By Joelle Y. Jean, FNP
Due to its busy nature, providers in the Emergency Room (ER) may not immediately identify patients for hospice care. Approaching patients or family members about hospice can also be challenging-especially if they have specific questions. This hospice checklist can help guide providers on when they should consider a patient for hospice.
What is hospice?
Hospice is for patients who are at the end of life. Patients can have a terminal illness or declining health from a chronic illness. The hospice team can coordinate care with health care providers to manage and treat patients.Benefits of hospice
Initiating hospice early in the disease process has many benefits for the patient and family members. Hospice is there to improve the quality of life and provide comfort for patients during their end of life. Benefits of hospice include:- Improved physical and psychological symptoms
- Caregiver relief
- Reduced hospitalizations
- Lowered hospitalization costs
- Reduced hospital deaths
Barriers to initiating hospice
Studies have shown that providers initiate hospice too late- patients die within weeks of entering hospice. There are barriers that cause ER providers to wait or not consider hospice. Some barriers include:- Not having the right resources
- Breakdowns in patient-clinician communication
- Failing to identify terminal stage of life
- Geographical and socioeconomic barriers
Head-to-toe hospice checklist
Alzheimer’s disease and dementia
Patients in the late stages of Alzheimer’s disease or dementia are candidates for hospice. At this stage, they start to lose activities of daily living (ADLs) and cannot complete basic functions on their own. These functions include:- Bathing
- Dressing
- Eating
- Swallowing
- Loss of the ability to walk (life expectancy is about a year)
- Frequent infections
- Candidate for a feeding tube
- Hip fracture (more than half of Alzheimer’s patients die within six months)
Heart disease
Patients in their late stages of heart failure (HF) are candidates for hospice. Providers should consider hospice if the patient has:- Visited the ER two or more times in the past six months
- A decline in ADLs
- Severe HF symptoms such as dyspnea, angina, fatigue
- Not responded to pharmacological and non-pharmacological interventions
- Ineligible for surgery
- Weight and muscle loss
- NYHA class three/four heart failure
Lung disease and lung cancer
Patients with end-stage lung disease and lung cancer are hospice candidates. Providers should consider hospice if the patient:- Has frequent ER visits
- Increased weight loss
- Increased dyspnea at rest even with oxygen
- Stage four non-small lung cancer
Liver disease
Patients with end-stage liver disease are candidates for hospice. Liver disease is the 12th leading cause of death in the United States. Patients with liver disease are often overlooked for hospice care. Providers should consider hospice for patients with end-stage liver disease if they are:- Ineligible for a liver transplant
- Increased pain
- Increased pruritus
- Increased nausea
- Depression and anxiety
- A decline in cognition and weight
Cancers
ER providers can opt for hospice for patients with cancer if treatment is no longer working or there are no other treatment plans. Patients also at the end stage of their cancer can benefit from entering hospice early. Other signs a patient is ready for hospice are if the patient:- Has increased weakness
- Significant weight loss
- Pain control
- In bed for most of the day
Sepsis
It’s not always easy to identify patients with sepsis who qualify for hospice. However, some patients meet the criteria. Providers should consider patients with sepsis for hospice if the patient:- Has impaired kidney failure
- Not responding to pharmacological treatment
- Require mechanical ventilation
- Injury to the liver
- Hyperlactemia
