TriCentral PC Toolkit : Chapter 2: Understanding Palliative Care and the TriCentral PC Program : Chart of palliative care and hospice care similarities and differences

HOSPICE ADMISSION CRITERIA

The Patient:

1. Is a member of the Kaiser Permanente Health Care Program.

2. Has a life threatening illness with an expected prognosis of six months or less.

3. Is not receiving potentially curative therapy.

4. Agrees with emphasis of care in the home setting with short term inpatient care limited to: (a) symptom control not obtainable at home, (b) care through the terminal event, (c) respite care.

5. Has a primary care person available to provide care, or to ensure that an appropriate caregiver is available to provide care when necessary.

6. Is not currently being covered by the Skilled Nursing Benefit, or patient chooses to stop Skilled Nursing Benefit to receive Hospice care. Patient may not be receiving Medicare funded care for chronic renal failure.

7. Completes Hospice consents.

PALLIATIVE CARE ADMISSION CRITERIA

The Patient:

1. Is a member of the Kaiser Permanente Health Care Program.

2. Has a life threatening illness with an expected prognosis of 12 months.

3. Is homebound, requiring a considerable and taxing effort to leave.

4. Has a deteriorating medical condition and is at risk for needing symptom management. Patient may have had 1-2 Emergency Department or Hospital admissions in the last year.

5. Has a primary care person available to provide care, or to ensure that an appropriate caregiver is available to provide care when necessary.

6. Agrees with emphasis of care in the home setting with short term inpatient care limited to: (a) symptom control not obtainable at home, (b) care through the terminal event. More aggressive therapy, if appropriate, may be provided by the primary physician in another care setting.

7. Does not meet Hospice admission criteria: (a) Patient/Family have difficulty accepting the life threatening diagnosis and prognosis, (b) Patient/Family are not agreeable to stopping aggressive therapy, (c) Physician is uncertain if patient meets the Hospice admission criteria.

8. Completes Home Health Department consents.

HOSPICE PROVISION OF CARE AND TREATMENT OPTIONS

1. The patient may or may not agree to a No Code Order. The patient/family or Palliative Care staff may call 911, but resuscitative care will be provided by emergency care personnel such as paramedics. Calling 911 is not encouraged. The cost of all services and care provided as a result is not a covered Hospice benefit. Under certain circumstances these costs may be covered by another Kaiser Foundation Health Plan benefit.

2. The Hospice Physician is responsible for the patient's care. The patient may choose to see the primary physician for care but treatments should be coordinated.

3. Supportive care is emphasized. More comprehensive therapy may be provided but not encouraged such as: IV's, TPN, NGT, transfusions, palliative chemotherapy.

4. Hospice Team Members include: Physician, Nurses, (RN and LVN), Social Worker. Additional services available if patient meets criteria include: Home Health Aide, Chaplain, Music Therapist, Volunteers, Homemaker, Physical Therapy, Occupational Therapy, Speech Therapy.

5. Bereavement support is provided to surviving family unit.

6. 24-hour after hours telephone support is provided.

7. Durable Medical Equipment and Oxygen is provided under the Hospice benefit.

8. Hospice Drug benefit is provided including prescription and over-the-counter medications required for symptom control.

PALLIATIVE CARE PROVISION OF CARE AND TREATMENT OPTIONS

1. The patient may or may not agree to a No Code Order. The patient/family or Palliative Care staff may call 911, but resuscitative care will be provided by emergency care personnel such as paramedics. Calling 911 is not encouraged. The cost of all services and care provided as a result is not a covered Hospice benefit. Under certain circumstances these costs may be covered by another Kaiser Foundation Health Plan benefit.

2. The Palliative Care Physician and Primary Physician are jointly responsible for the patient's care. Treatments should be coordinated.

3. Supportive care is emphasized. More aggressive therapy may be provided by the primary physician.

4. Palliative Care Team Members include: Physicians, Nurses, (RN and LVN), Social Worker. Additional services available if patient meets criteria include: Home Health Aide, Chaplain, Volunteers, Physical Therapy, Occupational Therapy, Speech Therapy.

5. Bereavement support is provided to surviving family unit.

6. 24-hour after hours telephone support is provided.

7. Durable Medical Equipment and Oxygen is provided based on the patient's Health Plan benefit.

8. Prescriptions are provided under the patient's Health Plan prescription drug benefit.

HOSPICE DISCHARGE CRITERIA

1. Patient/Family seek curative therapy.

2. Patient elects to receive Skilled Nursing Benefit for qualifying illness.

3. The Hospice Physician is unable to certify that the patient has a terminal diagnosis with a six-month prognosis.

4. The patient moves outside the Hospice catchment area. Patient may be referred to another Hospice Program if available.

5. The Patient/Family do not agree with Hospice admission criteria.

PALLIATIVE CARE DISCHARGE CRITERIA

1. Patient converts to the Hospice benefit.

2. Patient/Family do not agree with the Palliative Care admission criteria.

3. Patient condition stabilizes or symptoms are under control with minimal risk of decline.