PALLIATIVE CARE CARE CHOICES(bridge to Hospice)  HOSPICE
Admission Criteria
  • Patients at any stage of advanced/life-treatening/illness who desire palliation ot symptoms (social/physical/emotional/spiritual)
  • May be seeking curative therapies
  • No restrictions with prognosis
  • Patient DOES NOT have to be homebound
  • Patient must be homebound wilh skilled nursin of therapy needs
  • Pattern can also be receiving treatments for associated pain and symptom management challenges
  • Patient who aie not ready for hospice
  • Terminally ill (prognosis of 6 months or less if illness follow normal course)and desiring
    palliation of symptoms (social, physical,emotional, and/or spiritual) 
  • Patients who forego curative therapies
  • Patient DOES NOT have to be homebound
Diagnosis
  • All distressing or problematic diagnoses and symptoms are identified in the Plan of Care with suggested interventions
  • Diagnoses must be included in the Plan of Care as ordered by the physician
  • Care Choices patients must have a certified or skilled need
  • One diagnosis is selected to be the terminal diagnosis and is the hospice programs financial responsibility
  • Other diagnoses included in the Plan of Care and treated but continue to be covered under the traditional Medicare benefit 
Physician Responsibility
  • Palliative consult or admission to the palliative program must be ordered by physician
  • Plan of Care reviewed at least every 30 days
  • Primary physician must be available for prescriptions (NP has availability to write script in home related to pain/symptom mgt)
  • Service must be ordered by physician
  • Service must be medically necessary
  • Orders must be reviewed every 60 days
  • Primary phisician must be available for needed orders 
  • Certification by 2 physicians that patient is terminally ill
  • Plan of Care reviewed at least every 15 days
  • Certification for subsequent benefit periods are made by the hospice physician
  • Primary physician must be available for orders 
Caregiver
  • Not required
  • Patient’s and caregiver/family needs are the focus of care 
  •  Not required
  • Patient sillied needs are focused of care
  • Identification of caregiver required by Hospice (or plan est. for caregiver when needed)
  • Focus of care is on the patient and caregiver/family/needs 
Visit Frequency
  • Determined by patient and Palliative Team
  • Physician determined
  • Determined by patient and Hospice Team
Hospitalization
  • Goal is to keep patient OUT of the hospital
  • Discussion around changes in plan of care should be had with team members prior to hospitalization
  • Goal of keep patient OUT out of the hospital
  • Discussion around changes in plan of care should be had with team members prior to hospitalization
  • Must be coordinated by Hospice Team
  • Possible admission for respite cate or symptom management may be appropriate with team input