Geriatrics: hospice

Question 1

4 considerations for end of life care

Answer 1

Life prolonging measures (or not)
Location of care
Goals of care
End-of-life care preferences

Question 2

legal/ethical considerations for end-of-life care

Answer 2

1. Access to Hospice Care: Justice/Fairness + Autonomy
2. medicare payment
3. withholding/withdrawal of med txt

Question 3

medicare payment for hospice?

Answer 3

when prognosis gives 6 months or less to live

Question 4

what is the “natural death act” ?

Answer 4

In Virginia, the hierarchy of decision makers

Question 5

what is the heirarchy of surrogate decision makers in VA?

Answer 5

Documented POA
Legal Guardian
Spouse
Children
Parents
Siblings
Other living relatives
Physician

Question 6

what 5 things are included in Advanced-care-planning? (ACP)

Answer 6

Advance Directives
Living Wills
Durable Power of Attorney
DNR
Organ Donation

Question 7

define ACP

Answer 7

Talking about your values and goals for care at the end of life

Question 8

“recording your preferences, which could include written documents such as advance directives and medical orders”… what does this refer to ?

Answer 8

“advanced-care-planning”

Question 9

advanced directives

Answer 9

documents that help outline future preferences for treatment.

Question 10

durable power of attorney for health care

Answer 10

also known as a health care proxy
-a document that identifies a health care agent who is authorized to make medical decisions in the event that you cannot make them yourself

Question 11

living will

Answer 11

written (or video) statement about the kinds of medical care you do or do not want under certain specific conditions (often “terminal illness”) if you are no longer able to express your wishes

Question 12

ACP: what form is needed for a healthy adult, for chronic/progressive illness, and for last 12 months of life?

Answer 12

healthy adult: advanced directive
chronic illness: txt preferences form
last 12 months of life: POST form

Question 13

medical orders are based what 3 things? why?

Answer 13

based on your current health status, values, and goals for care and help ensure that care preferences are honored.

Question 14

” medical orders covering a range of topics likely to emerge in caring for a patient near the end of life” … what are these?

Answer 14

Physician or medical orders for life-sustaining treatment (POST)

Question 15

what are DNR orders? (what do they cover? where are they honored?)

Answer 15

cover specific treatments that are written in a health care facility.
These orders do not necessarily cross care settings and may not be honored outside of a health care facility setting.

Question 16

living will vs POST: who is it for?

Answer 16

living will: For every adult
POST: for end of life
Patient completes and reviews

Question 17

living will vs POST: instructions for what? how many formate?

Answer 17

living will: instructions for future txt; many formats

POST: instructions for current txt; one format

Question 18

living will vs POST: retrieval or interpretation required?

Answer 18

living will:yes and yes

POST: no (stays with the pt), no (clearly communicated)

Question 19

living will vs POST: who completes it?

Answer 19

living will: patient

POST: provider

Question 20

POST paradigm

Answer 20

End-User training for Providers and EMTs
Clear, specific language on an actionable form
Orders honored throughout the system

Question 21

POST form: comfort care vs only DNR order

Answer 21

Patients with a POST form indicating Comfort Care were far less likely to receive unwanted hospitalizations and medical interventions than those who had only a DNR order

Question 22

POST completion will improve end-of-life care where? what will it require?

Answer 22

throughout the system; requires communication

Question 23

what is covered in hospice benefit?

Answer 23

services + equipment
medications
bereavement care for family for 13 months

Question 24

qualifying criteria for hospice benefit coverage

Answer 24

Patient must have a life limiting illness that, if it were to run its usual course, may result in a prognosis of 6 months or less.

Question 25

4 requirements of palliative care unit

Answer 25

1. symptom management necessitating inpatient hospitalization
2. complex psychosocial issues
3. complex care planning
4. death is imminent

Question 26

general inpatient (GIP): hospice patients may be admitted for…

Answer 26

Short term general inpatient care

When deemed appropriate by the physician or the hospice interdisciplinary group (IDG)

Question 27

3 ways care me be aimed for GIP for hospice pts?

Answer 27

1. Pain control
2. Acute or Chronic Symptom Management
3. when care Cannot be feasibly provided in other settings.

Question 28

imminent death

Answer 28

death is expected in 5-7 days

Question 29

5 stages of grief

Answer 29

1. shock and denial
2. anger
3. bargaining
4. depression
5. acceptance