Nursing Homes
Hospice and Nursing Home Care Providers Partner for Quality Patient Care
Most of us, as creatures of habit and comfort, prefer to be in our own surroundings, especially when we are ill. For those individuals who consider a nursing home their usual place of residence, the provision of hospice services can allow them to remain in familiar surroundings, often with people who have come to know and care for them.
Hospice, originally conceived as a home-based service to support family care providers, has included services to nursing home residents since Medicare changes in 1989. Hospice involvement results in positive end-of-life outcomes for residents. The Department of Health and Human Services documents the following outcomes for nursing home residents who receive hospice care compared with those who did not:
- Received superior pain assessments, and when daily pain was assessed, were far more likely to be treated.
- Were significantly less likely to be hospitalized.
- Were less likely to experience a persistent mood disorder.
- Received fewer invasive procedures.
- Experienced less dyspnea or shortness of breath
Although these are impressive outcomes, recent national figures indicate that nursing home residents rarely use hospice services. Whereas one in five deaths in the US occurs in nursing home facilities, only one percent of the nursing home population enrolls in hospice care.
One potential reason for this is the unique disease progression of nursing home patients characterized by low initial function, with repeated episodes of sudden deterioration and recovery until a fatal episode, making it difficult to determine when hospice services are appropriate.
Collaboration
Legacy Hospice care for nursing home residents requires a unique collaboration between the two agencies to integrate services and coordinate care with specified roles. Under Medicare regulations, the nursing home is required to continue the same services and personal care as if the patient were not receiving hospice services. Legacy Hospice assumes overall responsibility for management and implementation of the care plan related to the terminal illness, including palliative care. Palliative care goals in a long-term care setting include:
- Pain control
- Relief of respiratory distress
- Advance directives
- Hygiene
- Support for the psychological and spiritual needs of the patient, family, other residents, and staff.
The combination of skills and services helps all care providers understand the needs of the dying person and the family. The dual focus of the two teams allows the staff to intervene early in the dying process and begin working with patients and families to establish quality end-of-life care.
Legacy Hospice Role
Legacy Hospice staff members become strong advocates for the patient and family. Legacy Hospice care providers help patients and families define goals, understand what to expect from the disease and end-of-life physical and functional changes, and explore patient options and alternatives. Legacy Hospice offers support and guidance as the patient and family make the necessary choices to meet their goals. Recommendations are shared with the nursing home staff as to how they can intervene to support patient and family defined goals.
Through this collaboration, interventions become consistent, focused, and congruent with the patient and family's wishes. Legacy Hospice offers the same continuum of services to nursing home patients that it provides for in-home patients. The medical director, nurse, social worker, chaplain, certified nursing assistant, and volunteer provide care and support. They also are available to collaborate with any nursing home department (e.g., dietary, billing, physical therapy, speech therapy, etc.), to provide expertise and consistency in the patient's care. Legacy Hospice personnel are trained in the regulatory requirement of long-term care. As in home care, the 24-hour on-call access to professional staff is available to patients and families as well as to the nursing home staff. Legacy Hospice nursing home residents receive the same durable medical equipment and supplies that are available to in-home patients.
Residents' families also may access bereavement care for 13 months after the death of their loved one. Patients in the final stages of chronic physical illnesses or dementia often prefer treatment that emphasizes pain management and supportive care, while limited life-prolonging treatments. Legacy Hospice and nursing home partnerships create a positive impact on end-of-life care for residents, addressing the components of self-determined life closure, safe and comfortable dying, and effective grieving. Legacy Hospice programs provide a mechanism for improved palliative care that can reduce acute care admissions at end of life, thus improving quality of life and reducing costs. Hospice has evolved from a service to patients and families in their homes, to one that collaborates and shares expertise with care providers, both family and professional, regardless of the setting.
Legacy Hospice team members are available as compassionate experts who bring a willingness to share and encourage others who help patients at end of life. Successful collaborations require that teams get together and make a commitment to integrate services. Legacy Hospice nursing home care providers develop valuable long-term partnerships with nursing home staff members to promote quality end-of-life care as defined by patients and families. Legacy Hospice offers In-Services for Nursing Care Facilities At Legacy Hospice, we are dedicated to educating area clinicians and members of our community about end-of-life care. We understand that all healthcare settings come with unique challenges and opportunities for learning. Legacy Hospice provides a network of education specifically designed for nursing care facilities. We provide free in-services to our contracted nursing care facilities.