Palliative Care in a Nursing Home – Is it Possible? Integrating Palliative Care in a Nursing Home

1. Palliative Care in a Nursing Home – Is it Possible?Integrating Palliative Care in a Nursing Home On Dulberg Vera’s Home, Vera Solomons Center Nursing Home Kfar Saba, Israel

3. Vera’s Home - Nursing Home

4. Elderly in Israel Palliative services in israel Palliative Care & Nursing home

5. 89 years old women End stage dementia Eating problems Pressure ulcer stage 3 Septic shock and hypothermia AND Blood tests, X-ray Fluids and AB Died 8 hours from admission

6. Prognosis Quality of life Satisfaction Emergency departments Cost effective

7. Place of death, age 65+ , Israel 2013 67% Hospitals

8. Precentage of elderly ( 65+ ) in israel (4) 80 (10) 84

9. Medical Journals June 2011 Oct 2014 May 2015

10. Alternatives? Acute care hospital Hospices Community-based palliative care Long-Term Care - nursing homes

11. Palliative Care & Nursing homes / Barriers Standarts & guidlines Geriatric & Palliative qualification Structures / equipment / Medications Coping with end of life Functional status Financing

12. Palliative Care - Israel Dying Patient Law 2005 2009 Palliative Care in hospitals, Nursing homes and community IMC = Israel Medical Cannabis 2011 Palliative residency programs 2013 2015 Advance medical directive & Power of attorney

13. Dying Patient Act Democratic Traditional Religious Values Ethical

14. Dying Patient Act Sanctity Quality of life Autonomy

15. Barriers to the Development of Palliative Care in Israel All population Equal services Palliative qualification Multidiscipilinary All stages of disease All diseases

16. Core Components of Palliative Care Relief pain and other distressing symptoms; Regards dying as a normal process; Integrates the psychological and spiritual aspects of patient care; Help patients live as actively as possible until death; Uses a team approach Support the family Bereavement;

17. Objectives • Integrating principles of the palliative approach in a nursing home. • Acute and chronic illness • Reducing end-of-life referrals to emergency rooms and hospitals. • Allow residents to die at the nursing home

18. Methods A strategic decision Integrating the palliative principles Medical Directives & powers of attorney Multidisciplinary team Education Support Acute care & IV treatments End-of-life situations

19. Methods Implementation Date (Year)

20. Results • A strategic decision • Integrating the palliative principles • Preliminary instructions and powers of attorney • multidisciplinary team • Education • Support • IV treatments • Acute care • end-of-life situations

21. Advance Medical Directives and Powers of Attorney (No’)

24. Emergency Room visits per year (No’) year Occupancy rate 101% 106% 105% 101% 93% 71%

25. Mortality Rate: Hospital Vs Nursing Home year Hospital Nursing Home

26. Traditional Ceremony

27. Palliative Care in a Nursing Home – Is it Possible?Integrating Palliative Care in a Nursing Home Thank You ! On Dulberg Vera’s Home, Vera Solomons Center Nursing Home Kfar Saba, Israel