Reed)
• Humanistic nursing theory
• Peaceful end of life theory (Rulland and Moore).
• Comfort theory (Kolcaba)
Shared theory
➢ Nurse's competence on providing quality palliative
care
➢ Bandura's social cognitive
➢ Orem's theory
• Nursing competence
o must have specialized training and clinical
care experience, including knowledge of all
areas of social, interpersonal, professional-
technological, intellectual, and practical skills
• Nursing self-competence
o the capability to judge one's abilities in
treating patient suffering.
o nurses with high self-perceived competence
provide better quality care than nurses with
low self-perceived competence.
• Nursing interventions
o Are tailored to patients' self-care deficits.
o Partially compensatory systems are used with
palliative care patients working together to
meet their self-care deficits and implement
supportive-educative systems.
o Total compensatory systems are used with
dying patients.
Unitary Care model
➢ Pattern
• Person’s unique story and experience
• The non-judgmental approach of nurses focuses
on the patient’s personal experience of health,
illness, death, and dying
➢ Wholeness
• Each person is greater than and different from the
sum of his/her parts
• Intervention in different areas of suffering
• Considering and appreciating the entireness of the
ill person along with their family and community
➢ Consciousness
• Cognition of the continuous transformation and
personal growth that occur for the patient, family,
and nurse during their relationship
• A non-judgmental and ‘authentic’ presence, helps
the patient and the family to express their
thoughts and to become conscious of their
experiences
➢ Caring
• Nurse accompany the patient and family through
the ‘journey’ of illness with humility, love,
kindness, heart-centered authentic presence,
compassion, and appreciation for patterns
➢ Transformation and transcendence
• Nurse helps patients to transform their point 9&&
view on illness, ‘reframing’ patients’ hopes by
identifying new wishes and goals
• Transcendence is when time, space, and
physicality pause in a caring moment called
‘sanctuary’
➢ Relationship
• Represents a connection between people’s spirits
within a caring moment and manifests as
continuous dialogue, negotiation, and meaning
creation and sharing
➢ Meaning
• Consists in the understanding of the illness and
the dying experience that the patient gains
through the caring of the nurse while improving
well-being.
Humanistic Nursing Theory
➢ Paterson & Zderad, 1976
➢ Nurse-patient relationship is characterized by
interaction designed to promote well-being and
existential growth in the context of the lived world.
The nurse cares for the patient, and other nursing
actions or activities.
➢ Elements in HNT
• Moreness-choice – each individual nurses’
preferences (alleviate suffering, providing holistic
care) on how to respond to situations in the field
• Call-response – the relationship between the
patient and nurse in the context of the patient
seeking for care.
It is a very specific situation because (1) the
patient is experiencing a form of discomfort or
pain, (2) the patient is actively asking for
treatment to alleviate said symptoms and (3) the
nurse reacts in a context-specific manner by
providing quality care to the best of their efforts.
Middle range theory: Peaceful end of life
➢ Developed by Cornelia M. Ruland and Shirley M.
Moore
Peaceful End-Of-Life Theory
➢ the structure-setting is the family system (terminally
ill patient and all significant others)
➢ positive outcomes of the following:
• (1) being free from pain
• (2) experiencing comfort
• (3) experiencing dignity and respect
• (4) being at peace
• (5) experiencing a closeness to significant others
and those who care. Incorporating patient
preferences into healthcare decisions
➢ Ruland and Moore's (1998) theory
• 1. The occurrences and feelings at the end-of-life
experience are personal and individualized.
• 2. Nursing care is crucial for creating a peaceful
end-of-life experience.
➢ Two additional assumptions are implicit:
• 1. Family and all significant others are an
important part of end-of-life care.
• 2. The goal in end-of-life care is to maximize
treatment so that the best possible care will be
provided through the judicious use of technology
and comfort measures, to enhance quality of life
and achieve a peaceful death.
➢ Six explicit relational statements were identified
(Ruland and Moore, 1998) as theoretical assertions for
the theory, as follows:
• Providing emotional support, monitoring and
meeting the patent's expressed needs for and
anxiety medications, inspiring trust, providing the
patient and significant others with guidance in
practical issues, and providing physical presence
of another caring person f desired contribute to
the patient's experience of being at peace.
• Facilitating participation of significant others in
patient care; attending to significant others' grief,
worries, and questions: and facilitating
opportunities for family closeness contribute to
the patient's experience of closeness to significant
others or persons who care.
• The patient's experiences of not being in pain,
comfort, dignity, and respect being at peace, and
closeness to significant others or persons who
care contribute to the peaceful end of life.
Comfort theory
➢ Kolcaba describes comfort as a relief, ease and
transcendence and comfort can occur in the following
contexts: Physical, psychospiritual, environment, and
sociocultural Current nursing.2011)
➢ Human being
• Comfort is achieved when the patient's pain needs
are met
• For example, in regard to pain medication
administration, when the patient receives pain
medication, they feel a relief from the
medication's effect on their pain. Relief is
achieved.
• Ease comfort is focused on the psychological state
of the patient (Kolcaba, 2007).
• They become at ease because their pain is
subsiding
• Transcendence happens when the patient is able
to rise above their challenge of health problems
and pain (Kolcaba, 2007).
• Three human needs:
o RELIEF
o EASE
o TRANSCENDENCE
➢ Environment
• A calm and comforting environment will allow the
patient's anxiety level to decrease. The patient's
anxiety level will be reduced and thus resulting in
the patient becoming relaxed and comfortable.
• A quiet and relaxed surrounding can be enhanced
by the caring nurse and the patient's loved ones
being near
➢ Health
• After anxiety and pain are addressed, the patient
is able to deal with the care they need and the
recovery process. According to Kolcaba, health is
considered to be optimal functioning, as defined
by the patient, group. family, or community
(Koicaba, 2011).
➢ Nursing
• The nurse addresses the patient's comfort needs
and creates a careplan. As the patient's comfort
needs change, the nurse interventions are
updated.
• If the patient feels that they are being cared for
properly, they will be emotionally and mentally
better, which will aid in their recovery (Kolcaba,
2011).
Hospice Interdisciplinary Team
➢ Core Hospice Interdisciplinary Team Members
• Hospice Physician
• Hospice Nurse
• Hospice Social Worker
• Hospice Chaplain
➢ Non-Core Hospice Interdisciplinary Team
Members
• Hospice Physical therapists
 • Hospice Occupational therapists • available to ease the burden on family caregivers
• Hospice Speech-language Pathologists by participating in activities such as light
• Hospice/ Home health aides housekeeping.
• Bereavement Specialist • Home health aides - assist the patients with
• Volunteers personal care and visit patients two to three times
a week to ensure that they are safe and
➢ Hospice Nurse comfortable.
• skilled in assessing and managing a patient's pain ➢ Bereavement Specialist
and symptoms. • addresses both anticipatory grief and loss after
• trained caregivers who provide hands-on patient death.
care. • hospice families receive bereavement support up
• skilled listeners, hospice nurses comfort the to 13 months after a death, including consistent
family while also teaching them how to take the contact, support groups, grief education, and one-
best care of their loved one. on-one visits.
• hospice patients receive two or three visits a week • always available to those who've experienced the
from their dedicated case manager nurse death of a loved one.
• an on-call nurse is available 24 hours a day, seven ➢ Volunteer
days a week, to provide medical assistance to • specially trained in hospice and end-of-life issues
hospice patients and their families. to provide compassionate companionship for
➢ Hospice Social Worker patients and families or to facilitate their care.
• provide emotional and psychosocial support to • Volunteer's duties can range from visiting patients
the patient and family. to crafting patient items to documenting patients'
• coordinate the logistics of the patient's care, work life stories to helping in the office.
with insurance companies or the Veterans • provide support to patients on a wide variety of
Administration, and help with finances, funeral levels, including comfort, preparing meals and
planning, or other tasks. running errands.
• always available to lend a friendly and listening
ear.
• assist patients with their emotional and social
needs.
➢ Hospice Chaplain
• Regardless of a person's beliefs or religious
traditions, hospice chaplains are available to
address the spiritual issues that often arise as a
patient nears death.
• Available for the patient and the family, honoring
and supporting the cultural traditions and values
they hold dear.
• When requested, the hospice chaplain works with
the patient's specified clergy.
• The role is to serve as a source of spiritual
guidance as well as to relieve some of the burdens
that families are facing during their grieving
process.
➢ Hospice Physical Therapists
• develop a treatment plan to enable a patient to be
able to move freely as well as to reduce pain,
restore function, and avoid further disability.
➢ Hospice Occupational Therapists
• identify life roles and activities that are
meaningful to them
• help them to overcome the obstacles hindering
the performance of these activities.
➢ Hospice Aide
• certified nursing assistants who provide personal
care to the patient, such as bathing, dressing, or
mouth care.
LEVELS OF CARE
➢ The level of hospice care will be determined by
interdisciplinary team in collaboration with the
patient and family
➢ hospice nurses assess prospective patients’ eligibility
for hospice services
➢ Philosophy remains the same: to offer expert medical
care and emotional support that respects the unique
wishes of the patient.
➢ Level of care:
• 1. Routine home care
• 2. Continuous home care
• 3. General inpatient care
• 4. Respite care
1. Routine home care
➢ Pain management, symptom management, emotional
and spiritual counseling for patient and family,
assistance with daily tasks, nutritional and therapeutic
services. Intermittent care based on patient’s needs.
➢ team ensures comfort and dignity. Diagnosis-specific
equipment, supplies and medication are provided at
no cost.
2. Continuous home care
➢ “crisis care”, experiencing a medical crisis, when
symptoms require more intensive management.
nursing or extended periods of support.
➢ Intensive Comfort Care 24/7. manage acute symptoms
and avoid hospitalization
3. General inpatient care
➢ maybe necessary if a patient’s symptoms can no
longer be managed at home. Goal: for the control of
severe pain and stabilize symptoms so he can return
home if possible. Some prefer to spend their final days
in an inpatient center as a neutral, safe space with
loved ones.
➢ cozy inpatient offers the support of an acute-care
facility with homelike amenities.
4. Respite care
➢ Much-needed break for loved ones providing care at
home while allowing patients to receive appropriate
RTC symptom management.
➢ patients spend a short time in a Medicare-certified
inpatient hospice setting so their primary caregivers
can take a break. To avoid burnout and provide care
more efficiently.
HOSPICE ADMISSION AND LEVELS OF CARE
HOSPICE ADMISSION
➢ Use the hospice eligibility criteria
➢ Determine the Level of hospice care
➢ Information shared at the initial meeting with the
patient and family should be accurate and clear to the
patient and family.
➢ Upon receiving a referral, a hospice nurse and a
hospice social worker conduct an initial assessment.
➢ information regarding hospice transition includes:
• 1. patient and family goals, (comfort and
treatment)
• 2. hospice philosophy and revocation options
• 3. services provided by hospice and those that are
not provided
• 4. availability of inpatient and respite services
• 5. fees or co-pays (if applicable)
• 6. process of discharge and/or revocation
➢ To initiate hospice services:
➢ The patient must sign a Notice of Election ( Medicare -
5 days)
➢ Notice of Election includes:
• 1. Name of the hospice that will provide care to
the patient.
• 2. the patient’s or patient representative’s
acknowledgment of understanding of hospice
services and waiver of certain Medicare benefits.
• 3. the date of election of hospice care, must be the
1st day of the
• hospice care or later, but not earlier.
• 4. the name of the physician, nurse practitioner, or
physician assistant who will serve as the attending
physician as well as the provider’s contact
information and National Provider Identifier NPI
• 5. acknowledgment that the provider serving as
the attending physician is the choice of the patient.
(Centers for Medicare and Medicaid Services,
2018)
ORIENTATING PATIENTS AND FAMILIES TO HOSPICE
SERVICES
➢ At the initial hospice visit, the nurse and SW should
establish rapport with the patient and family.
➢ If admitted the family should be oriented to the types
of services that will be provided such as:
• 1. durable medical equipment
• 2. medication related to terminal illness
• 3. 24-hour availability of hospice staff and
• 4. care from the IDT team
➢ Families should also be aware that hospice care does
not encompass:
• 1. curative treatment of the terminal illness
• 2. emergency services
• 3. live-in caretakers
• 4. long-term inpatient services or
• 5. ongoing individual counseling
CERTIFICATION AND RECERTIFICATION OF
REQUIREMENTS
➢ Patients admitted to hospice provided the eligibility
requirements
➢ The initial hospice certification period is six months,
which
➢ Medicare defines as two 90-day certification periods.
➢ Following the first 90-day period, the hospice medical
director certifies the patient’s terminality
➢ Following the 2nd 90-day certification period,
recertification of the terminal illness is required every
60 days for as long as the patient receives hospice
services.
➢ Patients who continue to meet eligibility requirements
can continue to receive hospice services for an
unlimited number of 60-day periods.
➢ A physician provides a face-to-face visit with the
patient during the 3rd and subsequent benefit periods
FACE-TO-FACE ENCOUNTERS
➢ As a result of the Patient Protection and Affordable
Care Act of 2010,
➢ The patient must be seen by a physician before the 3 rd
benefit( after the first 180 days of service).
➢ If the physician conducts the face to face visit, he/she
must be an employee of the hospice organization.
➢ The purpose of the encounter is to verify continued
eligibility for hospice services.
➢ Following the encounter, the provider must document
the clinical findings that rationalize a 6-month life
expectancy.
➢ Documentation is provided to determine whether
hospice services and LEVEL OF HOSPICE CARE are
attained
LEVELS OF HOSPICE CARE
➢ Hospice nurses determine which level of care is most
appropriate for the patient.
➢ For some, home care is the most appropriate level of
care. There is a caregiver present and the patient
prefers to stay at home rather than transfer to an
inpatient facility.
➢ In other cases, inpatient care may be most appropriate
due to the lack of a caregiver or it is in line with the
patient's preferences.
➢ Decision-making involves a series of questions and
decisions to determine the level of hospice care
ASSESSING THE PATIENT’S GOALS
➢ 1. What is the most important to the patient right
now?
➢ 2. If the patient’s condition were to change, would they
want to stay at home or go to an inpatient setting?
➢ 3. What symptoms or conditions would make the
patient or family consider a hospital admission?
➢ 4. Does the patient have a Living Will? Is an order
written and accessible?
ASSESSING CARE NEEDS
➢ 1. Is there a reliable caregiver at home?
➢ 2. Is the home environment safe?
➢ 3. Can the patient’s symptoms be managed at home by
the caregiver with the support of the hospice team?
➢ 4. Is the patient experiencing acute symptoms? Can the
symptoms be managed most effectively in an inpatient
hospice setting?
➢ 5. Does the patient already reside in a long-term care
facility? Is the staff able to co-manage e-o-l concerns
with the hospice team?
➢ 6. Can the patient’s symptoms be managed in the
home with continuous care from the hospice staff?
After completing the assessment, and in consultation with
the patient and family, the hospice team may recommend
one of the following hospice level:
➢ 1. Routine home care: care in the home with regularly
scheduled visits from the hospice team
➢ 2. Continuous home care: continuous care is provided
in the home, predominantly by nurses, but can be
supplemented with hospice aides. This type of care is
intended to support patients and families through
crises on a short-term basis to allow the patient to stay
at home.
➢ 3. Inpatient Respite Care: care is provided within an
approved facility for a short period of time to allow
respite for the caregiver.
➢ 4. General Inpatient Care GIP: care is provided in an
inpatient facility to achieve pain control or symptom
management that cannot be accomplished at home.
Last 7 days: this service intensity add-on provides
additional reimbursement for the care of a patient during
the last week of life, which is intense and costly. To receive
reimbursement in addition to the per diem routine rate,
following criteria must be met:
➢ 1. The patient’s level of care is “routine home care”
➢ 2. the date of care is within the last 7 days of the
patient’s life
➢ 3. Direct patient care is provided by a registered nurse
or licensed social worker.
➢ With the appropriate level of care determined, the
nurse coordinates the plan of care for the patient with
the IDT.
➢ The IDT may update the plan of care as often as
necessary, but no less frequently than every 15 days.
➢ A documentation checklist may be useful for the
hospice IDG in ensuring that all documentation is
complete.
➢ Sample documentation checklist is available at
https:www.
cgsmedicare.com/hhh/education/materials/pdf/j15_
hospice_doc_checlistre.pdf/
➢ The hospice nurse’s role in determining the
appropriate level of care for a patient and coordinating
care with the IDT during transitions was reviewed.
EVALUATION
➢ Conduct a hospice admission
➢ Orient a patient and family to hospice services
➢ Assess ongoing eligibility for hospice care
➢ Identify the levels of hospice care.
HOSPICE DISCHARGE END-OF-LIFE SYMPTOMS
➢ Hospice services are reserved for those facing
terminal conditions. PAIN MANAGEMENT
➢ However, prognostication is an inexact science with ➢ PAIN ASSESSMENT
some hospice patients living well beyond the ➢ PHARMACOLOGICAL AND
anticipated 6-month estimate. ➢ NON-PHARMACOLOGICAL MANAGEMENT
➢ Although the number of very lengthy hospice stays has ➢ PAIN PROBLEMS AND TREATMENT CHALLENGES
decreased in recent years, the number of live
discharges has steadily increased. (MedPac, 2016; SYMPTOMS MANAGEMENT
Russel et al, 2017) ➢ PRINCIPLES OF SYMPTOM MANAGEMENT
➢ Patients maybe discharge due to revocation of hospice
benefit, change of hospice provider, improvement in
medical status, for cause or through death.
➢ Patient may revoke the hospice benefit any time
➢ She/he must sign a revocation form the specifies the
date of termination for hospice services.
➢ It should not be back dated.
➢ Once signed, patient’s care is no longer covered under
the
➢ Medicare hospice benefit and Medicare coverage that
was previously waived may resume.
➢ Private insurance coverage varies and individuals
should be counseled regarding their benefits.
➢ Most commonly patient revoke care to seek disease
modifying treatments.
➢ Roughly 7% of all hospice discharges are due to
revocation.
➢ Patients who choose to withdraw actually have a
higher 6-month mortality rate than those who are
discharge for other reasons.
➢ Therefore, the hospice IDG should carefully counsel
patients and families who revoke hospice benefits in
favor of aggressive treatment regarding their rights to
reenroll in hospice any time.
➢ Currently, only about 1 quarter of those who disenroll
from hospice reenroll prior to death. (LeSage & Rhee
2015, Russel et al 2017)

CHANGE IN HOSPICE PROVIDER

➢ A patient may choose to change hospice agencies once
in each hospice benefit period.
➢ The patient is not required to revoke benefits, rather
the change is considered a transfer of services.
➢ The hospice from which the patient transfers must
discharge the patient into the care of the newly
designated hospice.
➢ Discharging hospice agency must obtain a signed
statement from the patient indicating the effective
date of transfer.
➢ Names of both discharging and receiving hospice must
be included
➢ Receiving hospice must file a new NOE but the benefits
remained unchanged.
➢ If the transfer takes place in the 3rd benefit period or
later, a f2f encounter is required unless the
discharging hospice agency provides verification that
one has taken place.