1. hospice

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1. Hospice and End of Life care MODERATOR :- Dr. B. Sandilya , ASSt. PROF., DEPARTMENT OF SURGERY PRESENTOR:- dr. m. gowri Shankar, 3 rd YEAR PGT , DEPARTMENT OF SURGERY

2. Objectives., Introduction History Myths and Realities Hospice - Interdisciplinary care Levels of care in Hospice D/B Hospice and Palliative care Some important symptomatic management dealt in hospice

3. Dame Cicely Saunders 1918-2005 Founder of the modern hospice and palliative care m ov em e n t David Tasma 1911-1948 Inspirer of the modern hospice and palliative care m ov em e n t

4. Dame Cicely Saunders 1918-2005 Founder of the modern hospice and palliative care m ov em e n t

5. The Hospice “ will try to fill the gap that exists in both research and teaching concerning the care of patients dying of cancer and those needing skilled relief in other long-term illnesses and their relatives. ” * Saunders , 1967 *

6. OVERVIEW ON HOSPICE What is Hospice? From the word “ Hospes ” Originally , referred to shelter or way station for weary travelers. Today, means a concept of care that provides comfort and quality of life to clients (patients) and their significant others who are facing life’s final journey associated with terminal illness .

7. OVERVIEW ON HOSPICE What is Hospice? A type of care/ a philosophy of care, which focuses on palliation of terminally ill patient’s symptoms. Physical Emotional Spiritual Social

8. The primary goals of hospice care are to: Provide comfort , Relieve physical, emotional, and spiritual suffering, P romote the dignity of terminally ill persons . Care is provided by an interdisciplinary team. Hospice care neither prolongs nor hastens the dying process .

9. Dame Cicely Saunders 1918-2005 Founder of the modern hospice and palliative care m ov em e n t

10. Hospice - Is It a Place ? Hospice care is a philosophy or approach to care rather than a place. Care may be provided in a person’s home, nursing home, hospital, or independent facility devoted to end-of-life care.

11. Hospice is … , (Not necessarily) a place A philosophy of care A structure for care

12. HISTORY OF HOSPICE CARE

13. 11 th century, around 1065= the 1 st hospice care are believed to have originated when the first incurably ill were permitted into places dedicated to treatment by Crusaders. 14 th century – Knights Hospitaller of St.John of Jerusalem church opened the 1 st hospice in Rhodes . 17 th century - Hospices were revived in France by the Daughters of Charity of Saint Vincent de Paul. HISTORY OF HOSPICE CARE

14. Knights Hospitaller

15. The Knights Hospitaller Hospice Central Area in Rhodes

16. 19 th Century - established also in UK where attention was drawn to the needs of the terminally ill. 1902-1905- hospice care spread to other nations.( Australia, North America, Japan, China, Russia) HISTORY OF HOSPICE CARE

17. Cecily Saunders introduced the idea of specialized care for the dying to the United States during a 1963 visit with Yale u niversity . Her lecture, given to medical students, nurses, social workers, and chaplains about the concept of holistic hospice care, included photos of terminally ill cancer patients and their families, showing the dramatic differences before and after the symptom control care. The Modern Hospice Movement

18. In the 1950s, as medical technology developed, most people died in hospitals. The medical profession increasingly saw death as a failure. Physical pain associated with terminal illness was not a target of treatment. Dame Cicely Saunders, MD, founded St. Christopher’s Hospice in London in the 196 7 , in an effort to discover practical solutions to alleviating human suffering. She introduced hospice in the U.S. in a lecture at Yale in 1963. This contact set off a chain of events which resulted in the development of hospice care as we know it today. The Modern Hospice Movement

19. A Swiss psychiatrist, Kübler -Ross first introduced her five stage grief model in her book  On Death and Dying .

20. 1972 : Kubler - Ross testifies at the first national hearings on the subject of death with dignity, which are conducted by the U.S. Senate Special Committee on Aging. In her testimony, Kubler - Ross states , “We live in a very particular death-denying society. We isolate both the dying and the old, and it serves a purpose. They are reminders of our own mortality . We should not institutionalize people . We can give families more help with home care and visiting nurses, giving the families and the patients the spiritual, em otional , and financial help in order to facilitate the final care at home .” HISTORY OF HOSPICE CARE

21. HISTORY OF HOSPICE CARE 1996 : Major grant-makers pour money into funding for research, program initiatives, public forums, and conferences to transform the culture of dying and improve care at the end of life.

22. Myths and realities of Hospice A place. Only for people with cancer. Only for old people. Only for dying people. Can help only when family members are able to provide care. About 80% of hospice care takes place in the home. Hospices are increasingly serving people with the end-stages of chronic diseases. Hospices serve people of all ages. Hospice focuses as much on the grieving family as on the dying patients. Alternative locations or resources may be available.

23. Myths of Hospice For people who don’t need a high level of care. Only for people who can accept death. Expensive. Not covered by managed care. For when there is no hope.

24. Hospice is serious medicine, offering state-of-the-art palliative care. Hospices gently help people find their way at their own speed. Hospice can be far less expensive than other end-of- life care. Most people who use hospice are over 65 and entitled to the Medicare Hospice (in US) Benefit, which covers virtually all hospice services . *Medicare – Ayushman Bharath of America* realities of Hospice

25. Principles Underlying Hospice ( SAUNDERS - founder of St . Christopher’s Hospice in London,19 67 ) Death must be accepted. The patient’s total care is best managed by an i nterdisciplinary team whose members communicate regularly with each other. Pain and other symptoms of terminal illness must be managed. The patient and the family should be viewed as a single unit of care. Home care of the dying is necessary. Bereavement care must be provided to family members. Research and education should be ongoing.

26. What Services Does Hospice Offer? For the Patient…. Providing care to the patient. Medical care to relieve pain and other symptoms arising from a life-limiting illness. Basic needs of daily living. Counseling. Assisting the patient with unfinished legal or financial business and in making funeral arrangements. Religious care.

27. What Services Does Hospice Offer? For Caregivers/Family Members… 1.Counseling services.. 2.Respite care. 3. Health Education. 4.Practical assistance. 5. Assistance with cremation/burial arrangements and with funeral/memorial services. 6. Bereavement care.

28. Members of the interdisciplinary Hospice Team Primary Physician Hospice physician Nurse Home health aide Social worker chaplain

29. Members of the Hospice Team Primary Physician Provides the hospice team with medical history. Oversees medical care through regular communication with the hospice team. Provides orders for medications and tests, signs death certificate, etc. Determines his or her level of involvement on a case-by-case basis with the hospice medical director.

30. 2. Hospice Physician Provides expertise in pain and symptom control at the end of life. Works closely with the hospice team and primary physician to determine appropriate medical interventions. Makes home visits on as needed basis. May oversee the plan of care, write orders, and consult with patient and family regarding disease progression and appropriate medical interventions on a case-by-case basis.

31. 3. Nurse Visits patient and family in the home or nursing home on regular basis. May provide on-call services. Assesses pain, symptoms, nutritional status , bowel functions, safety, and psychosocial - spiritual concerns. Educates patient and family. Educates and supervises nursing assistants. Provides emotional and spiritual support to patient and family.

32. 4. Home Health Aide Assists patient with activities of daily living. Provides a variety of other services depending on assessment of need .

33. Social Worker Attends to both practical needs and counseling needs of patient and family. Arranges for durable medical equipment, discharge planning, funeral/burial arrangements Serves as liaison with community agencies. Assist family in finding services to address financial needs and legal matters. Provides counseling. Assesses patient and family anxiety, depression, role changes, caregiver stress. Provides general grief counseling.

34. 6. Chaplain Provides patient and family with spiritual counseling. Assists patient and family in sustaining their religious practice and in drawing upon religious/spiritual beliefs. Ensures that patient and family religious or spiritual beliefs and practices are respected by the hospice team. serves as a liaison with the patient/family faith, community . May conduct funeral and memorial services. Provides hospice staff with spiritual care and counseling.

35. 7. Volunteer Provides respite care to family members May assist with light housekeeping or grocery shopping. Helps patients stay connected with community groups and activities. Facilitates special projects. provide community education and outreach. May assist with office work.

36. Volunteers - ABSTRACT – Timelink US In 2019, the U.S. Census Bureau reported that by 2035 there will be 78 million people 65 years and older compared to 76.4 million under the age of 18, marking an important demographic turning point. In Long Beach, a city in Los Angeles county, 11.7% of its population is 65 years and older, and adding to this, by 2025 22% of Long Beach’s senior citizens will be living below the poverty line. TimeLinks US aims to help and support these people in a holistic way by providing services that go beyond clinical care. Specifically, we aim to provide in-home support to seniors with daily chores, picking up medicines, buying groceries, or just keeping companionship in the face of growing prevalence of Alzheimer's and dementia. Our mission is to promote giving and receiving through time banking credits that will help support families, neighborhoods , and the community by empowering seniors. Time credits/dollars is something that TimeLinks US will use to exchange services with other members, save it for future needs , or they can also be donated to other members who cannot earn their own Time credits. We believe that no one should have to feel helpless and alone in this crowded world by building strength, support, trust and creating networks in the community. This proposal will give a detailed overview on how we shall achieve these

37. How hospice works?? Hospice care  can be provided onsite at some hospitals, nursing homes, and other health care facilities , although in most cases hospice is provided in the patient’s own home. With the support of hospice staff, family and loved ones are able to focus more fully on enjoying the time remaining with the patient. When hospice care is provided at home, a family member acts as the primary caregiver , supervised by the patient’s doctor and hospice medical staff.

38. The hospice team makes regular visits to assess your loved one and provide additional care and services, such as speech and physical therapy or to help with bathing and other personal care needs. As well as having staff on-call 24 hours a day, seven days a week, a hospice team provides emotional and spiritual support according to the wishes and beliefs of the patient. They also offer emotional support to the patient’s family, caregivers, and loved ones, including grief counseling . How hospice works??

39. LEVELS OF CARE ROUTINE HOME CARE- - most common level of care provided. - interdisciplinary team members supply a variety of services during routine home care, including offering necessary supplies. ( d iapers , bed pads, gloves, & skin protectants)

40. CONTINUOUS CARE Is a service provided in the patient’s home. Intended for pts. who are experiencing severe symptoms & need temporary extra support. Provides services in the home a minimum of 8 hours a day.

41. - Is an intensive level of care which may be provided in a nursing h ome . -intended for pts. who are experiencing severe symptoms which require daily interventions from the hospice team to manage. -Often, patients on this level of care have begun the “ active phase” of dying. GENERAL INPATIENT CARE

42. addnl - RESPITE CARE - ( referred as respite inpatient) Is a brief & periodic level of care a patient may receive. A unique benefit in that the care is provided for the needs of the family, not the patient. Is provided for a maximum of 5 days every benefit period.

43. hospice and home health nurse and palliative care

44. Is Hospice the Same as Home Health Nursing ? Two primary differences between hospice care and home health nursing : 1. Any patient with a skilled medical care need is qualified to receive home health nursing care. Hospice care, on the other hand, is limited to persons with a terminal illness , with a life expectancy of six months or less , and with a focus on palliation not cure. 2. Patients in home health care receive visits primarily from a nurse while patients in hospice care receive the services of an entire interdisciplinary team whose area of expertise is end-of-life care.

45. Palliative vs. Hospice Both focus on improved qualify of life Both are delivered by specialists Both have been shown to improve survival Both tend to be delivered by a team of individuals with knowledge of complex symptom management Both work with the patient’s other clinicians to provide an additional layer of patient care

46. Palliative vs. Hospice Hospice is a medical insurance benefit, with its own set of regulations Hospice care is typically provided in the home, whereas palliative tends to be hospital or clinic based Hospice specifically cares for patients with terminal conditions where survival is typically <6 months Palliative medicine is delivered irrespective of prognosis Both are provided regardless of diagnosis

47. Palliative vs. Hospice

48. Palliative vs. Hospice

49. Five Most Common Symptoms Pain Nausea/vomiting Breathlessness Weight loss Weakness / fatigue

50. Shanti Avedna Sadan in Mumbai, a hospice, in 1986 . Over the next five years, it established two more branches, one in Delhi and one in Goa; Guwahati Pain and Palliative Care Society in Assam the Jivodaya Hospice in Chennai, Cansupport in Delhi Lakshmi Palliative Care Trust in Chennai Karunasraya Hospice in Bangalore Some Hospice centres in INDIA

51. Thank you “as the body becomes weaker, so the spirit becomes stronger”