Congestive Heart Failure and Hospice - Does it Qualify?
By: Elizabeth Townsend, RN
Congestive heart failure happens when the heart muscle begins to not pump blood as it should. Conditions of congestive heart failure, such as narrowed heart arteries or continuous high blood pressure, eventually weaken the heart and make it unable to pump the blood throughout the body. This will result in fluid retention in the heart and lungs.
What criteria must be met for CHF patients and hospice care?
- Progressive decline in status
- Continuous weight loss
- Weakness and fatigue
- Other uncontrolled symptoms such as shortness of breath and chest pain
Impaired heart rhythms
Irregular or abnormal heart rhythms may occur due to heart damage and changes in heart muscle. Diseases of the heart muscle can also cause the heart to become large and thick. CHF advances the development of atrial arrhythmias, specifically atrial fibrillation, and atrial flutter. These two arrhythmias can make the heart’s left ventricle not work properly or exacerbate the problem.
Weight loss
Due to fluids collecting in digestive organs, the patient may feel full and bloated. This could cause appetite loss and weight loss. Smaller, more frequent meals can help remedy.
Impaired sleep
The patient may feel they are sleeping too much or not getting enough sleep because of fatigue. This can happen from organs not getting enough oxygen. Also, symptoms such as shortness of breath or pain may keep the patient awake when they would usually be sleeping.
Physical decline
As time goes on, there may feel a physical decline as the symptoms continue:
- Shortness of breath
- Chest tightness
- Problems sleeping
The hospice team will work with your healthcare team with medication adjustments and other comfort methods to help the patient be as comfortable as possible.
Functional impairments
You may notice an inability to perform regular activities as time goes on. You may notice functional declines in:
- Showering or bathing
- Grooming
- Dressing
- Walking
- Feeding
- Toileting
Poor response to medications and vasodilator
The patient’s body may no longer respond to medications such as vasodilators. Vasodilators are medications that open blood vessels.
Required documentation
The physician must document a life expectancy of six months or less. Documentation should include clinical findings such as signs and symptoms, lab results, and weights.
Characteristics of end-stage congestive heart disease
Heart failure is classified according to the severity of symptoms. The New York Heart Association Functional Classification has four classes:
- No limitation of physical
- Slight limitation of physical
- Marked limitation of physical
- Unable to carry on any physical activity without These symptoms are present, even at rest.
Dyspnea
Labored or difficult breathing can worsen, and previous relief methods may not lessen the difficulty and discomfort.
Chronic cough
A cough may be a sign that the medication stopped working to prevent fluid buildup in lungs. It can also be a side effect of certain medications. This is a symptom to report to your physician for evaluation.
Edema
Impaired blood flow can cause excess fluid to collect in the legs, ankles, hands, face, and feet.
Changes in appetite
Changes in appetite may happen because of excess fluid, causing a feeling of bloating or a full sensation.
Mental confusion
Decreased blood flow to the brain and abnormal levels of sodium in the blood can cause memory loss, disorientation, or confusion.
Shortness of breath
As fluid builds up in the lungs, it can interfere with breathing. The patient may begin waking up feeling breathless. This can result in feeling anxious and exhausted.
When is the right time to request hospice care?
When the patient has:
- Frequent episodes of chest pain, shortness of breath, fatigue, and a decline in the ability to function
- Been provided treatment for improvement, and the healthcare team can provide no further medical interventions
- Deciding not to engage in further treatment
Symptoms are getting more difficult to manage
Symptom management strategies are no longer working, and the patient has symptoms such as shortness of breath, even at rest.
Frequent ER/Doctor visits
Emergency room visits at least once in the past six months for CHF.
Feeling overwhelmed as a caretaker
Taking care of a loved one with end-stage CHF can be extremely stressful. Hospice can provide respite care for the caregiver for a much-needed break.
How does hospice care help congestive heart failure patients?
Our hospice team guides families through the complicated problems, including medical care and financial concerns. We give the patient and their family emotional support and provide education to caregivers to help them care for their loved ones. Care is provided where the patient lives, which can be their home or a facility.
Physical pain and symptom management
- Medication
- Low sodium diet
- Monitoring of fluid intake
- Tracking of symptoms
- Monitoring weight
- Nursing assessment
Emotional assistance
A social worker and nurse can help by listening and referring resources, such as a chaplain or continuous therapy.
Provide comfort
Our team can provide comfort by listening to concerns. Physically, we assist with comfort measures such as teaching positioning techniques to relieve pain and make breathing easier.
Medical equipment
Equipment and supplies such as hospital beds, walkers, and commodes are covered as related to the primary hospice diagnosis necessary to care for the patient.
The hospice support team may include:
- Social Workers
- Counselors
- Chaplain/Spiritual Care Coordinators
- Licensed nurses
- Hospice aides/Certified Nursing Assistants
- Therapists such as Occupational, Speech, and Physical
- Medical director
- Primary care provider (PCP)
Ways that hospice helps the family of the patient
Hospice helps the family by providing education to the caregivers to provide safe care at home and supports them as they prepare emotionally and mentally for the end of life of their loved one.
Assistance with difficult decision-making
The hospice team can help with an advanced directive to make the hard decisions before the situation occurs. We can assist with appointing a healthcare proxy in a document called a durable power of attorney for healthcare. We also help the family and patient with insurance, legal documents, and other practical issues that may arise.
Respite care
Respite care is a benefit of hospice available for up to five days. Hospice of North Alabama will care for your loved one to give you the much needed break you deserve.
Bereavement services
Bereavement support and counseling are made available for caregivers and families.
Speak with your doctor about when to begin hospice care.
