NUR101 - Chp. 10 - End-of-Life Care

Living Will

* Only used when terminally ill. Written or printed statement describing a person's wishes concerning medical care & life-sustaining tx's that are wanted or unwanted in the event that a person is unable to personally make those decisions. * Usually describes a desire to avoid being kept alive by artificial means or the use of heroic measures.

Respite Care

5-day inpatient stay provided on an occasional basis to relieve the family caregivers.

For a client to use the Medicare Hospice Benefit, life expectancy needs to be what length of time?

6 months

Clients who are enrolled in hospice care are often believed to suffer unnecessarily because they do not receive adequate attention for their symptoms of the underlying illness. What factor most contributes to this phenomenon?

Rules concerning completion of all cure-focused medical treatment. * Because of Medicare rules concerning completion of all cure-focused medical treatment before the Medicare hospice benefit may be accessed, many clients delay enrollment in hospice programs until very close to the end of life.

A patient's family member asks the nurse what the purpose of hospice is. What is the best response by the nurse?

"It will enable the patient to remain home if that is what is desired." * The goal of hospice is to enable the patient to remain at home, surrounded by the people and objects that have been important to him or her throughout life.

What is the general criteria for hospice care?

1. Serious, progressive illness. 2. Limited life expectancy. 3. Informed choice of palliative care over cure-focused tx.

A client diagnosed with a terminal illness appoints her oldest son as the authorized individual to make medical decisions on her behalf when she is no longer able to speak for herself. Which proxy directive is the patient using?

Durable power of attorney for health care. * A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. It allows another individual to make medical decisions on the client's behalf.

Five Wishes Document

Advance directive that includes medical issues as well as personal, emotional, & spiritual concerns of a dying person.

Elation

Great happiness & exhilaration.

Which is a sign of approaching death?

Irregular breathing patterns. ** Irregular breathing patterns are a sign of impending death. Other signs of approaching death include decreased urinary output, mental confusion, and sleeping for longer periods of time.

The hospice nurse is providing in-home care for a 45-year-old parent of three young children. During the most recent visit, the nurse has observed that the client has a new onset of altered mental status. What intervention should the nurse implement?

Teaching family members how to interact with, & ensure safety for, the client with impaired cognition. * Nursing interventions should be aimed at accommodating the change in the client's status & maintaining safety.

The nurse arrives to the home of a client with a terminal illness who has just passed away. Which response will the nurse make when the family member states that the last dose of pain medication provided caused the death?

"It is possible that your family member died close to the time of the medication but the medication did not cause the death." * The nurse teaches the family caregivers about comfort measures and pain medications when caring for a dying client. At the end-of-life, clients may receive more frequent doses of pain medication; however, there is always a strong possibility that a client approaching end-of-life will die in close proximity to the time of the medication.

Medicare and Medicaid hospice benefit criteria allow clients with a life expectancy of 6 months or less to be admitted to hospice. However, the median length of stay in a hospice program is just 21.3 days. Which reason explains the underuse of hospice care services?

Clients and families view hospice care as giving up.

Palliative Care (Comfort Care) (Hospice Care)

Management & tx of symptoms that reduces physical discomfort but does not alter a disease's progression.

Angiogenesis

The growth of new capillaries from the tissue of origin. This process helps malignant cells obtain needed nutrients and oxygen to promote growth.

A medical nurse is providing end-of-life care for a client with metastatic bone cancer. The nurse notes that the client has been receiving oral analgesics for pain with adequate effect, but is now having difficulty swallowing the medication. What should the nurse do?

Request the analgesics be prescribed by an alternative route. * A change in medication route is indicated and must be made by a primary health care provider's order. Many pain medications cannot be crushed and given to a client.

An adult oncology client has a diagnosis of bladder cancer with metastasis and the client has asked the nurse about the possibility of hospice care. Which principle is central to a hospice setting?

The client and family should be viewed as a single unit of care.

A 50-year-old client is an alcoholic. The client has been diagnosed with pancreatic cancer and underwent surgery to remove the tumor. Despite the tumor being removed, the physician informs the client that chemotherapy needs to be started immediately. Using evidence-based practice, which intervention might the nurse expect the physician to include, with the goal of improving quality of life, mood, and median survival.

Palliative Care * In a study of referral to palliative care for clients newly diagnosed with a disease with very poor prognosis, researchers found that those clients receiving palliative care plus standard oncology demonstrated improved quality of life and mood and had longer median survival.

A client is declared to have a terminal illness. What intervention will a nurse perform related to the final decision of a dying client?

Respect the client's and family members' choices. * In the final decisions of a dying client, the nurse will present options for terminal care and respect the client's and family members' choices. ** When the client has a living will, physicians must abide by the client's wishes.

Hospice

Facility for the care of terminally ill patients who can live out their final days with comfort, dignity, & meaningfulness. Emphasizes helping patients live however they wish until they die. Pain is liberally controlled.

The family of a client in hospice decides to place their loved one in a long-term care facility to establish an effective pain control regimen. Which aspects of hospice care is the family using?

Palliative Care * Long-term care is increasing as a setting to provide palliative care that addresses management of symptoms such as pain.

Depression (4th Stage of Dying)

Patients realize the reality of their situation, they may mourn their potential losses, such as separation from their loved ones, the inability to fulfill their future goals, & loss of control.

The nurse is providing home care to a dying client and has noticed over the course of several weeks that the client's daughter is usually quiet and withdrawn when in the client's room. Which intervention should the nurse perform in this situation?

Sit with the client's daughter privately and encourage her to express her feelings frankly. * Failure to verbalize feelings, express emotions, and show tenderness for the dying person is often a source of regret for grieving relatives. Therefore, families must feel that they can express their feelings with nurses who are compassionate listeners. If nurses encourage family members and listen to them in their frank communication, family members may feel more prepared to carry on a similarly honest dialogue with the dying client.

Waiting for Permission Phenomenon

Situation in which some terminally ill patients forestall dying until their loved ones indicate they are prepared to deal with their death. * Often occurs shortly after a significant family member communicates that they are strong enough & ready to "let go."

A terminally ill client has feelings of rage toward the nurse. According to Elisabeth Kübler-Ross, the patient is in which stage of dying?

Anger * Anger includes feelings of rage or resentment.

Death Rattle

Accumulation of secretions in the respiratory tract coupled with noisy respirations.

Mutual Pretense Awareness

The patient, the family, & the health care professionals are aware that the patient is dying, but all pretend otherwise.

Which term is used to describe the personal feelings that accompany an anticipated or actual loss?

Grief

A type of comprehensive care for clients whose disease is not responsive to cure is

Palliative Care

Passive Euthanasia

When a terminally ill patient voluntarily stops eating or drinking or when rx'd analgesics at a level that renders unconsciousness; facilitate death by letting nature take its course.

What are the series of 5 reactions regarding death & dying?

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

The nurse is admitting a client with a diagnosis of ovarian cancer. The client has just been told that her ovarian cancer is terminal. What question should the nurse include in a spiritual assessment of the client?

"Do you have a sense of peace of mind and a purpose to your life?" * In addition to assessment of the role of religious faith and practices, important religious rituals, and connection to a religious community, the nurse should further explore with the client the presence or absence of a sense of peace of mind and purpose in life; other sources of meaning, hope, and comfort; and spiritual or religious beliefs about illness, medical treatment, and care of the sick.

A client is dying. Place the following steps in the usual sequence of grieving that the nurse would anticipate for the client.

1. Denial 2. Anger 3. Bargaining 4. Depression 5. Acceptance

Spirituality

A personal belief system that focuses on a search for meaning and purpose of life.

Physician Orders for Scope of Treatment (POST)

Advance directive or care planning tool to safeguard a patient's wishes for care during a serious illness and/or end-of-life care. * Aka POLST or Medical Orders for Scope of Treatment (MOST)

What is the purpose of Atropine Ophthalmic 1% Drops regarding oral secretions?

Atropine ophthalmic 1% drops administered sublingually help to reduce oral secretions.

Bargaining (3rd Stage of Dying)

Attempt to postpone death by the patient usually attempting to make a secret bargain with God or some higher power, typically until after a particularly significant event.

Which intervention should a nurse perform during the grieving period when caring for a dying client?

Avoiding criticizing or giving advice.

What states allow physician-assisted suicide as of 2016?

California, Montana, Oregon, Vermont, & Washington.

Which is also known as a proxy directive?

Durable power of attorney for health care

Which of the following would be inconsistent with a normal grief reaction?

Elation

What does each letter in the NURSE framework stand for?

N - Name the emotion. U - Understand the emotion. R - S - Support the patient. E - Explore the emotion.

Continuous Care

Provided in the home to manage a medical crisis.

What does the Physician Orders for Scope of Treatment (POST) provide?

The patient provides specific information about resuscitation & medical interventions such as abx, artificial feedings, comfort care, hospitalization, intubation, & mechanical ventilation. Patient's preferences are documented as physician orders & signed off by patient's PCP.

Durable Power of Attorney (DPOA) for Health Care (Medical Power of Attorney) (Health Care Proxy)

Person the patient designates to make medical decisions when the patient can no longer do so.

A client with a brain tumor recently stopped radiation and chemotherapy for treatment of the cancer. The client recently reported dry mouth. Which intervention by the hospice nurse demonstrates that the nurse understands treatment measures for dry mouth?

Provide gentle oral care after each meal.

Open Awareness

The patient, the family, & the health care professionals are aware that the patient is dying & openly acknowledge that reality.

A nurse has made a referral to a grief support group, knowing that many individuals find these both comforting and beneficial after the death of a loved one. What is the most important positive action that can come from a grief support group?

Normalization of feelings and experiences. * Although many people complete the work of mourning with the informal support of families and friends, many find that talking with others who have had a similar experience, such as in formal support groups, normalizes the feelings and experiences and provides a framework for learning new skills to cope with the loss and create a new life.

Which action by the nurse demonstrates an effective method to assess the client and the client's family's ability to cope with end-of-life interventions?

Remaining silent, allowing the client and family to respond after asking a question related to end-of-life care. * A key to effective listening includes allowing the client and family sufficient time to reflect and respond after asking a question. Hospice nurses with effective listening skills resist the impulse to fill the empty space in communication with talk, avoid the impulse to give advice, and avoid responses indicating, "I know just how you feel."

A medical nurse is providing palliative care to a client with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse's care?

To improve the client's and family's quality of life.

When providing palliative care to a 95 year-old terminally ill client, what should a nurse keep in mind when coming to terms with the client's approaching death? Select all that apply.

- The client may have some unfinished life goals. - The client has the right to decide how to spend the rest of his or her life. - The client should be informed about advance directives. * Older adults require as much emotional support from the nurse as do young or middle-aged dying clients. However, ageism may involve the myth that all older adults are ready to die because future life has no meaning or personal value has diminished.

The family members of a dying patient are finding it difficult to verbalize feelings and show tenderness for the dying person. Which of the following nursing interventions should a nurse perform in such situations?

Encourage the family members to express their feelings and listen to them in their frank communication. * Family members usually find it difficult to communicate frankly with a dying person. By encouraging family members to express their feelings and listening to them in their frank communication, family members may feel more prepared to carry on a similarly honest dialogue with the dying patient.

Nearing Death Awareness

Phenomenon characterized by a dying patient's premonition of the approximate time or date of death, or in general that death is near; delirium or terminal restlessness. * As death approaches, patients may reach out, point, or open their arms as if to embrace someone of call them by name.

Near-Death Experiences (NDE)

A person almost dies but is resuscitated.

The nurse is participating in a family meeting with a client who is identifying preferences for end-of-life care. Which action will the nurse take to follow end-of-life care choices?

Contact the primary health care provider for a prescription for life-sustaining treatment. ** A physician prescription for life-sustaining treatment (POLST) is a form that translates the client's preferences in the advance directive to medical orders that are transferable across settings and available to all health care providers. The form is signed by the client and health care providers.

The client has been diagnosed with terminal COPD. The client and the client's family have not yet agreed on the final arrangements and are discussing options. How can the nurse best intervene in these final decisions?

Respect the client's autonomy and right to determine how to spend the rest of his or her life. * Nurses honor a dying client's right to know the seriousness of their condition. One outcome of being truthful includes respecting the client's autonomy and right to determine how to spend the rest of their life.

After caring for several clients who died in the hospital, the nurse has identified some lapses in the care that many of these clients received toward the end of their lives. What have research studies identified as a potential deficiency in the care of the dying in hospital settings?

The perception that palliative care constitutes "giving up."

A nurse is developing a teaching plan for a terminally ill client and his family about the stages of dying and emotional reactions experienced. The nurse integrates knowledge of which of the following in the teaching plan?

The stages are applicable to any loss. * The five stages of dying describe the five emotional reactions applicable to the experience of any loss. Not every client or family member experiences every stage. Many clients never reach a stage of acceptance. Clients and family fluctuate on a sometimes daily basis in their emotional responses.

The nurse is assessing a client with end-stage liver failure for the presence of hope. What should the nurse identify as a hope-fostering category?

Uplifting memories * Hope is a multidimensional construct that provides comfort as a person endures life threats and personal challenges. Uplifting memories are noted as a hope-fostering category.

A nurse is assessing a terminally ill female client. Which client statement indicates that the client is in the bargaining stage of dying?

"I just want to see my daughter graduate from college. That's all." * Bargaining is manifested by pleading for more time to reach an important goal. This is reflected in the client's statement about wanting to see her daughter's college graduation.

What are the five wishes in the Five Wishes Document?

1. Who can make proxy health care decisions. 2. The types of medical tx desired/undesired. 3. Actions that will promote personal comfort as death nears. 4. Ways in which the patient wants to be treated. 5. Info the person wants loved ones to know.

Within a care team meeting in a long-term care facility, discussions continue with family members of a 59-year-old client regarding his deteriorating condition. Although the physician has indicated that the client's condition is terminal, his family doesn't want the client to know the gravity of his condition—they don't want him to worry. Why does the nurse advocate that the client needs to know the truth?

All of the options are correct. * Nurses honor dying client's right to know the seriousness of their condition. The nurse-client relationship is based on honesty, and every client has the right to determine how to spend the rest of his or her life and complete unfinished business. Honesty promotes meaningful communication between clients and family members.

Mourning

An expression of grief and associated behaviors.

Patient Self-Determination Act

Federal law that was effective as of 1991; all Medicare funded healthcare facilities in the US must inform patients on admission of their right to refuse medical tx & their right to prepare advance directives.

A patient diagnosed with terminal pancreatic cancer is unaware of the diagnosis and his daughter has requested that he not be told. What awareness context does the nurse determine this is?

Closed Awareness * In closed awareness, the patient is unaware of his or her terminal state, whereas others are aware.

Interdisciplinary Collaboration

Communication & cooperation among members of diverse health care disciplines jointly to plan, implement, & evaluate care.

A client who has been demonstrating signs of impending death is awake, alert, and wants to see grandchildren after they attend school. Which action will the nurse take to support this client's request?

Contact the family to ask for grandchildren to come to visit the client. * Days before death the client will demonstrate neurologic changes that include somnolence, restlessness, dulled senses, and a possible "rally" in energy. The client demonstrating signs of impending death who is now awake, alert, and asking to see grandchildren is experiencing a rally which should be supported by asking the family to bring the grandchildren to see the client.

A nurse who has just taken a new nursing position at an inpatient hospice begins to question if they are "strong enough" to withstand the continual dying of clients. The nurse's mentor relates the most effective method of dealing with client loss. What action is instrumental to being able to offer effective care and comfort to dying clients?

Exploring personal mortality and feelings on death and dying. * Healthcare providers must acknowledge death as the final stage of growth and development (Kübler-Ross, 1975). They also must explore their own mortality and feelings about dying and death. This is the only way that they can then provide care and comfort to dying clients and their families.

Bereavement

Period during which mourning for a loss take place.

The nurse is describing palliative care and hospice services to a client with end-stage congestive heart failure. The client and family have many questions about the differences between palliative care and hospice. Which statement should the nurse provide the family?

"Hospice is the application of palliative care at the end of life." * Palliative care focuses on symptom management and quality of life in clients with serious symptoms and life-limiting diseases. Hospice is a type of palliative care that focuses on comfort at the end of life. Palliative care can take place in a number of settings; it does not need to take place in the inpatient hospital setting. Hospice care may also occur in a variety of settings, or it can take place in a client's home without the need for a special facility.

A terminally ill patient in pain asks the nurse to administer enough pain medication to end the suffering forever. What is the best response by the nurse?

"I will notify the physician that the current dose of medication is not relieving your pain." * Palliative sedation is most commonly used when the patient exhibits intractable pain, dyspnea, seizures, or delirium, and it is generally considered appropriate in only the most difficult situations.

What are the Principles of Palliative Care?

- Affirms life & regards dying as a normal process. - Neither hastens nor postpones death. - Provides relief from pain & other distressing symptoms. - Integrates the psychological & spiritual aspects of care. - Offers a support system to help patients live as actively as possible until death. - Offers a support system to health patient families cope during the patient's illness & in their own bereavement.

What events have been reported by those who have experienced Near-Death Experiences?

- Floating above their bodies. - Moving rapidly toward a bright light. - Seeing familiar people who have already died. - Feeling warm & peaceful. - Being told that is it not time yet for them to die. - Regretting having to return to their resuscitated body.

The spouse of a terminally ill client is confused by the new terminology being used during discussions regarding the client's treatment. The nurse should explain that palliative care is:

Care that will reduce the client's physical discomfort and manage clinical symptoms.

A client in the hospital is nearing the end of life, is unconscious, and is experiencing gurgling from the respiratory tract. Which route will the nurse use to provide the client atropine?

Intravenous * Because the client is unconscious, intravenous administration is the safest route to provide the medication. * Rectal nor topical route is offered for this rx.

A nurse is providing care to a client experiencing symptoms associated with terminal illness. Which of the following would be most appropriate to use as a means for managing the client's symptoms?

Client's goals * When managing the symptoms of a client with a terminal illness, the client's goals take precedence over the clinician's goals to relieve all symptoms at all costs. Although the length and invasiveness of the treatment may influence decision making, ultimately it is the client's goals that determine what will be done.

General Inpatient Care

Provides inpatient stay for symptoms management that cannot be provided in the home.

For individuals known to be dying by virtue of age and/or diagnosis, which sign indicates approaching death?

Increased Restlessness * As the oxygen supply to the brain decreases, the client may become restless. As the body weakens, the client will sleep more and begin to detach from the environment. For many clients, refusal of food is an indication that they are ready to die.

Why might a client who is approaching death suddenly vomit?

Intestinal Distention * Intestinal distention may stimulate the vomiting center.

A patient with end-stage heart failure has participated in a family meeting with the interdisciplinary team and opted for hospice care. On what belief should the patient's care in this setting be based?

Meaningful living during terminal illness is best supported in the home. * The hospice movement in the United States is based on the belief that meaningful living is achievable during terminal illness and that it is best supported in the home, free from technologic interventions to prolong physiologic dying.

A group of nursing students is reviewing information about palliative care. The students demonstrate a need for additional review when they identify which of the following?

Palliative care is the same as hospice care. * Palliative care is not synonymous with hospice care. All hospice care is palliative but not all palliative care is hospice care. Palliative care is conceptually broader than hospice care and is an approach to care as well as a structured system for delivering care. Palliative care followed the development of hospice care. It does not begin when cure-focused treatment ends but is most helpful when provided along with disease-remitting treatment.

A client with a terminal illness who is incapacitated is experiencing intractable pain that is no longer effectively addressed by conventional pharmacology. Which type of pain management will the nurse anticipate for this client?

Palliative sedation (unconsciousness) * Effective control of symptoms can be achieved under most conditions; however, some clients may experience distressing, intractable symptoms and other clients may be incapacitated. Although palliative sedation remains controversial, it is offered in some settings to clients who are close to death or who have symptoms that do not respond to conventional pharmacologic and nonpharmacologic approaches, resulting in unrelieved suffering. Palliative sedation is distinguished from euthanasia and physician-assisted suicide in that the intent of palliative sedation is to relieve symptoms, not to hasten death.

Advance Directive

Provides the patient with the opportunity to identify their wishes concerning healthcare & tx if too mentally or physically incapacitated to do so independently. * Examples: Dementia, stroke, coma.

Anger (2nd Stage of Dying)

Patient expresses resistance or intense anger at God, other people, or the situation. - "Why me?" - "I'm still young. My children still need me. Why did I get this disease?"

Suspected Awareness

Patient suspects what others know & attempts to find out details about his/her condition.

Acceptance (5th Stage of Dying)

Patients accept their fate & make peace spiritually & with those to whom they are close. May begin to detach themselves from activities & acquaintances & seek to be with only a small circle of relatives or friends.

Physician-Assisted Suicide

Practice of providing a means by which a patient can end their own life.

What is the hospice-specific criteria for hospice care?

Presence of a family member or other caregiver continuously in the home when the patient is no longer able to safely care for themselves (some hospices have created special services within their programs for patients who live alone, but this varies widely).

A client's rapid cancer metastases have prompted a shift from active treatment to palliative care. When planning this client's care, the nurse should identify what primary aim?

To prevent and relieve suffering. * Palliative care, which is conceptually broader than hospice care, is both an approach to care and a structured system for care delivery that aims to prevent and relieve suffering and to support the best possible quality of life for clients and their families, regardless of the stage of the disease or the need for other therapies.

A client with cancer, who has just learned that the cancer has spread to distant organs, tells the nurse, "I am not sure how many more treatments I can put up with." The nurse responds by saying, "You have been through so many treatments for your cancer." Using the NURSE framework for responding to emotions, which empathic response did the nurse use?

UNDERSTAND the emotion. * The NURSE framework provides a structure for nurses to use when responding to client's emotions. The response of "You have been through so many treatments for your cancer" represents the empathic response of UNDERSTAND the emotion.

In spite of administering the prescribed pain medication, a dying client is still experiencing dyspnea due to fear and anxiety. Which nursing intervention should the nurse use to potentiate the effects of pain medication and help reduce the dyspnea?

Use imagery, humor, and progressive relaxation. * Imagery, humor, and progressive relaxation are the various techniques to potentiate the effects of pain medication.

Shortly after a client's death from a long-term illness, his daughter says to the nurse, "Things changed so suddenly. I told him yesterday how much I loved him but that it was OK to let go if that's what he wanted." The nurse would identify this as what phenomenon for the daughter?

Waiting for Permission

While providing care to a terminally ill client, the client asks, "Am I dying?" Which response by the nurse would be most appropriate?

"Tell me some more about what is on your mind." * When responding to the client, the nurse needs to acknowledge the client's fears. Having the client tell the nurse what's on his or her mind acknowledges the client's feelings and opens the way for more discussion.

A nurse who sits on the hospital's ethics committee is reviewing a complex case that has many of the characteristics of assisted suicide. Which of the following would be an example of assisted suicide?

Administering a lethal dose of medication to a client whose death is imminent. * Assisted suicide refers to providing another person the means to end his or her own life. This is not to be confused with the ethically and legally supported practices of withholding or withdrawing medical treatment in accordance with the wishes of the terminally ill individual.

A dying patient wants to talk to the nurse. The patient states, "I know I'm dying, aren't I?" What would an appropriate nursing response be?

"This must be very difficult for you." * In response to the question "Am I dying?" the nurse could establish eye contact and follow with a statement acknowledging the patient's fears ("This must be very difficult for you") and an open-ended statement or question ("Tell me more about what is on your mind").

Denial (1st Stage of Dying)

Psychological coping mechanism where the patient refuses to believe certain information. Dying patients usually first deny that the dx is accurate.

The nurse is caring for a client who is having difficulty adjusting to a terminal diagnosis. The nurse notes the client's tears and sits down by the bedside. The client tells the nurse, "There are so many things I still want to accomplish." Which response would be most therapeutic and appropriate for the nurse to make?

"Tell me what's most important to you now." * Asking the client what is most important at this point in life allows the nurse to learn about the client's values and goals. Giving advice is not a therapeutic response and does not allow the client to talk about what is most important to the client. Asking if the client wants to speak with a chaplain might be appropriate, but it is not a therapeutic response that encourages the client to verbalize concerns and preferences. Giving false reassurances and platitudes also is not therapeutic.

The nurse learns that a computed tomography scan a client underwent to investigate new seizure activity revealed a brain tumor. When the client later asks about the results of the scan, which therapeutic response should the nurse give the client?

"What is your understanding of your condition?" * By asking what the client knows, the nurse conveys acknowledgement of the client's question and establishes a baseline of knowledge for further discussion.

A patient with end-stage chronic obstructive pulmonary disease is admitted to a hospice facility and asks the admitting nurse, "How long will I be allowed to stay here?" What is the best response by the nurse?

"When your stay reaches 6 months, you will be recertified for a continued stay." * Federal rules for hospices require that eligibility be reviewed periodically. Patients who live longer than 6 months under hospice care are not discharged, provided that their physician and the hospice medical director continue to certify that they are terminally ill with a life expectancy of 6 months or less (assuming that the disease continues its expected course).

What are the Medicare & Medicaid Hospice Benefits eligibility criteria?

- Your hospice doctor & regular doctor (if had) certify that the patient is terminally ill (expected to live 6 months of less). - Patient accepts palliative care (for comfort) instead of care to cure the illness. - Patient signs statement choosing hospice care instead of other Medicare-covered tx's for their terminal illness & related conditions.

What factors influence the decision to use institutionally based palliative care?

- Patient weakness or immobility creates the need for more assistance that can be provided at home. - Patient cannot manage elimination needs. - Uncontrolled or inadequately controlled pain or nausea. - Family cannot provide adequate care. - Patient requires care that is too complex & demanding. - Caregiver is too exhausted to provide care.