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Part 1: The Evolution of Hospice – from Practices to Regulations Over Time
Any discussion of the evolution of hospice must include recognition of the significance of Dame Cicely Saunders’ body of work as she tended terminally ill patients in 1948. As a result of her work, hospice has gradually morphed into the heavily regulated industry of today. This session will explore these changes and offer opinions and recommendations that might re-direct hospice providers to consider the true essence of hospice, examine best practices related to hospice agency culture and discuss ethical dilemmas that hospices face today. The session will also include an in-depth review of how provider PEPPER reports, HIS data, CAHPS reports, and survey results contribute to OIG and MedPAC, work plans and recommendations to Congress that could ultimately influence legislation and regulation.
Part 2: The Hospice Plan of Care – An Interdisciplinary Document
Too often, the hospice plan of care becomes a dormant document not relevant to the on-going, ever-changing needs of the patient and family. In the day to day work of caring for hospice patients, it is critical that all team members be heard and respected, and that their observations be included in the development of a comprehensive, living plan of care. In this session, the importance of a thorough hospice plan of care based on the interdisciplinary team’s assessments and observations will be evaluated and discussed from the perspective of all disciplines. This session will address how poorly written plans of care can lead to poor outcomes and patient and family dissatisfaction and offer suggestions for more positive outcomes.
Part 3: Hospice Levels of Care – A Team Effort
In this session, the four levels of care will be examined to include how the interdisciplinary team determines the appropriate level of care for each patient. This discussion will include detailed descriptions of each of the hospice team members and how each member influences the quality of hospice care and ultimately the appropriate level of care. There will be a thorough discussion on how to meet the Interdisciplinary Group Conditions of Participation and how effective engagement of the team members leads to improved patient and family satisfaction and ethical practices. This session will explore ideas on how to handle situations when the team doesn’t agree on the appropriate level of care, and how to deal with live discharges incorporating licensure and Conditions of Participation compliance requirements for these important, potentially life-changing decisions.
Part 4: Hospice Documentation – The Evidence of a Hospice’s Daily Work
This discussion will focus on how the entire hospice admission is built on details, dates, facts, research, patient history, subjective and objective findings from all disciplines, the patient and family, and the patient’s attending physician. Medical and legal implications and ethical issues will be included in this discussion. A comparison of paper vs electronic documentation will include standards of care and how interdisciplinary documentation collectively supports the hospice plan of care.
Part 5: Hospice Referral to Discharge -A Comprehensive Review Including Marketing Practices
In this session, the importance of detailed referral development will be discussed. A referral for hospice does not automatically equal the order to admit a patient to hospice. Thoughtful vetting during the referral process is vital to establishing a solid admission based on eligibility, patient and family acceptance of the election process, and, ultimately, a successful hospice experience. Included in this session will be expectations of a hospice marketer to avoid inappropriate or rushed patient elections. This discussion will also include the consequences of ill-planned, ill-prepared admissions that can lead to a failed hospice experience for patients, families, physicians, and staff. The emphasis of this discussion will be on how to improve a hospice’s outcomes and reputation by developing thorough practices from referral to discharge with an emphasis on compliance throughout these processes.
Part 6: Palliative Modalities – A Look at Hospice vs Palliative Programs
As we confront the issues of the opioid crisis in our nation, hospice providers must be mindful of potential abuses of prescriptive pain management. Alternative methods of palliative management will be discussed in addition to thoughtful, overall medication management for the hospice patient. We will dive into issues such as over-medication, poly-pharmacy interventions, and problems with drug diversion. The discussion will include other specific non-prescriptive management of patient pain and symptom control that hospices might consider in their practices.