Having a hospice provider working as a partner with a nursing home may improve the quality of care a nursing home resident receives during end of life. Many studies have shown that having a hospice presence in nursing homes reduces hospital readmissions, improves the facility’s performance scores, and facilitates conversation between the resident and their families regarding end-of-life treatment options.
The difference between nursing homes and hospice
When a loved one’s health condition declines, the decision to transition to comfort care is not an easy one. However, before a decision is made you must know the difference between a nursing home and hospice.
Hospice care services
Hospice is an approach to care for people experiencing a life-limiting illness. It offers comprehensive services that address the physical, spiritual, social, and emotional needs and preferences of the patient and family. The hospice team includes nurses, doctors, social workers, certified nursing assistants, and chaplain and bereavement services to ensure that the patient receives medical, physical, emotional, and spiritual support in any place the patient calls home.
Nursing homes and long-term care facilities
Nursing homes and long-term facilities serve as a place where the patient lives and needs assistance with activities of daily living such as bathing, dressing, and toileting. Care is provided by trained nurses that are ready to handle the nursing and medical requirements of the residents.
Patient hospice care eligibility
For a resident to qualify for hospice care, the resident must meet the hospice eligibility requirements that have been established by the U.S. Centers for Medicare & Medicaid Services (CMS). Although there is not a standardized list to qualify, CMS guidelines help with determining if a resident’s condition is appropriate to receive hospice care.
Role of hospice in long-term care homes
Hospice care is provided wherever an individual resides, which includes long-term care facilities and nursing homes, and provides specific services at the end of life to residents and their families. The long-term care facility staff provides residential, custodial services to the resident, while hospice care tends to the end-of-life needs. This is what makes hospice and the long-term facility mutually beneficial to each other. Here are few examples of the role hospice plays in long-term care facilities:
Specialized skill sets. Hospice staff provide additional expertise to the long-term care facility which include quality of life and comfort during the end-of-life phase. Additionally, once the resident has passed the family is provided with grief support.
Improved resource management. The hospice team will coordinate everything related to the hospice plan of care, including medications and coordinated care for the resident that includes their primary doctor, hospice doctors, hospice aides, and hospice nurses.
Expert medical education. The hospice team provides education that focuses on the resident’s condition, symptoms, and medications.
How hospice can assist nursing home staff
The hospice team and the nursing home staff share the responsibility for the resident’s end-of-life care.
Upskilling
The nursing home’s staff has a key role in the care of residents since these professionals are often the first individuals to notice changes in the resident. It is important to educate nursing home staff on recognizing signs and symptoms of end-of-life and when to notify the proper healthcare provider. The hospice team provides education that focuses on the resident’s condition, symptoms, and medications, and how to best care for a resident’s medical needs.
Coordinating patient care
Hospice staff helps in the coordination of the resident’s care and medications needed across all their healthcare providers, hospice team, and nursing home staff. This coordination of care assures proper communication and gives the resident’s family the ability to have questions answered.
By Joelle Y. Jean, FNP
Due to its busy nature, providers in the Emergency Room (ER) may not immediately identify patients for hospice care. Approaching patients or family members about hospice can also be challenging-especially if they have specific questions. This hospice checklist can help guide providers on when they should consider a patient for hospice.
What is hospice?
Hospice is for patients who are at the end of life. Patients can have a terminal illness or declining health from a chronic illness. The hospice team can coordinate care with health care providers to manage and treat patients.
Initiating hospice early in the disease process has many benefits for the patient and family members. Hospice is there to improve the quality of life and provide comfort for patients during their end of life. Benefits of hospice include:
Improved physical and psychological symptoms
Caregiver relief
Reduced hospitalizations
Lowered hospitalization costs
Reduced hospital deaths
Barriers to initiating hospice
Studies have shown that providers initiate hospice too late- patients die within weeks of entering hospice. There are barriers that cause ER providers to wait or not consider hospice. Some barriers include:
Not having the right resources
Breakdowns in patient-clinician communication
Failing to identify terminal stage of life
Geographical and socioeconomic barriers
Head-to-toe hospice checklist
Alzheimer’s disease and dementia
Patients in the late stages of Alzheimer’s disease or dementia are candidates for hospice. At this stage, they start to lose activities of daily living (ADLs) and cannot complete basic functions on their own. These functions include:
Bathing
Dressing
Eating
Swallowing
Other signs providers should consider patients with Alzheimer’s disease or dementia for hospice are:
Loss of the ability to walk (life expectancy is about a year)
Patients in their late stages of heart failure (HF) are candidates for hospice. Providers should consider hospice if the patient has:
Visited the ER two or more times in the past six months
A decline in ADLs
Severe HF symptoms such as dyspnea, angina, fatigue
Not responded to pharmacological and non-pharmacological interventions
Ineligible for surgery
Weight and muscle loss
NYHA class three/four heart failure
Lung disease and lung cancer
Patients with end-stage lung disease and lung cancer are hospice candidates. Providers should consider hospice if the patient:
Has frequent ER visits
Increased weight loss
Increased dyspnea at rest even with oxygen
Stage four non-small lung cancer
Liver disease
Patients with end-stage liver disease are candidates for hospice. Liver disease is the 12th leading cause of death in the United States. Patients with liver disease are often overlooked for hospice care. Providers should consider hospice for patients with end-stage liver disease if they are:
Ineligible for a liver transplant
Increased pain
Increased pruritus
Increased nausea
Depression and anxiety
A decline in cognition and weight
Cancers
ER providers can opt for hospice for patients with cancer if treatment is no longer working or there are no other treatment plans. Patients also at the end stage of their cancer can benefit from entering hospice early. Other signs a patient is ready for hospice are if the patient:
Has increased weakness
Significant weight loss
Pain control
In bed for most of the day
Sepsis
It’s not always easy to identify patients with sepsis who qualify for hospice. However, some patients meet the criteria. Providers should consider patients with sepsis for hospice if the patient:
Has impaired kidney failure
Not responding to pharmacological treatment
Require mechanical ventilation
Injury to the liver
Hyperlactemia
Hospice is available to patients who are at the end of their life. They can entire at any stage in their disease process. Initiating hospice early benefits the patient. Studies have shown that hospice improves mood, decreases medical interventions, and enhances the patient’s overall quality of life.