Hospice Levels of Care

Routine hospice care is provided at a patient’s home or other place of residence. The focus is on partnership with the patient and caregivers. Team members visit intermittently and visits are of fairly short duration. All disciplines visit, working with and encouraging the patient, family and caregivers.

Respite hospice care gives home caregivers a break from their demanding duties. Care is provided at one of our two inpatient facilities, Tranquility at Cobb Hospital or Tranquility Kennesaw Mountain. Medicare limits visits to five days at intervals established by the team.

Acuity-based/continuous hospice care is delivered during periods of acute illness or crisis at the patient’s home or other place of residence. Team members help manage symptoms like pain, vomiting, breathing problems, restlessness and confusion that cannot typically be managed by home caregivers.

Conditions requiring continuous care include:

• Frequent medication adjustment to control changing symptoms
• Short-term needs requiring the skills of a nurse
• Collapse of family care structure
• Rapid deterioration
• Imminent death

Inpatient hospice care may be required for pain control or to manage challenging/changing symptoms that cannot be provided in other settings. Among indications that inpatient care is needed:

• Home-based treatment has not effectively managed symptoms
• Complex technical intervention is needed
• Frequent evaluation/adjustment of medication is needed
• The family determines that required treatments are not possible or practical in the home
• Patient/family instruction is needed
• Imminent death requires skilled care

Conditions

Individuals choose hospice for many reasons and as a result of many life-limiting conditions. Among the most common are:

Cancer

• WellStar Community Hospice provides care to a high percentage of patients with cancer diagnoses with increasing levels of symptoms. Some oncologists desire to be totally involved in the medical orders for their patients, while others utilize the expertise of the palliative medical team to provide symptom management orders.
• Complex pain and symptom management is provided consistent with the patient and/or family’s wishes and goals of care.
• The patient and their family receive rich multi-disciplinary visits and support from the hospice team which includes physicians, nurse practitioners or physicians assistants, nurses, social workers, chaplains, clinical care partners, complementary therapists and volunteers.
• Complementary therapy is offered for the inpatient and home patients enhancing the benefit of medications and other treatment approaches.

Alzheimer’s Disease/Dementia

• Hospice care is appropriate at the time the dementia patient has difficulty verbalizing greater than 6 meaningful words and can no longer ambulate, dress, bath, or perform other activities of daily living without assistance.
• WellStar Community Hospice strives to maintain the patient in their home or choice of residence for as long as possible and in accordance with the individual’s personal wishes, providing the appropriate level of care in a familiar setting. Our dementia program is specialized to meet these patient and family needs, recognizing the dementia patient is most comfortable and at ease when able to remain in familiar surroundings.
• WellStar Community Hospice offers complementary therapies to dementia patients and caregivers for anxiety reduction, and for emotional benefit.

Cardiac Disease

• Hospice care is appropriate at the time cardiac patients cannot perform average daily activities without shortness of breath or chest pain and may require frequent emergency room visits and/or hospitalizations.
• When these patients elect hospice services, symptom management is brought to them so that emergency room visits and hospitalization can be avoided.
• The hospice professionals and palliative medicine team are experts in the management of cardiac symptoms, the resulting anxiety, and other correlating systematic illness that often accompany cardiac disease.
• Cardiac patients and their loved ones help to develop a care plan in accordance to their wishes for symptom management, comfort and quality of life.

COPD/Pulmonary Disease

• Hospice care is appropriate at the time pulmonary patients cannot perform average daily activities without shortness of breath and may experience other related symptoms requiring frequent emergency room visits and/or hospitalizations.
• When these patients elect hospice services, symptom management is brought to them so that emergency room visits and hospitalization can be avoided.
• The hospice professionals and palliative medicine team are experts in the management of respiratory symptoms, the resulting anxiety, and other correlating systematic illness that often accompany pulmonary disease.
• Pain management is a significant aspect of medical management with the need to balance the agent against the other medications required for pulmonary care management, while not causing significant anxiety.
• Complementary therapy in the form of relaxation exercises, massage, aromatherapy- topical are preferred- all have been shown to enhance the effectiveness of the administered medication.
• WellStar Community Hospice receives high satisfaction scores from families regarding the amount of effectiveness of pulmonary care provided to their loved one, and support for themselves in provided the patient supportive care.

Debility/Adult Failure to Thrive

• Hospice care is appropriate at the time patients that have more than one significant diagnosis accompanied by pronounced weight loss (10% in 6 months, or 5% in previous month), with a marked decline in physicial and/or cognitive status in the previous six months. This is often shown by increasing need for assistance with toileting/bathing/dressing, frequent recurrent infections and/or frequent emergency room and/or hospitalizations.
• WellStar Community Hospice can provide support and guidance for the family to provide a safe environment and manage any symptoms that may occur with the disease process.
• WellStar Community Hospice team is available 24 hours daily as necessary to support problem-solving and crisis management.

Stroke/Coma

• Hospice care is appropriate at the time patients having suffered a stroke are limited to the bed, may have reduced ability for intake or problems swallowing without choking or coughing, weight loss, confusion or unconsciousness. They benefit greatly from hospice care as does their family in supporting the care in the home- as often the care is extensive and challenging.
• WellStar Community Hospice treats pain for non verbal patients assessing their non verbal response and establishing a safe plan of care in collaboration with the physician and caregivers.

Neurological Diseases

• Hospice is appropriate for many patients with other neurological disorders in the late stage.
• The hospice team assesses the patient, reviews their history, listens and communicates with the patient and /or families to understand the expected course of care and the desired strategy for treatment.
• Each patient is evaluated from an individual perspective – considering their care needs, and disease progression, as well as other diseases that are being treated concurrently.
• WellStar Community Hospice team provide individualized care for these patients to meet their needs.

Liver Disease

• Patients with various liver diseases can benefit greatly from hospice care as care needs escalate, whether hepatitis, cirrhosis metastatic cancer disease related.
• Complementary therapy is offered with the inpatient and home patients enhancing the benefit of medications and other treatment approaches.

Kidney Disease

• Kidney disease can be a result of different diseases. Patients with end stage renal disease often choose hospice after renal dialysis is no longer beneficial or is creating great discomfort and/or poor quality of life. Hospice has limitations with long-term dialysis when the terminal disease is kidney related; However, any patient can be considered for hospice and often the family and hospice medical team can come to agreement to bridge the patient toward the palliative care perspective of comfort over aggressive treatment planning.

HIV/AIDS

• HIV/AIDs patients can benefit greatly from hospice care, once the hospice team is assured that they have been optimally treated with the available protocols such as the HARRT regimen.
• The WellStar Community Hospice multi disciplinary team is uniquely suited to support the HIV/AIDs patient and family when the disease has progressed to the late stage.
• Understanding the long and difficult tract that HIV/AIDs often has taken the patient and their support team whether family or friends, makes hospice uniquely suited for their care.

Diabetes

• Diabetes is not a primary hospice diagnosis, but is often the causal agent as the cumulative organ damage of less than optimally controlled diabetes, heart disease, renal disease, stroke. It will always remain a critical factor in the care of the patient.
• The WellStar Community Hospice professional team monitors and supports ongoing blood sugar management in consultation with the patient and the family as the terminal disease plan of care is developed and implemented.

Wound Management

• Patients with a variety of disease diagnoses have concurrent slow or non- healing wounds.
• WellStar Community hospice nurses, nurse practitioners, and physicians assess, plan and implement appropriate wound care protocols individualized to the patient, source of the wound, and its current condition. Goal setting is essential in the care of symptoms and care of a wound. Often the primary goal is comfort, and secondary goal is managing the wound with as little disruption for the patient. The possibility of pain during the care is anticipated and premedication is provided- even if patient is unable to verbalize their pain.
• available when the treatment needs indicate and the patient and family are in agreement for a change of treatment location.
• WellStar Community Hospice also utilized complementary therapies in the treatment of nausea and vomiting to enhance the treatment plan.