Hospice and Ventilators? Need input please

[ovnerati]

I am doing some work determining hospice coverage and I've run into a situation that I am unsure of. Hospice is not one of my specialties and I could use some input. So here is a brief situation:

A patient is placed on hospice for end stage cardiac disease. He has to receive hospice care in a long term care facility because he also has COPD and requires a ventilator. Can the COPD be considered seperate from the admitting diagnosis or would you consider these related conditions. Does the ventilator count as palliative care or is it an agressive treatment?

Just not sure how to approach this situation. What do the experts in hospice nursing think?

[FLArn]

If the patient was admitted as end stage cardiac with COPD as a co-morbidity, the ventilator would be considered palliative for respiratory distress. People die while on ventilators everyday.

[tewdles, RN]

Sad, IMHO, that the E/S COPDer is on a ventilator but elects hospice for cardiac dx.

I have participated in many ventilator weans for hospice patients to allow a "natural", dignified, and comfortable death in the home.

[FLArn]

Oh, by the way, sometimes vents are "passed off" as BiPaps or CPaps; but I know a vent when I see one. LOL

[Double-Helix, BSN, RN]

I'm assuming the patient had a tracheotomy and was awake while on the ventilator (not intubated and sedated). People who are chronically ventilator dependent for respiratory disease can actually live very full lives. I've known a patient who was ventilator dependent who drove to work every day, held down a job, and had a family. However, if you removed the ventilator, these patients would struggle to breathe, became anxious and agitated, and be very uncomfortable. In these situations, the ventilator is used for palliative (comfort) reasons and would not be considered aggressive treatment.

[Double-Helix, BSN, RN]

A good rule of thumb (in general) is that if an intervention is assisting with or aiding in the comfort of a basic need (such as BiPAP for breathing, pacemaker for cardiac function, morphine for pain control, PEG tube for inability to swallow) then it's a palliative treatment.

But if the intervention is controlling the basic function (ventilator when the patient is unable to breathe on their own, vaso-pressors to control HR and BP) then it's aggressive treatment.

[tewdles, RN]

In my opinion, the ventilator for a COPD patient is aggressive treatment.

The COPD can be considered a co-morbidity, however, E/S COPDers often have heart failure secondary to their pulmonary disease rather than as a seperate disease state. Long before they have failure they often have chronic tachycardia, palpitations, poor fluid tolerance, and problems with orthostatic hypotension.