HSA Quiz Essay

* A physician must re-certify the patient at the beginning of each benefit period (two periods of 90 days each, one of 30 days, and an indefinite fourth period).

A person’s life can end at any age. They can depart quickly or slowly. End of life care, also known as palliative care, is the care of patients that are not only in their final hours or days but the patients with a terminal illness that has become incurable. End of life care takes into mind what the patient desires so it is recommended that they consider an advanced care plan also known as an advance directive and living will. These documents allow the patient to formulate decisions on the future of their care if, at any point, they cannot vocally express themselves.

A survey was conducted in 2000 on more than 9,000 patients discharged from more than 2,000 hospices on the services they received (Carlson, 2007). It revealed that 22% of them received five major palliative care services, which varied among the hospices. These palliative care services were nursing care, physician care, medication management, psychological care, and caregiver support. Approximately 14% of the hospices provided all five services and 33% provided only one or two services. Only 59% of these patients received medication management services. These included administering medication, dispensing correct dosages, and setting and following dosage schedule.

Caring for patients at the end of life is a challenging task that requires not only the consideration of the patient as a whole but also an understanding of the family, social, legal, economic, and institutional circumstances that surround patient care.

Essentially, Hospice and palliative care focus on managing symptoms when a patient is deemed to have 6 months or less to live and allows patients to live out their lives away from a hospital or nursing home setting. Partially the reason why most people, including me, haven’t heard that much about Hospice is most likely because it is intended for people at the very end of their lives. However, another major reason is addressed in Gawande’s book, and it revolves around the idea that doctors don’t inform their patients every time that Hospice is really an option. Gawande admits himself throughout his book that like most doctors, he is always over-optimistic and focus on the treatment of the disease, forgetting to focus on the idea of just managing the symptoms in cases where treatment would only prolong the inevitable or giving too many choices for families to make. Gawande explains “All-out treatment, we tell the incurably ill, is a train you can get off at any time- just say when”, however other options are often never talked about (2014, p. 187). One example from Being Mortal is the story of Sara Monopoli, who faced an incurable form of cancer at a rather young age. Sara, along with her family and husband, never focused on just symptom management, but rather what new and outrageous treatment can be done

The first hospice care was established in 1974. A hospice must make physician, nursing, drugs, and medical supply services available 24/7. It must have social workers and counseling services available to the patient and the family. Hospice also provides therapy and homemaker services when needed in order to be qualified under Medicare certification. Hospice is a combination of special services for terminal ill patients. Beside the medical service, hospice care also supports patients and family psychologically and spiritually to put their emotional suffering at ease. The psychological suffering can weight more than physical suffering. Many terminal ill patients cannot accept the bad news and living under emotional distress. Certified chaplains can work with people from different religions, they focus on the world-view of the patient and family. Using patient personal goal as the measurement, chaplains are the

Hospitals and other health care facilities also contribute to the failure of advance care directives, by failing to include copy of the patients advance directives in his or her chart. Physicians may be unaware of a patients advance directives, even when the document is placed in the patients chart. Healthcare directives have failed because, we as healthcare providers don't enforce it. For example, upon admissions we may ask the question do you have one, but we do not express the importance of an advance care directive to our patients. Failure of an advanced care directive can simply be because; the form was started but never completed. Due to human factor mistakes sometimes happen, a person that has chosen “Do not resuscitate” may be resuscitated, and prolong his or her life vice versa. In an emergency situation especially those that

Hospice care differs from other forms of medical care in that when the patient is dying, hospice works hard to relieve needless suffering. Normally, a patient is approved for hospice care if his or her life expectancy is 6 months or less. Hospice workers treat the person, rather than the disease. They aren't trying to cure a disease, but rather, they are trying to make the patient as comfortable as possible. Family and friends are encouraged to gather round and engage with the hospice patient. Many people have the misconception that the dying want to be left alone, but why would they want to be abandoned? Hospice is good for families, because they educate them on the dying process. Hospice care can be rendered in the family home, a nursing home, or in a hospital. Normally the majority of care is given by the family in the family home, or by nursing staff in a nursing home or hospital; however there are also private in-house hospice facilities-for those that may not have the family support. In the home, nursing home and hospitals the hospice workers come at specified times to work with the dying patient. They spend take vital signs, offer palliative care, and also offer support for family members. If you were to be admitted to hospice care you would find a great team of doctors, nurses, social workers, counselors, home healthcare assistants,

The purpose of hospice is to effectively provide palliative care to terminally ill patients and their families, it is available to any age, religion or race. According to the National Hospice and Palliative Care Organization, “hospice provides expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes Support is provided to the patient’s loved ones as well” (NHPCO, 2015). In

There are four general levels of hospice care: routine home care, continuous home care, general inpatient care, and inpatient respite care. The facility where I currently

Hospice care is a model of care that focuses on relieving symptoms and supporting patients with a life expectancy of six months or less (Altshuler, 2013). For most nurses, caring for a dying elder (individual aged 65 years and above) is a discrete, time-limited experience that begins with first contact, often in a hospital, emergency room, or long term care facility, and ends with the death itself (Phillips & Reed, 2008).

Very few people possess an ample enough financial position to afford long-term care from their own funds. A few have prepared by purchasing annuities or long-term care insurance, but these numbers are small. By the time that most people enter long-term care they have multiple chronic diseases and have exhausted their personal wealth on direct medical care. The great majority of people depend upon

Within the past ten years, multiple studies have been conducted regarding the completion rates of advance directives. Topics discussed include structure, evolution, benefits and challenges of advance directives (Perkins, 2007; Castillo, Hooper, Sabatino, Weithermon & Sudore, 2011; Cohen, MCannon, Edgman-Levitan & Kormos, 2010; Halpern et. all, 2013; Johnson, Zhao, Newby & Granger, 2012;Later & King, 2007; Mickelsen, Bernstein, Marshal & Miles, 2013; Yoo, Nakagawa & Kim, 2013; Waite et. all, 2013; Watson, 2010). Through initial research the same articles also provided possible solutions and recommendations that could be used to improve advance directives education procedures. However, the data did not provide a guideline that instructed how to conduct patient education procedures for advance directives. Therefore, the discovered data will be used to develop a possible guideline.

(Schapira, 2010) It is important for patients to have all the facts in order to accept and prepare for death. Another area not always communicated well has to do with advance care planning. Many patients do not learn about options or talk about end of life issues until it is very late. Studies have shown that younger doctors are more likely to initiate conversations about end of life care options. (Pahwa, Babu & Bhatnagar, 2005)

A palliative approach can be provided in the resident’s familiar surrounding if adequately skilled care is available, which reduces the need for transfer to an acute care setting; thereby, avoiding potential distress to the resident and his/her family.