Transition Through The Continuum of Care

1. Transition Through The Continuum of Care • Hospice and Long-Term Care

2. Hospice Philosophy • Hospice is a philosophy of healthcare for people at the end of life, which seeks not to prolong life unnaturally, but to ensure that in the time left to the dying person, his or her life is as full and comfortable as possible. • Hospice seeks to enhance the dying person's quality of life and to provide support for family and other caregivers.

3. Goals of Hospice • The main goal of hospice care is to reduce potentially unavoidable physical, emotional, psychosocial, and spiritual suffering encountered by patients during the dying process. • As a result, medical care during this period is very delicate and needs to be individually tailored. End-of-life care requires detailed attention to each person's wishes, beliefs, values, social situation, and personal characteristics.

4. History • The term “hospice” (from the same linguistic root as “hospitality”) can be traced back to medieval times when it referred to a place of shelter and rest for weary or ill travelers on a long journey.  • The name was first applied to specialized care for dying patients by physician Dame Cicely Saunders, who began her work with the terminally ill in 1948. • Create the first modern hospice: St. Christopher’s Hospice in London.

5. History • Saunders introduced the idea of specialized care for the dying to the United States during a 1963 visit with Yale University.  • Her lecture, given to medical students, nurses, social workers, and chaplains about the concept of holistic hospice care. • Included photos of terminally ill cancer patients and their families, showing the dramatic differences before and after the symptom control care.  • This lecture launched the following chain of events, which resulted in the development of hospice care as we know it today.

6. History • In the United States, hospice was originally run by volunteers who cared for dying patients. In the 1980s • Medicare authorized formal hospice care and Medicare hospice benefits became part of Medicare Part A. • State-run insurances or Medicaid also offer hospice benefits, as do most private insurances.

7. Medicare Hospice Benefit • Covered Services: • Medicare covers a wide range of services to provide the most comprehensive care as possible. Your Medicare benefit covers the following services and pays nearly all of the cost associated with them: • Physician care • Nursing care • Medical supplies (bandages, catheters, diapers, etc.) • Medical equipment (oxygen machine, wheelchair, hospital bed, etc.) • Medications for pain and symptom control • Home health aide services • Medical social services • Counseling (spiritual, emotional, dietary) • Therapists (speech, physical, occupational) • Short term stays in nursing facilities for respite care

8. Medicare Benefit • Length of Coverage • Once you have been certified for hospice by two physicians, you are eligible for two 90 day periods of hospice care followed by an unlimited amount of 60 day periods. • What this means is, at the beginning of each 90 day or 60 day term, your doctor will have to re-certify that you still have a terminal illness. • If you improve dramatically during hospice care, for example if your cancer suddenly goes into remission or your terminal illness gets much better, and your life expectancy increases from 6 months or less, your doctor may “graduate” you from hospice care. • This would mean your Medicare benefit is no longer a hospice benefit and reverts back to standard Medicare Part A. • You can be readmitted to hospice any time you experience a decline and two doctors certify you have a terminal illness with a life expectancy of 6 months or less

9. Complex Care • The complex care of hospice patients may include the following: • Managing evolving medical issues (infections, medication management, pressure ulcers, hydration, nutrition, physical stages of dying) • Treating physical symptoms (pain, shortness of breath, anxiety, nausea, vomiting, constipation, confusion, etc.) • Counseling about the anxiety, uncertainty, grief, and fear associated with end of life and dying • Rendering support to the patient, their families, and caregivers with the overwhelming physical and psychological stresses of a terminal illness • Guiding patients and families through the difficult interpersonal and psychosocial issues and helping them with finding closure • Paying attention to personal, religious, spiritual, and cultural values • Assisting patients and families reaching financial closures (living will, trust, advance directive, funeral arrangements) • Providing bereavement counseling to the mourning loved ones after the death of the patient

10. 4 Various Level Of Care • Routine Home Care-This is the most common level of hospice care. Routine home care includes, but is not limited to, nursing and home health aide services. Patients may receive Routine Hospice Care in their home or what they “call home”—in a long-term care or assisted living facility. • General Inpatient-  is care for pain control and symptom management that cannot effectively be provided in other settings. It is usually of a short-term nature and can be provided in a hospital, hospice unit or long-term care facility. Compassionate Care Hospice has dedicated inpatient hospice units in some of our programs. • Continuous Home Care- is provided during periods of crisis in which a patient requires continuous nursing care to achieve palliation or management of acute medical symptoms. This intensive care is provided in the patient’s home or facility where they live. In addition to being visited by the team members, the patient will receive up to 24 hours a day care by a licensed nurse and hospice aide, when on Continuous Home Care. • Respite Care-  short-term inpatient care provided to the patient when necessary for the purpose of providing a break in care giving to the patient’s caregiver(s). It is only provided on an occasional basis, for a maximum of five days approximately every 90 days. Respite Care is provided in a hospital, hospice unit or long-term care facility.

11. Interdisciplinary Team • Occupational therapists and other therapy services • Speech therapists • Home health aides • Volunteers • Nurses • Social Workers

12. Interdisciplinary Team • Social Workers: •  work closely with patients, families and caregivers to create and maintain a supportive care setting. • They are available to help patients and families deal with personal, financial, emotional and care planning issues that arise. The social worker may: • Identify community resources and provide referrals. • Help with confusing paperwork for assistance programs and insurance. • Help with the emotional side of the dying process.

13. Interdisciplinary Team • Social Workers: •  work closely with patients, families and caregivers to create and maintain a supportive care setting. • They are available to help patients and families deal with personal, financial, emotional and care planning issues that arise. The social worker may: • Identify community resources and provide referrals. • Help with confusing paperwork for assistance programs and insurance. • Help with the emotional side of the dying process.

14. Interdisciplinary Team • Social Workers: • Assistance with funeral planning. • Identifying emotional and spiritual needs of the patient and their loved ones and finding appropriate support as needed. • Assistance with bridging family gaps to bring loved ones together whenever possible (for example, help obtaining temporary Visa's for out-of-country family members). • Assisting survivors with necessary arrangements and paperwork after death occurs. • Assisting survivors in obtaining appropriate grief counseling. • Identifying other needs of the patient and their support circle and assisting as needed. • Advance Care Planning

15. Myths • Hospice Care Means Giving Up Hope • Hospice Is Only for Cancer Patients •  Hospice Is Only for Patients who Are Close to Death or Actively Dying • Hospice Means That I Have To Sign a DNR

16. Settings • Home • Assisted Livings • Long Term Care Facilities

17. THE ROLE OF THE SOCIAL WORKER IN THE LONG TERM CARE SETTING ISU SOCIAL WORK DAY MARCH 19, 2014

18. APOSTOLIC CHRISTIAN RESTMOR • LONG TERM CARE • RESTMOR • MY ROLE

19. The Role of the Social Worker • RESIDENT • FAMILY • ACR TEAM MEMBER • REGULATORY AGENCIES

20. The Resident • PRE-ADMISSION ASSESSMENTS • PROMOTES & PROTECTS RESIDENT RIGHTS • CARE PLANNING • GRIEVANCES • COORDINATES APPOINTMENTS

21. THE FAMILY • COORDINATES FAMILY MEETINGS • CARE PLAN MEETINGS WITH FAMILY • LONG DISTANCE FAMILY BRIDGE

22. THE TEAM • ABUSE OFFICER • SECURITY COUNCIL • ADMINISTRATIVE STAFF • QUALITY ASSURANCE-PERFORMANCE IMPROVEMENT TEAM • NEW EMPLOYEE ORIENTATION FACILITATOR

23. REGULATIONS • RESIDENT RIGHTS • HIPAA • ABUSE INVESTIGATION AND REPORTING

24. WHY LTC? WHY NOT? • SOCIAL WORKER-RESIDENT RELATIONSHIP • VITAL TEAM MEMBER • POTENTIAL LONG TERM EMPLOYMENT • VARIETY & CONSISTENCY

25. LTC SOCIAL WORKER • PASSIONATE AS AN ADVOCATE FOR THE ELDERLY • FLEXIBLE TIME MANAGER • EXCITING ROUTINES

26. References • NHPCO (National Hospice and Palliative Care Organization) (nhcpo.org). • Medicare (medicare.gov). • Apostolic Christian Restmor - Mission Statement; Social Work Job Description, Facility brocure