Hospice
Hospice 101
Palliative
Care of Sick
Care of Sick 101
100
What are the different levels of care that hospice can provide?
Routine, Continuous Care, General Inpatient
Routine - Most hospice patients on this level
Continuous Care - When symptom management is not controlled and hourly assessment of the patient is required to titrate medications - normally provided in home and ALF when nursing staff is not already available
GIP - when symptom management is not controlled and requires elevated level of care not able to be provided in home setting, example continuous medication provided via IV
100
What scale is used to assist in determining a cognitive decline in a dementia patient?
What is FAST scale:
100
Curative treatment can be pursed and soon a hospice nurse will be managing patients on this program.
What is the Palliative Program
100
This is due no later than 8 am the following day.
What is documentation.
- Visits must be locked by 8am the following day
- Admission paperwork- to be handed in completed via Worldview or in-person to branch or storage unit by 8am the following day Locking of SOC, ROC, Recert, Transfer or D/C- within 24 hours of receiving the LO Note
- Locking of interim/verbal orders – write them and lock them up
- Locking of discharge summaries- by 8AM the following day
Validate oasis documents by 8am the following day prior to sending an OR note
100
This is a model designed to give Medicare-certified home health agencies incentives to give higher quality and more efficient care.
What is Home Health Valued-Based Purchasing
200
What is the definition of a terminally ill patient?
•Conditions of Participation/terminally ill (COP) – “the individual has a medical prognosis that his or her life expectancy is 6 months or less if the illness runs its normal course.”(§ 418.3 Definitions)
200
Are hospice nurses allowed to assess for hospice eligibility and complete care prior to signing the notice of rights?
No - Hospice must provide patient or representative notice of rights during the initial assessment in advance of furnishing care
The hospice must obtain the patient’s or representative’s signature confirming that he or she has received a copy of the notice of rights and responsibilities
Verbal and written notice of patient rights and responsibilities in a language and manner the patient understands
200
True or False:
Palliative patients do not have to be homebound to receive services.
False
Patient needs to be homebound and have a skilled need for nursing.
200
What are the three Valued Based Purchasing components?
Rehospitalization, Patient Survey and Oasis
200
A form used to notify Original Medicare beneficiaries receiving home health care benefits of plan of care changes.
What is the Home Health Change of Care Notice (HHCCN)
300
In the first benefit period, the number of days before the recertification needs to be completed.
What is 90 days.
90 days for first benefit period, 90 days for second benefit period and 60 days for third and greater benefit period. (90, 90, 60)
Most private insurance run same as Medicare.
300
Hospices will have a maximum of how many days to have the NOE submitted and accepted by their Medicare contractor
What is 5 days - if the NOE is not submitted there is a finical impact to the agency (unable to bill)
Medicare will not cover and pay for days of hospice care from the notice of election date to the date that the agency files the notice of election
300
Provide two examples of patients that would benefit from the palliative program.
Cancer patient seeking curative treatment with symptoms to manage.
Patient with multiple hospitalizations and a serious illness.
Patient with hospice diagnosis but not ready for hospice services
300
A form that notifies beneficiaries when their Medicare covered services are ending.
What is a Notice of Medicare non-Coverage (NOMNC)
Deliver at least 2 calendar days before Medicare covered services end or the second to last day of service if care is not being provided daily
The 2 day advance requirement is not a 48 hour requirement
Patient has appeal rights
300
What is the EAP program?
The Employee Assistance Program
400
When does an APRN or MD need to complete a visit and assess for the patient appropriateness to meet hospice criteria?
When the patient enters any benefit period greater than the second.
If a face to face visit is missed, one needs to be scheduled as soon as possible. Patient will be discharged as of the last day of pervious benefit period. Hospice will continue to service patient at their cost for as long as it takes for the agency to obtain a face to face from APRN/MD (any visits will be non billable until face to face completed and new soc can be completed.
400
A brief physician narrative describing why the patient is eligible for hospice?
What is a Certificate of Terminal Illness (CTI)
Must be obtained no more that 2 days from start of care.
Two MDs need to sign the CTI. One Attending Physician and One Medical Director, however in some cases the Medical Director can sign as both the Medical Director and Attending Physician.
400
There is no life expectancy requirements to be on Palliative care - True or False
True:
Patient can have serious illness with a limited live expectancy but it is not required.
Symptom management can be the focus, easing side effects of treatments and improving quality of life.
400
Name four of the 6 criteria to be eligible for Medicare home health services.
Must have
Medicare Part A and/or Part B
Be confined to home
Need skilled services
Be under the care of a physician
Receive services under a plan of care established and reviewed by a physician
Have had a face to face encounter with a physician or allowed non-physician practitioner.
400
A waiver of liability, is a notice a provider should give you before you receive a service if, based on Medicare coverage rules, your provider has reason to believe Medicare will not pay for the service
What is Advance Beneficiary Notice (ABN)
Your provider has a reason to believe Medicare will not pay for services
Dually eligible for Medicare and Medicaid
Given when care is physician ordered and Medicare denial is expected.
500
Is there ever a time when hospice can NOT honor advanced directives?
Yes - Hospice must provide a statement of limitation if advance directive cannot be honored. Policy/procedure explains limitation of service and response of hospice provider related to the care. Example: Patient wishes to be resuscitated, but hospice policy is that staff do not provide CPR. The hospice could call 911 if present during a cardiac arrest, but not provide CPR.
Hospice must provide advance directive information as needed/per patient request. Cannot refuse service based on advance directive content (Full Code vs DNR)
500
When can we get a verbal order to extent hospice services if a face to face is missed?
Never
Patient will need a face to face scheduled as soon as possible. Patient will be discharged as of the last day of pervious benefit period. Hospice will continue to service patient at their cost (any visits will be non billable until face to face completed and new soc can be completed.
500
The definition of Palliative Care.
Palliative care is specialized medical care for people living with a serious illness that focus on symptom management to improve the quality of life.
500
A group of data elements that: Represent core items of a comprehensive assessment for an adult home care patient; and. Form the basis for measuring patient outcomes for the purposes of outcome-based quality improvement
The Outcome and Assessment Information Set (OASIS)
500
What is Masonicare's Mission Statement?
to enhance the quality of life of seniors through compassionate and exceptional care.