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Integrating Palliative Care into Nursing Homes

Around a quarter of older Americans die in nursing homes each year, including nearly 70 percent of individuals with advanced dementia.

For these individuals, the delivery of coordinated, person-centered services at the end of life is a central component in the array of supportive and therapeutic services they receive. Although growing numbers of nursing home residents are accessing Medicare’s hospice benefit before death, substantial barriers continue to impede the meaningful integration of palliative and hospice care into the long-term services and supports that most nursing home residents receive. These barriers range from the orientation of nursing homes — and the regulatory standards that govern them — toward rehabilitative care, to the fragmented approach of Medicare and Medicaid in financing acute, post-acute, palliative, and supportive services.

Palliative care is not just for people at the end of life; rather, it can be integrated throughout the continuum of illness to address physical, intellectual, emotional, social, and spiritual needs and to facilitate patient autonomy, access to information, and choice.” Hospice is a type of palliative care that focuses on the final months of life, whereas palliative care is provided at all stages of serious illness, regardless of the patient’s prognosis or treatment choices. Key features of palliative care are: open communication about future illness trajectories, which allows for patient and family-centered discussions of treatment options and goals of care; documentation of these goals, often through completion of advance directives or a Physician’s Orders for Life-Sustaining Treatments (POLST) form; holistic assessment and interventions to minimize physical, psychosocial, and spiritual suffering; support of activities to bring life closure; and bereavement services for families.

Currently, most formal palliative care programs operate in clinic and hospital settings, where there is evidence that these programs enhance the quality of care, increase patient and family satisfaction, and decrease health care costs. The failure of palliative care to take hold in nursing homes stems from several factors:  regulations that favor rehabilitation over palliative care; inadequate staff knowledge and skill in palliative care; financial disincentives (e.g., higher reimbursement for skilled nursing care and invasive therapies); misconceptions about palliative care; and lack of reimbursement for specialized palliative care.

There are 3 models for delivering palliative care in nursing homes:
  • Hospice agency/nursing home partnerships.
  • Externally based palliative care.
  • Facility-based palliative care.
To read more of the original article from Health Affairs blog, Click Here

In each of the nursing home based settings, palliative care relies to varying degrees on the education training of the facility nurses and staff.  The facility staff often functions as the eyes and ears of the hospice nurse and must have knowledge of proper assessment, what to observe and when to call the hospice service.  Special training is required to familiarize the staff with palliative concepts, expectations, communicating with the resident and family, and preferred palliative treatment methods.

It is often necessary to have the facility nurses and direct caregivers examine their own beliefs, conceptions, attitudes and spirituality towards death- to be able to effectively provide care.  Facilities should establish and implement palliative care practices as well as palliative related policy and procedures that serve as clear guidelines. Staff education is the underlying foundation for effective palliative care and many facilities are providing this education to their staff with online education courses.

Pedagogy presents several online continuing education courses to prepare caregivers:

The Role of the Hospice Caregiver

Whether one is moving into the field of hospice for the first time or is well-seasoned as a professional caregiver, he or she has a significant chance of encountering some surprising hindrances that could mentally eradicate the caregiver’s emotional balance. This online course reevaluates the basic understanding of caregiving to achieve balance in this altruistic trade and provides the necessary tools to help the caregiver maintain a healthy balance in the field while providing quality service to patients and their family members.

To additional course details or to purchase the class, Click Here

Using Hospice and Palliative Preferred Practices to Create a Plan of Care

Because of the complex needs of hospice and palliative care patients, clinicians must be able to construct a plan of care that will accurately chart a patient’s progress towards outcomes that enhance his or her quality of life. To accomplish this important service, clinicians should employ a system of preferred practices to effectively assess, document, and manage the end of life needs of patients and their families. Keep in mind that preferred practices arise from a need to solve problems in the development, management, and implementation of healthcare services. By understanding the problems that hinder positive healthcare outcomes, the preferred practices that improve these outcomes, and the rationale for developing these practices, clinicians will increase their knowledge, expand their scope of practice, and foster quality of life. Since it is necessary for clinicians to continually develop and hone their healthcare skills to ensure the best outcomes, this course has been designed to teach nurses and end of life care professionals how to use preferred practices to create and implement a plan of care that is patient- centered and based on an assessment of the patient’s physical, psychological, social, and spiritual needs. When these needs are considered, patients receive practical and compassionate care developed from quality assessment and communication.

By considering these needs, clinicians empower themselves with the insight to confidently care for the dying and the ability to maintain quality of life in the face of death. In addition, this course contains innovative videos which uniquely illustrate elements of a case study and highlight important concepts of care to establish a learning experience grounded in the principles of mentoring. Through these videos, clinicians have an opportunity to experience aspects of the Lester family’s end of life journey and see how the problems that hinder positive healthcare outcomes are solved through the use of preferred practices

To view additional course details or to purchase the class, Click Here

Addressing the Spiritual and Cultural Needs of Clients

The instructional course is designed for nurses, social workers, and those providing pastoral services to culturally diverse individuals who are experiencing an illness. Those who are providing spiritual care and support have a responsibility to develop competencies that respond to the concerns and distresses expressed in uniquely spiritual and cultural ways by the person and significant others during an illness event. Therefore, the course is designed to assist health care professionals develop competencies to ensure the emotional, cultural, and spiritual needs of the person and significant others’ needs are met.

To view additional course details or to purchase the class, Click Here

Interested in purchasing these classes for your facility? Getting started is as easy as 1…2…3…

In a matter of hours, you can be up and running and your staff can be on their way to quality education!

  1. Give us a call @ 903-871-2150 or email us at sales@pedagogy-inc.com and provide your basic facility information.
  2. Choose desired education and a list of names of participating staff.
  3. Complete payment for your order and start your education instantly!

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