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My physician suggested hospice, now what?

Because every patient is different, every hospice admission is different. However, there are steps that must take place prior to a patient starting care.

Once a patient has decided to consider hospice treatment, a physician will provide a hospice evaluation order to Apreva.  An Apreva Liaison will meet with the patient, or their family, to explain the benefits of hospice, answer questions, and sign a set of consents, which allow Apreva to obtain medical records for the nursing staff.  These standard consents are a Medicare and/or Insurance Company requirement. This consultation may occur wherever the patient or family chooses, which may be their home, the hospital, or a convenient public location like an office or local coffee shop.

After consents are signed, an admission nurse will perform an evaluation of the patient, and/or the patient’s records, to confirm the patient meets the clinical guidelines for hospice services. If the patient is found appropriate for hospice, based upon Medicare Criteria for Hospice Guidelines, the hospice admission may occur.

The admission team will assess the patient and family’s needs.  From there, the nurse will assist the patient in developing a Plan of Care, detailing what can be expected from hospice. In addition to staff visits, hospice services include medical supplies, and durable medical equipment, such as a hospital bed, wheelchair, and incontinence supplies. Medication related to pain and comfort management are covered by the Medicare Hospice Benefit. Medical equipment and necessary prescriptions will be delivered to the patient.

Over the first few days, members of the Apreva team including nurses, a home health aide, a social worker, and a chaplain will contact the patient or family. The team will coordinate a schedule for regular nursing visits, personal care, emotional support and spiritual assistance.

When is the right time to ask about hospice?

Now is the best time to learn more about hospice and ask questions regarding what to expect from hospice services.  Although end-of-life care may be difficult to discuss, it is best for patients members to share their wishes long before it becomes a concern.  This can greatly reduce stress when the time for hospice is needed.  By having these discussions in advance, patients, nor family, are forced into uncomfortable situations.  Instead, patients can make an educated decision that includes the advice and input of family members and loved ones.

Who will provide the care?

Every hospice patient has access to a physician, nurse, social worker, chaplain, and home health aide, known as the Interdisciplinary Team. Volunteers are also available for needed support. On a routine basis, the Interdisciplinary Team will review the Plan of Care with the patient and family to ensure the care needs are met.

All visits are based on the patient and family needs, which fluctuate during the course of the illness.  The frequency of volunteers is dependent upon the need and request.

Is hospice available after hours?

Hospice care is available seven days a week, 24 hours a day.  Apreva has nurses available to respond at any hour assistance is needed.

Unlike many other hospices, Apreva does not utilize a call center or voice mail, each call is answered by a live Apreva staff member in our San Diego office.  Nurses are present and available for calls 24/7/365. End of life care is too important for voice mail or pager systems. This is the way we would want our family treated, so it is how we ensure every contact is as positive of experience as possible.

How does the hospice work to keep the patient comfortable?

Many hospice patients have pain and other symptoms as their illness progresses.  Apreva provides special training for staff so they are equipped to assist with these symptoms. Hospice staff works with the patient’s physician to ensure medication, therapies, and procedures are designed to achieve the goals outlined in the patient’s Plan of Care.  As the patient’s condition and goals of care change, the Plan of Care is updated according to the patient’s needs and wishes.

What role does the hospice volunteer serve?

Hospice volunteers are available to provide a variety of support to patients and their loved ones, including companionship, preparing light meals, short visits to give family members a break, lending emotional support, reading and many other tasks.

Because hospice volunteers spend time in patients’ and families’ homes, Apreva has a diligent application, interview, and vetting process.  In addition, Apreva has an organized and thorough training program for their volunteers.  Areas covered by our training program includes understanding hospice, confidentiality, working with families, listening skills, loss and grief support and bereavement assistance.

Can I be cared for by Apreva if I live in a nursing facility or other type of long-term care facility?

Hospice services are provided to the terminally ill wherever they live.  This means a patient living in a nursing facility, long-term care facility board and care, or assisted living may receive visits from hospice nurses, home health aides, chaplains, social workers, and volunteers, in addition to other care and services provided by the facility.  The hospice and the facility will coordinate the patients Plan of Care in accordance to the patients’ needs and wishes.

What happens if I cannot stay at home due to my increasing care and need to relocate during my final phase of life?

Apreva may assist in making arrangements with inpatient residential centers/skilled nursing facilities, or Board and Care homes, so care can continue at a higher level. However, Medicare considers this type of care to be custodial and is not covered under the Medicare Hospice Benefit, nor by most private insurance.  Medicare considers Skilled Nursing Facilities and Residential Care Facilities to be custodial and Medicare will not cover these services, nor do most private insurances. It is best to find out if your insurance or any other payer covers this type of care prior to being needed. If custodial care is not covered by insurance, typically the patient is responsible for payment.

Do state and federal reviewers inspect and evaluate hospices?

Yes.  Hospices must comply with federal regulations in order to be approved for reimbursement by Medicare.  Hospices periodically undergo inspection to ensure federal and state regulatory standards are met.

In addition to the state and federal requirements, Apreva is also accredited by Joint Commission, which means we are held to a much higher more rigorous standard than the minimum standard required by others.  Joint commission is the gold standard in health care.

What are the signs that hospice services may be needed for me or my loved one?

When the curative treatment outweighs the benefits, hospice may be the best option. Other indications include:

  • Repeat trips to the emergency department
  • Multiple hospitalizations
  • Unrelieved pain
  • Frequent infections
  • Frequent falls
  • Sudden or progressive decline in physical functioning
  • Weight loss/difficulty swallowing
  • Shortness of breath/oxygen dependence

What happens after my loved one dies?

Apreva strives to attend every death. Depending on how fast the patient declines, a member of the Apreva team may be at the bedside at the time of death. If a team member is not present, one will arrive soon after being notified. A hospice nurse will make a visit and pronounce the patient, make necessary phone calls to the prechosen mortuary, prepare the body for pick up and support the family as needed.

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