Hospice Criteria

[TangoLima]

I currently work on a Telemetry floor and will soon transfer to a MICU. I am a big advocate for hospice. While in nursing school, we all did an orientation with hospice and I remember being very impressed with the services provided. I feel that most people think if they call in hospice, that means their loved one is going to die immediately. However, my impression from my orientation was that hospice can offer many services to the patient and family other than a place to die. And, as I can remember, criteria for hospice care included losing x% of one's functionality.

I recently had a patient who was end-stage dementia and was on a Peg-tube feeding. He was basically unresponsive, but otherwise in stable condition. I talked to the family about code status and also consulting hospice. At the very least, they could talk to hospice and educate themselves about their services, even if they decided they didn't want to go that route yet.

But, I do have some questions after reading some posts here. What is your criteria for admitting a patient to hospice? Does hospice admit patients who are on tube feedings? TPN? I know hospice gives great pain management, and respite care for the family, but what other services does hospice provide?

Thank you.

[tewdles, RN]

Ok...big topic...and you will get some good info here...

I will address this part; all hospices are required to provide Nursing care, aide assistance, MSW, pastoral and bereavement services and they MUST have a volunteer structure in place. Hospice is reimbursed by the insurance (usu Medicare) on a daily or per diem basis and out of that money the hospice pays for the staff visits, the equipment rentals (beds, w/c, oxygen, etc), all medications related to the hospice diagnosis and to comfort and palliation of symptoms. Most hospices will accept patients who have PEG tubes, chest tubes, trach tubes, endotracheal tubes, rectal tubes, pretty much any tube protruding from any orifice. Hospice offers excellent palliation of symptoms, excellent psychosocial support, excellent spiritual support (regardless of religious preference), excellent bereavement support, and a variety of additional services ranging from massage and music or pet therapy to healing touch. Hospice provides companionship and case management wrapped altogether with clinical intervention and huge doses of compassion. These people develop long term relationships with a consistent interdisciplinary team...this gives them a foundation of trust and familiarity which allows the patient and family to worry less about what we are doing and more about their quality of life.

The basic criteria requires 2 physicians to sign a statement or certification that the patient is (in the docs professional opinion) unlikely to live more than 6 months should they continue on their current course of decline. There are some specific criteria that must also be met for specific diseases and diagnoses, but I will let one of my peers address that...I'm tired, I had a long snowy drive today and a long IDT meeting.

Thank you for advocating for your terminally ill patients!

[MarciCRN]

In addition, Medicare has strict guidelines for who they will pay for Hospice care, medicare has been denying payment in the agencies in my area because they (medicare) didn't feel the pt's met requirements. We of course appealed as we know the pt's are appropriate. We have had to beef up documentation as we wern't reflecting a true pt picture. If you want to know eligibility, it is online ..http://www.ucop.edu/agrp/docs/la_hospice.pdf... is a good reference.