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INTRODUCTION

Prior parts of this book addressed that the Medicare Hospice Benefit is prognosis-based, which means that the patient must have a limited life expectancy, and the hospice is responsible for caring for and covering all costs for the terminal or primary diagnosis and all diagnoses that contribute to the terminal prognosis. The benefit covers services, drugs, supplies, and medical equipment related to the terminal diagnosis and diagnoses that contribute to the terminal prognosis.

The hospice physician determines which diagnosis is primary and which comorbidities contribute to the terminal prognosis by reviewing all available clinical information from the referral source and other medical records and outcomes from the interdisciplinary comprehensive assessment. Determining the relatedness of diseases to the terminal diagnosis is a complex process, so it is extremely important for the hospice physician to have as much information about the patient as possible. Determining relatedness is not a one-time event; it is a continuous process that begins at admission and continues throughout the hospice service period. A patient may have a disease process at the time of admission that does not contribute to the terminal prognosis, but as the disease progresses and the patient’s status declines over time, that same disease process may contribute to the terminal prognosis and become the responsibility of the hospice interdisciplinary group (IDG) to manage.

IMMINENT DEATH OF THE PATIENT CARE

The hospice IDG works together toward common goals determined by the patient, family, and IDG collaboratively. This means individualizing the care to manage the terminal diagnosis and diagnoses that contribute to the terminal prognosis. However, there are common symptoms at the end of life that a patient may experience no matter the specific diagnosis(es)—Table 4.1 outlines these common symptoms. A common goal is the preservation of quality of life and dignity for the patient. Adequately managing common symptoms at the end of life contributes to maintaining the quality of life the patient and family desire (National Cancer Institute, 2022). Of course, the care is individualized, follows physician orders, and teaching for the patient and family should be included related to each category. All recommended interventions are subject to individual patient plans of care and physician orders.

TABLE 4.1Common Symptoms at the End of Life

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