When My Healthcare Provider Recommends Hospice Care Does That Mean They’ve Given Up On Me
If your healthcare provider recommends hospice care, its another example of their commitment to your wellbeing.
Its important to remember that you have the final say about enrolling in hospice or continuing treatment. And if you decide against hospice, its important to remember you can always change your mind.
Life Expectancy Of Hospice Patients
If a patient is recommended for hospice with the disease running its normal course life expectancy should be 6 months or less. However, every person is different and patient case is different. There are many factors effecting life expectancy such as the patients age, genes, environment, and prior treatments. Some patient cases an act of god can prolong the life more than expected.
Receiving Intravenous Treatments At Home
Often, home health care nurses will come to your home to give you the medicine. Sometimes, a family member, a friend, or you yourself can give the IV medicine.
The nurse will check to make sure the IV is working well and there are no signs of infection. Then the nurse will give the medicine or other fluid. It will be given in one of the following ways:
- A fast bolus, which means the medicine is given quickly, all at once.
- A slow infusion, which means the medicine is given slowly over a long period.
After you receive your medicine, the nurse will wait to see if you have any bad reactions. If you are fine, the nurse will leave your home.
Used needles need to be disposed of in a needle container. Used IV tubing, bags, gloves, and other disposable supplies can go in a plastic bag and be put in the trash.
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What To Do If Youre Concerned About The Care Your Relative Is Receiving During Hospice
If you have the energy to do so, I recommend first being proactive right when the hospice care begins. In particular, I recommend:
- Asking to see what medications are being ordered, and under what circumstances theyll be given.
- Bringing up any concerns you might have regarding the use of opioids or benzodiazepines.
- Clarifying your familys goals and priorities regarding use of the medications.
- For instance, you could specify that although pain management is indeed important, youd like to minimize sedation and have your loved one remain as alert as possible.
- Given that benzodiazepines often arent the best way to manage people with dementia, you could consider asking that those be minimized.
You should also know many hospice agencies use pre-made templates to prescribe medications. Such templates will often include orders to provide morphine as needed, and also lorazepam as needed.
You can view a hospice order template here: Initial Hospice Admission & Comfort Med Orders.
As youll see if you view the order template, as needed orders often give the nurses quite a lot of latitude in how much morphine and lorazepam they can give. So its important to bring up your goals and priorities regarding medication use right away. This will enable to nurse to better calibrate her care to the needs and preferences of your older loved one and your family.
If youre concerned about the hospice care provided
What Are Iv Drips Used For
A catheter and a saline-based electrolyte solution containing your chosen vitamins and minerals are used in an IV fluid drip. An IV drip introduces these vital nutrients and fluids directly into your circulation, bypassing your digestive process. This allows your body to quickly access what it needs while preventing gastrointestinal upset.
An intravenous drip consists of a tube that goes into a large vein in your arm or hand. The other end is attached to a bottle that contains the liquid medicine you will receive through this route. You may receive several doses a day via this method.
Nurses commonly use IVs to give you drugs when other routes of administration are not appropriate. For example, if you cannot take pills orally, then they may be given via an IV. Intravenous therapy is also used to deliver nutrition and fluids to patients who cannot ingest any form of food or drink.
The most common use of IVs today is to give chemotherapy patients’ their medications. Other uses include delivering immunizations, blood products, and insulin. Nurses are also responsible for monitoring and maintaining IVs. They check them frequently for leakage or obstruction and replace clogged tubing as needed.
Intravenous drips were first developed by a nurse named Lois Lee.
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Infusions For The Terminally Ill
It is better to die dry than wet. Oasis hospice & palliative care avoid parenteral fluids to avoid fluid organ buildup . The issue is that delirium typically exacerbates the challenges of end-of-life careone of the four most common crises requiring palliative care at home and hospice hospitalization. Reduced oral intake might cause dehydration and delirium in some people. Prevention of fever requires early rehydration and volume restoration. So, how can dehydration be treated without agitation, an unexpected side effect of IV hydration in terminally sick patients? Some advocate for enhanced parenteral fluid therapy, especially in dehydrated patients. IV hydration may improve quality of life and reduce delirium rates.
Receiving Medical Treatment During Hospice
Hospice care teams include a variety of medical professionals .
A medical recommendation for hospice care always follows a regular course of medical care. That being said, once the medical diagnosis is made recommending hospice care, medical care will continue, but under the auspices of the hospice care program rather than the hospitals regular medical team. Hospice care teams include a variety of medical professionals . The patients regular physician may also continue providing care, even under hospice.
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Patients No Longer Eating Food And Water
A hospice patients needs for food and water are different from those of a healthy individual. As the end of life nears, the body gradually loses its ability to digest and process foods, liquids. Patients in hospice eventually have their organs and bodily functions shut down. Due to this minimal amounts of nutrition or hydration and liquids might be needed. Families often ask how long if left in life after patient stops eating. Our team looks at many patients signs of not eating water and food. If disease prognosis runs its normal course we often say patients may have months or weeks left.
Continuing to offer food and water, or opting for artificial nutrition or hydration such as nasal or stomach feeding tubes or IV fluids for hydrationcan actually complicate the process and lead to other health problems.
Data Collection And Variables
We comprehensively reviewed each patients medical record in including daily progress notes, infectious disease and palliative care service consultation notes, and discharge summaries. Data were collected via manual medical record review using a standardized data extraction form created using the Research Electronic Data Capture application.9 Additional administrative, demographic, and comorbidity data were collected from the Pharmacy Research Repository , a longitudinal repository of patient healthcare data created in partnership with the Oregon Clinical and Translational Institute Research Data Warehouse at OHSU. We defined aggregate comorbidity burden using the Charlson comorbidity index.10
Our primary outcomes of interest were the infectious indication, documented rationale, and contextual variables of each antibiotic prescription. Although patients may have had multiple infections during their hospital stay, we specifically focused on the primary indication or indications for which antibiotics were prescribed on discharge to hospice care. Indication data were documented and classified into the following categories: bloodstream infections, septicemia or endocarditis, pneumonia, urinary tract infections, sepsis, gastrointestinal infections, pressure ulcers and skin and soft tissue infections, respiratory tract infections, and other infections. We also documented if patients were prescribed a single antibiotic to treat more than one infection.
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Patients Wishes Of Traveling In Final Days
Hospice patients even though are termed end of life patients may travel upon physician approval. If the disease has not progressed to the final days with doctor approval hospice patients can travel with proper arrangements. Again hospice is about being comfortable and we want to fulfill the families desire of requests. If the patient condition permits travel hospice doctors will give an approval for travel.
Medical Director Minute: The Role Of Antibiotics In End
In hospice care, our primary goal is to maximize patient comfort while adhering to a patients and familys goals of care. We work to accomplish these goals by employing an interdisciplinary team approach to address all aspects of the patients plan of care. Of course, medications are a mainstay of our treatment plan to ensure patient comfort and symptom palliation. A class of medications that can elicit questions on benefit and purpose is certainly antibiotics.
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What Are My Hospice Care Options
There are four levels of hospice. The levels are based on daily rates Medicare pays hospice providers. Those levels are:
- Routine home care. Your family and/or loved ones care for you at home and you receive regular visits from hospice team members.
- Continuous home care. Hospice team members provide short-term in-home nursing care as needed so you can remain in your home.
- General inpatient care. Youre receiving hospice care in a facility because you have pain or other symptoms that cant be managed at home.
- Respite care. You receive short-term temporary hospice care in a facility to give your caregivers a rest.
Hospice care is intended to help you be comfortable throughout the rest of your life and to give your choices about your care.
Sobering Truths Reflected In This Q& a
In truth, the concerns described in this question make me a bit sad. I know that most of my colleagues in healthcare are really trying hard to help the patients and families they work with.
But, it remains absurdly common for patients and families to encounter sub-optimal healthcare. Health providers often arent able to communicate and partner with families as well as we want them to. And they may not be up-to-date on the latest clinical evidence or best practices.
In short, healthcare usually involves good intentions but frequently flawed execution.
Its important to not fault individual health providers too much for this. Most of the time, they are doing their best. But, they are stuck working within a system that just doesnt provide them with the support, resources, and time that they need to do better.
So, if youre a patient or family caregiver, remember: If you can muster the time and energy to do so, its often a good idea to do a little homework and ask questions about the healthcare that you or your older loved ones are getting.
Hospice is an important and valuable service for those who are dying and for their families. A good hospice team should welcome the opportunity to hear your questions, your concerns, and your priorities.
Please note: I will no longer be approving or responding to comments on this article. Thank you for reading, I hope you found it helpful!
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Patient Criteria For Hospice Patients Dementia
Dementia patient to meet the hospice eligibility criteria, must have a life expectancy of six months or less if the disease continues in its typical progression. For patients with dementia, it may be time to consider hospice when the patients physical condition begins to decline:
- A diagnosis of other conditions as COPD, CHF, cancer or congenital heart disease
- An increase in hospitalizations, frequent visits to the doctor and/or trips to the ER
- A diagnosis or pneumonia or sepsis
- Weight loss or dehydration due to challenges in eating/drinking
- Speech limited to six words or less per day
- Difficult swallowing or choking on liquids or food
- Urinary and fecal incontinence
- Sitting upright without arm rests on chairs or may slip out of chairs and require sitting in special chairs
- Not being able to walk without assistance such as a walker or now requiring a wheelchair
- Unable to sit up without assistance
- No longer able to smile
Inpatient Medical And Palliative Care Measures
- IV fluid
- wall suction for bowel obstruction
- limited courses of TPN/PPN
- advanced wound care
- selected home medications
- routine blood and urine tests
- urine culture
- plain x-rays
- EKG
- non-invasive and invasive ventilator support
- CPAP/BiPAP
- labs and x-rays
- ultrasound guided/assisted procedures, including paracentesis, thoracentesis, and midline placement
- urine culture
- plain x-rays
- EKG
- non-invasive and invasive ventilator support
- CPAP/BiPAP
- labs and x-rays
- ultrasound guided/assisted procedures, including paracentesis, thoracentesis, and midline placement
- advanced imaging studies .
- advanced cardiac life support and intubation . CPR is initiated and 911 is called for those patients with respiratory or cardiac arrest who wish these interventions.
- CPAP/BiPAP and non-invasive/invasive ventilator settings are not adjusted at the Branford facility, and 911 is called for those patients in need of and wanting adjustment of these devices.
- CPAP/BiPAP and non-invasive/invasive ventilator settings are not adjusted at the Branford facility, and 911 is called for those patients in need of and wanting adjustment of these devices.
Comfort-oriented measures are available to all patients using assisted ventilation who wish to change their goals of care and resuscitation status, and aggressive symptom management is offered to all patients.Hospice enrollment is available to all eligible patients.
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Antibiotics In Hospice Patients To Treat Symptoms Of Infections
The current JPSM has an article prospectively following hospice patients who were given antibiotics to see if antibiotics alleviated symptoms associated with the infections. About 1600 people were followed 600 were treated with antibiotics for suspected or proven infections& symptoms were prospectively followed. Most infections were UTIs or respiratory. Except for UTI’s, 50% or fewer patients had symptomatic improvement with antimicrobials . 66-88% of the people with UTI’s had improvement. The median mortality was at 30 days. Clearly there are lots of problems with this study and TMP-SMX –the next logical step would seem to be randomizing hospice patients with suspected UTI’s to symptom relief only or symptom relief plus antibiotics to see if there’s any difference.
Help Related To Funeral Costs With Low Income Patients
Hospice team is legally not required to pay for funeral expenses. California dose not offer assistance for funeral costs. However, some hospices may provide some assistance via non profit solutions for cremations upon request. Some California hospices may also offer additional assistance via volunteer or charity programs. However, in most cases your loved ones assigned social worker will be available to help you make post-mortem arrangements. Their assistance can help streamline the planning process and ease your burden of responsibility.
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When Should You Use Antibiotics In Hospice Care
Case 1: You have a 94-year-old woman with multiple medical problems in hospice who develops a fever , shortness of breath, and a cough producing yellow sputum. Her daughter asks if she can be treated with antibiotics to make her feel better. The patient is not well enough to make decisions, but in earlier conversations had stated a goal of remaining comfortable at home, while also hoping to live until her first great grandchild is born. Should you treat with antibiotics?
Case 2: You have an 84-year-old man in the hospital being treated for a fungal infection of the heart. The condition is non-operable and he decides to focus on comfort. The plan is to discharge to hospice. The infectious disease team recommends a 12 week course of IV antifungals, or at the every least oral anti-fungals. The patient, who has already had one stroke from a fungal clot in his heart that shot up to his brain, is willing to take the medication. Should you follow these recommendations?
Case 3: You have a 98-year-old woman with advanced dementia on hospice in the nursing home. She is unable to speak and is fed by hand. She develops a fever, is urinating more frequently, grimacing and moaning. Should you send a UA? Should you treat with antibiotics?
Though loosly based on real world expereinces, these cases are all made up.
We need more clarity in this area. Its a rich area, involving symptom relief and communication, topics at the heart of hospice and palliative care.
Proper Use Of Antibiotics
I would imagine that most of us have been prescribed an antibiotic for some ailment throughout our lives. Over the last ten years, inappropriate antibiotic use has been a focus area for the CDC and WHO . In 2013, both organizations declared antibiotic resistance a national and global threat. In their joint statement, they stated that Antibiotic use is the most important modifiable driver of antibiotic resistance. Vast campaigns were employed to educate both prescribers and patients about the risks of inappropriate antibiotic usage. Per Dr. Amesh Adalja, MD, the Infectious Diseases Society of America Spokesperson, Antibiotics are misused so often because of the belief that these are benign drugs, and that patient satisfaction depends upon being prescribed an antibiotic.
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What Drugs Are Used In End
For any patient in hospice, the advent of myriad therapeutic interventions can help achieve comfort and pain relief.
For any patient who is receiving hospice care and faces a challenging, chronic, or progressive disease state, the advent of myriad therapeutic interventions can help achieve comfort and pain relief.1
The existence of unrelieved pain is viewed as a critical factor that can obstruct dignity at the end of life.1 Within the hospice care setting, patients can be placed on specific therapies that are designed with the primary intent of alleviating pain or removing the discomfort that can be associated with a terminal diagnosis. At times, it can prove difficult for family members to watch a loved one in pain and not receiving sufficient medication.2 The existence of a subset of medication classes that are approved for pain management are considered go-to medications when providing comfort care in the hospice care setting. Historically, attention has been given to adequate symptom management at the end of life, with less attention given to the medications that are prescribed to people in hospice.3 The most commonly prescribed drugs include acetaminophen, haloperidol, lorazepam, morphine, and prochlorperazine, and atropine typically found in an emergency kit when a patient is admitted into a hospice facility..3
Within the hospice care setting it is vital to maintain continuity of care as it relates to pain
References
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