Physician Orders for Life-Sustaining Treatment (POLST): This form is used for DNAR orders. See California version of form here: http://capolst.org/; Direct link to PDF here.
Hospice Eligibility Card by Physicians Ross & Sanchez-Reilly, 2008
LCD-Local Coverage Determination Criteria for Hospice Eligibility (Used by Dr. Cohen at Family Hospice)
Predicting Prognosis: How to decide when End-of-Life Care is Needed
Table of Contents
Activities of Daily Living
CDC website lists:
- Transferring,
- using the toilet room
- Bathing,
- Dressing,
- Walking
- Eating,
DEATH SHAFT
- Transferring (to or from bed or chair)
- Using the toilet
- Bathing
- Dressing
- Caring for incontinence
- Eating
Which one is accurate?
Certification and Recertification of Hospice Patients
Initial certification = You certify patient as meeting requirements for hospice.
1st benefit period = The first time the patient is on hospice. Length = 3 months.
Recertification @ 3 months.
2nd benefit period. Length=3 months.
Recertification @ 6 months mark.
3rd benefit period. Length=2month.
After 6 month recertification, recertification changes to q2mo instead of q3mo.
There is a requirement that hospice physician must do face-to-face. https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice/downloads/HospiceFace-to-FaceGuidance.pdf
The Four Levels of Hospice Care
- Routine care. This is the most common level of hospice services in the United States. Nearly 100% of all patients are admitted at the routine level and expire at the routine level.
- Respite care. Respite care is short-term (5 consecutive days) inpatient care given to the hospice patient for the purpose of removing them from the home environment so that caregivers can have time to rest. B/c hospice care is supportive care, the bulk of the work of the caregiving falls on the patient’s family/friends. Respite care is given because of the recognition that providing 24/7 care for a family member on hospice is very draining. Patients may be placed in respite once every benefit period.
- Intensive comfort care (ICC). This is Continuous Care that intended to support the patient and their caregiver(s) through brief periods of crisis. Care can be provided for a minimum of 8 hours and up to 24 to achieve management of acute medical symptoms. This period may last until the crisis is resolved, but the general timeframe set by Medicare is 3-5 days. The care must be predominantly skilled nursing care. Continuous home care may be provided in the home or other places of residence, such as a nursing facility. Care must primarily be provided (more than 50%) by an LPN or RN. Home health aide and homemaker services of both may be used to the cover the additional time.
- General inpatient (GiP) care. Provided in an acute care hospital or another setting where intensive nursing and other types of support is available outside of the home.
This article, levels of hospice care per law, discusses the four levels of hospice care accurately.
ABHR is a compounded medication used in hospice patients.
ABHR = Ativan, Benadryl, Haldol, Reglan.
Lawsuits are very low among hospice doctors.
End of Life planning
Durable Power of attorney for Healthcare
Durable Power of attorney for Finances
Advanced directives – spells out what you will want done in case you don’t have the capacity to make decisions
POLST = Physician Ordered Life-Sustaining Treatment. DNAR will be in POLST.
The will is usually part of a trust. Dr. Cohen recommends getting a lawyer to do your trust, which will include the will. He has done his trust including his choice to be cremated and where to spread his ashes.