Medical Guidelines for Hospice Patients

July2013 079 copy

Hospice upholds the physician-patient relationship established prior to the patient’s Hospice admission. In accordance with the patient’s wishes a continuing collaboration between the patient’s physician and the Hospice medical team will take place throughout the patient’s stay in Hospice.

The primary focus of Hospice care is on pain and symptom management along with other supportive measures.  Hospice is an alternative to aggressive medical regimes which may no longer be helpful or desired.

For a procedure or treatment to be considered appropriate as part of the Hospice care plan, the patient, primary caregiver, physician and Hospice interdisciplinary team must review the treatment in light of the patient’s life expectancy and quality of life at that point in time. Treatment decision-making is thus focused on enhancing the quality of the patient’s remaining life.

According to Hospice regulations, and in order to be covered by insurance, all services and medical treatments must be reasonable and necessary for the management of the life-limiting condition and pre-authorized by Hospice.

Hospice care includes optimizing the patients’ ability to participate in activities of daily living.  Hospice provides teaching for patients and caregivers regarding the provision of safe care which promotes patient’s comfort.

Medications will be ordered for the control of pain and other symptoms in order to achieve maximum comfort. Diagnostic tests and other assessments are appropriate when results are needed to obtain additional information in an attempt to try to improve pain and/or symptom management. Testing for the purpose of evaluating progression of disease is usually no longer appropriate unless for the purpose of symptom and pain management.

Hospice works with the patient, family, and attending physician to evaluate the goals and effectiveness of treatments and therapies such as:

  • Radiation therapy
  • Chemotherapy
  • Surgery
  • Artificial nutrition, ie. Tube feedings
  • Blood transfusions
  • Intravenous antibiotics/medications/hydration
  • Spinal pain medications

The risks, burdens, and benefits of such treatments, the patient’s functional status and estimated prognosis, and the supporting medical data will be considered when making decisions about providing these types of treatments. When possible, Hospice and the patient will choose the least burdensome treatment for the patient.

A Do Not Resuscitate Order (DNR) is appropriate for hospice patients and shall be consistent with New York State regulations. Hospice team members are not obligated to perform heroic measures such as cardiopulmonary resuscitation (CPR) on a Hospice patient for whom a DNR order is not in effect. The hospital medical staff will assume this responsibility when the patient is in the hospital. For hospice patients at home or in a long term care facility, existing emergency medical services such as 911, and caregivers, are instructed or assisted in doing so.

Hospice provides an on-call service which is available to patients and families 24 hours a day, 7 days a week, to handle questions, problems, emergencies, and to provide home assessment of problems which may develop. Ambulance or emergency room services are not covered unless authorized by the Hospice plan of care.

A patient-physician decision to pursue curative or more aggressive therapy through medical intervention will be respected. Patients are always free to withdraw from Hospice. Under such circumstances, Hospice will discuss with the patient and their physician the continuing appropriateness for Hospice care. Upon the decision to discharge the patient, Hospice will make appropriate referrals and schedule a timely transfer to other health care or social services if necessary.