Consider palliative care, hospice as options
December 1, 2012 4 minutes read
Consider palliative care, hospice as options
Start engaging MDs, family early in the hospital stay
Case managers have the opportunity to provide valuable assistance to their patients who are frequently readmitted to the hospital with advanced chronic illnesses or who are approaching end of life, says Jennie Roberts, RN, CCM, MBA, chief nursing officer for Evercare Hospice and Palliative Care, based in Minneapolis, which provides hospice and palliative care services throughout the country.
"When patients are chronically ill or dying, we have one chance to do it right. Palliative care and hospice services are just another way of making sure patients get the right care at the right time," Roberts says.
When case managers think a patient may benefit from palliative care and/or hospice care, it's important for them to start engaging the physicians and talking to the family early in the hospital stay, Roberts says. "It's critical for case managers to develop close relationships with patients and families and to encourage open communication so the treatment team and the family can work together to come up with the best plan of care," she says.
Look at the discharge plan to determine if all the patient's options are included and approach the physician about how a palliative care or hospice consultation might fit, she suggests.
Referrals to palliative care are a good first step in a discussion of end-of-life care, Roberts says. "Palliative care is appropriate at every stage of advanced chronic illness. The palliative care team sees patients as they consider the options to transition from curative treatment to hospice and can provide valuable assistance," she says.
Palliative care is appropriate for patients with frequent readmissions for respiratory or cardiac issues, patients on ventilators, patients with advanced metastatic cancer, patients with combined dementia, and those with sepsis, recurrent urinary tract infections, or any patient with uncontrolled pain.
"It's important for patients and families to understand what palliative care is and that palliative care doesn't signal the end of life but can be implemented while curative treatment options occur. In addition, they need to know that in some cases, palliative care can reduce symptoms and have an impact on improved outcomes," Roberts says.
She suggests that case managers familiarize themselves with the palliative care process so they will be prepared to discuss options with the patient and family members. She recommends The Center to Advance Palliative Care (www.capc.org) as a good resource for a definition of palliative care and other tools to educate and guide healthcare professionals.
When you have the initial discussion with patients, focus on their care goals and their personal goals and wishes as they consider palliative care options. "By listening to patient wants and needs, case managers can more effectively discuss the conditions, the diagnosis, and treatment options to help meet individual needs, including palliative care. Patients and family members need to understand what will happen in the future and all of their options so they can make informed decisions," she says.
Helping families choose care options has three key elements, Roberts says:
- Understand the immediate needs of the patient and family from the clinical perspective, including symptom and pain management.
- Evaluate and understand the psychological and social support of the family and caregivers.
- Develop an action plan and monitor how it is working.
If the patient plans to leave the hospital, make sure the caregiver is ready to take care of all of the patient's needs at home. Educate the caregivers and have them demonstrate what they need to do before the patient goes home.
Give caregivers information on what to expect next and practical suggestions of what to do when something happens. Make sure they understand that if they have problems, they can call someone for help.
Make sure the patients have access to medical supplies and equipment as well as follow-up care after discharge. If pain medication and equipment don't arrive in a timely manner, it could result in a hospital readmission, she says.
Caregivers and patients need a lifeline to someone such as a case manager to answer questions after the patient is home. Caregivers may believe that they can take care of the patient; however, the care needs may seem overwhelming once they get home. They may need someone to answer their questions or reassure them as they take on the day-to-day activities of caring for the patient.
"Caregivers need to understand that it's OK to call for help if they are not certain about something, and they should have a number to call," she says.
Check with the patient and caregivers after discharge to make sure everything is going smoothly and answer any questions. Monitor the caregivers regularly for the potential of burnout and the need for respite care.
"Support is critical. Case managers need to assess and understand what the patient and caregiver are capable of doing. Caregivers have a huge impact on patient outcomes," she says.
An interdisciplinary team at Evercare Hospice and Palliative Care provides services to patients and families and includes nurses, chaplains, social workers, and hospice aides.
The team sees patients in the hospital as well as in the home setting, skilled nursing facilities, or assisted living facilities. They collaborate with the hospital case managers and discharge planners to develop a plan of care that includes patient and family support and resources. They continue to support the patient and family through the entire episode of care.
Case managers have the opportunity to provide valuable assistance to their patients who are frequently readmitted to the hospital with advanced chronic illnesses or who are approaching end of life, says Jennie Roberts, RN, CCM, MBA, chief nursing officer for Evercare Hospice and Palliative Care, based in Minneapolis, which provides hospice and palliative care services throughout the country.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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