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  • Hospice: aims to provide aggressive palliative care for pts at the end of their life, usually when life-prolonging treatment options have stopped
    • Eligibility: less than or equal to 6 month life expectancy
      • Consider: palliative performance scale (PPS) rating of <50-60%, dependence in 3 of 6 ADL’s, alteration in nutritional status, or documented deterioration in 4-6 months
    • Levels of Care
      • General inpt care: Pts must require skilled nursing care that could not be provided at home (IV medications, suction, high flow O2,) No cost to the pt under this level of care.
      • Home hospice Pts are discharged to their "home,” which could be a long term care facility, assisted living facility, or their house.
    • What is covered?
      • Personnel:
        • Hospice RN visits at least weekly and as needed; crisis on-call visits available 24/7
        • SW, Chaplain, Hospice MD oversight
        • CNAs: usually 1 hr, 2-3/wk at most
      • Medication for comfort
      • Medical equipment for comfort and safety including oxygen
      • Up to 13 months of bereavement for caregivers after the death
      • Respite care for 5 days, usually in a nursing home
      • Inpt hospice at hospice facility or at certain hospitals for symptom control for up to 7 days
    • Hospice can be offered to pts without insurance.

VA Specifics for Hospice:

  • Main difference compared to VUMC is pt is allowed concurrent care
    • This means vets can continue to receive some treatments for the primary condition (e.g. palliative radiation or chemotherapy) and still receive hospice services
  • Additionally, all veterans that go on hospice should have any needed nursing home stay (at a contracted SNF) covered by the VA regardless of service connection
  • VA Palliative Care team will help with these referrals
  • One (1) F Status at the VA
    • Designates “treating specialty” as NA-HOSPICE. Reduces costs for families, helps quality metrics. Use this if pt qualifies and agrees to hospice care
    • Write Delayed Transfer Orders: Admit to NA-HOSPICE and Specialty as “Hospice for Acute Care”
    • Write a nursing text order to “Change Pt to 1-F Status”