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REHABILITATION FACILITIES
AND HOSPICE ANDPALLIATIVE CARE
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REHABILITATION HOSPITALS OR
FACILITIES Special facilities exist to provide sub acute care to patients
w/ complex health needs. e.g. Head injuries/with ventilators
Require services and intensive treatment from specialistlike
y Physiciany Occupational therapisty Dietitiansy Psychologisty Physical therapisty PsychiatristRequire agressive rehabilitation after injury and surgery
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HOSPICE Historically...
Derived from a term use todesignate a resting place for wearytravellers.
Today...
Is a multidimensional and
interdisciplinary package thatprovides rest for weary patients andtheir families.
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Hospice patients have usually been through different
treatment for curative purposes including ...y Chemotherapeutic protocols
y Radiation therapy
y Surgeries
y Multiple regimens
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Those battling diseases like..y Cancer
y AIDS
y Cardiac disease
y Pulmonary diseases
y And other for years...
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What is a hospice?y
Provides support and care for persons in the lastphases of incurable diseases so that they may live asfully and comfortably as possible.
y Recognizes dying as part of the normal process of
living and focuses on maintaining the quality ofremaining life.
y Affirm life and neither hastens nor postpones death.
y Exist in the hope and belief that through appropriate
care, patients and families may be free to attain adegree of mental and spiritual preparation for deaththat is satisfactory for them.
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HOSPICE CARE
y Is a special approach to caring for terminally illpatients that stresses palliative care (relieve of pain
and uncomfortable symptoms)y Focus is on care, not cure
y Emphasis of the hospice program is keeping patientwith family at Home
y Some are located in the hospital, skilled nursingfacilities (SNFs) and Home Health Agencies (HHAs)
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HOSPICE SETTINGy Emphasis of the hospice program is keeping patient
with family atHome
y Primary community based
y Some are located in they hospital,
y skilled nursing facilities (SNFs) and
y
Home Health Agencies (HHAs)y Continuing Care Retirement Community (CCRC)
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PATIENTS SEEN IN HOSPICEy Admission to hospice is predicted on-poor prognosis of the patient .
- 6 months or less if the disease runs its expectedcourse.
- Infant,child and adult are also cared in hospice.
- Disease s like:
- Various cancer ,AIDS, end stage renal, cardiac andlung diseases,dementia,and other disease that areassociated with limited life expectancy.
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The Interdisciplinary Team The IDT is the key component of hospice .The team
members are:
y Patients and familiesy Clinician
y Social worker
y Physicians (including hospice medical directors
y Dietitians /dietary counselors
y Bereavement councilors/chaplains
y Volunteers
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y Physical therapist
y Occupational therapisty Speech language therapies
y Home health aids
y Home makers
y Pharmacists
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Conditions for Hospice Eligibility under
Medicare
y Limited life expectancy (less than 6 months )- certifiedby physician.
y Patient chooses palliation as a goal rather than curey Care provided by medicare certified hospice program
y A physician to direct care,
y available /willing caregiver at home
Patient may choose to stop hospice care and revert toCure-oriented Care anytime.
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Palliative Care
y The active total care of patients whose disease is notresponsive to curative treatment.
yControl pain, of other symptoms, and psychological,social, and spiritual problems.
y Goals is achievement of the best quality of life forpatients and families. (WHO,1990)
y Maybe combined with curative therapies or may be thefocus of care.
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Mrs. A.W
hat her prognosis?y 94 y /o with congestive heart failure, severe
peripheral vascular disease, a systolic bloodpressure of 100, and shortness of breath at rest orwith mild exertion. She is judiciously
With medication.
Is the patient terminally
Ill?
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Potential goals of Carey Cure of disease
y Avoidance of premature death
y Maintenance of improvement in function
y Prolong life
yRelief of suffering
y Quality of life
y Staying in control
y A good health
y Support for families and loved ones
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ComparingHOSPICE CARE VS PALLI
y Prognosis of 6 months or less
y Focus on comfort of carey Medicare hospice benefit
y Volunteers Integral andrequired aspect of theprogram
y Anytime during illness
y Maybe combined with curativecare
y Independent payer
y Health care professional
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Responsibilities of Hospice Nursey Specialist in the management of pain and control
symptom
y
Assess the patients and families coping mechanismsy Check available resources
Care of the patient
Patient wishes
Support system in place
Continue supportive care after death.
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