Hospice

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Hospice

• Veronica Southard PT MS GCS

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Philosophy

• 1. Accepts dying s a natural process
• 2. Dying is a human not medical process
• 3. Quality of life is more important than
  quantity
• 4. Patient and family unit direct the care needs.

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Types of patients on Hospice

• End Stage
• Parkinsons
• Dementia
• Cardiacs
• AIDs
• Cancer

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Goals of Hospice

• 1. Promote safe and comfortable dying
• 2. Empower the client to self determine life
  closure
• 3. Promote effective grieving before and after
  death
• 4. Support self care and independence in
  achieving these goals

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Origins of Hospice

• Dame Cicily Saunders
• US programs

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Core staff required

• RN
• SW
• MD
• CHAPLAIN

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Why involve therapists?

• Mobility issues
• Functional decline
• Provide support

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Role of the therapist

• Provide our skills to the team
• Develop skills relevant to terminal care

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Clinical PT for hospice pts.

• Challenge is that some will improve
• Your program may be Rehablyte
• Rehab in reverse
• Educate caregivers

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What to do?

• PT.s may incorporate
• TENS, Biofeedback, Massage, Ther Ex
• Bed mobility, Transfers

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Focus on Function

• Achieve best result with the least amount of
  energy
• Make biomechanical adjustments to equipment
• Enable pt. to achieve a functional desire
• Allow them to decide what they want to do

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EXERCISE

• Dont place your values on these pts.
• Limited reserves
• 1-2 exercises may be adequate
• Prioritize what is most important

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Caregiver Training

• Youre only there for an hour.
• Instruct and give feedback to responsible
  caregiver.
• Break down tasks to make them easier

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Commitment

• See the pt. less frequently but try to stay in
  longer.
• They have already lost the surgeon, PCP, even the
  oncologist sometimes

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Communication

• Make sure the team knows how important you are.
• Each pt. is reviewed every 2 weeks
• Talking with other team members affords support
  for you
• PTs are often called in to train volunteers and
  staff

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Reimbursement

• Medicare hospice benefit is about 100./ day

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PT GOALS

• Maximize function
• Provide comfort measures
• Train caregivers

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Communication

• Most difficult part
• Listen to their story, validate them and their
  experience
• Its OK we dont have the answers
• Provide support

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Comfortable Communication

• PT related issues
• Disease process education
• Pathology of the disease
• Exertion

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5 things people can do to have closure

• 1. Ask for forgiveness from someone
• 2. Give forgiveness
• 3. Be able to say thank you
• 4. Be able to say I love you
• 5. Be able to say goodbye

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Why work in Hospice?

• We have empathy for the dying
• Within ourselves we can struggle with other
  peoples fears
• We can enter that house with unconditional love,
  no baggage, use our skills, and acknowledge their
  courage.
• The family can emulate some of the above