5.24 – Care of Terminal Conditions-Palliative or Hospice Care

Open Door allows individuals and guardians to direct services and care plans.  Open Door supports individuals through all aspects of life including those diagnosed with chronic, terminal illnesses. 

As the individual or guardian’s choice, Open Door believes in providing comfortable, palliative care principles including:

• Respecting the dignity of both individual and care givers.
• Being sensitive and respectful of the individual’s [individual’s] and family’s wishes.
• Using the most appropriate measures that are consistent with individual choices.
• Encompassing alleviation of pain and other physical symptoms.
• Assessing and managing psychological, social and spiritual/religious problems.
• Offering continuity (the individual should be able to continue to be cared for if so
desired by his primary care and specialist providers).
• Providing access to any therapy that may be expected to improve the individual’s
quality of life including alternative or non-traditional treatments.
• Providing access to palliative care and hospice care.
• Respecting the right to refuse treatment.
• Respecting the physician’s professional responsibility to discontinue some
treatments when appropriate with consideration of both individual and
family preferences.

Hospice Services

When an individual has elected the hospice benefit, the hospice and Open Door interdisciplinary team must meet, communicate, establish, and agree upon a coordinated plan of care which reflects the hospice philosophy, and is based on an assessment of the individual’s needs and unique living situation in the facility.

The hospice scope of care includes:

• Skilled Nursing
• Medical Social Services
• Personal Care
• Spiritual Support
• Volunteer Support
• Bereavement Support
• Physician Services

Individual’s benefit from hospice care in several ways. By electing hospice, the individual
has clearly asked that his or her care be focused on palliation. There are significant
benefits to this choice, especially the added attention of nurses to help manage the pain
and symptoms relating to the life-ending illness, and the one-to-one emotional support for
the individual and the family.

Moreover, hospice volunteers visit individuals on an as needed basis and often
provide valuable interaction with the individual or family.

The plan of care must include directives for managing pain and other uncomfortable symptoms and be revised and updated as necessary to reflect the individual’s current status.

Hospice must designate a registered nurse from the hospice to coordinate the
implementation of the plan of care. This coordinated plan of care must identify the care and services which Open Door and hospice will provide in order to be responsive to the unique needs of the individual and his/her expressed desire for hospice care.

Open Door and the hospice provider are responsible for performing each of their
respective functions that have been agreed upon and included in the plan of care.
The hospice retains overall professional management responsibility for directing
the implementation of the plan of care related to the terminal illness. Drugs and medical supplies must be provided as needed for the palliation and management of the terminal illness and related conditions.

Hospice Payment

Medicaid Room and Board — Hospice bills Medicaid for room and board, then reimburses Open Door.  Open Door invoices Hospice according to per diem rate established in contract.

Miscommunication of Hospice

Since hospice services are elected by the individual/guardian, it is the individual’s right to discontinue or transfer hospice services at any time. If an individual decides to pursue curative measures, or no longer wants hospice care, the individual/legal guardian may revoke the hospice benefit.

If, on the other hand, the individual no longer meets the criteria for appropriateness, hospice may need to discontinue hospice services or decertify the individual. If a individual moves to another location or prefers to use another hospice, the individual may transfer his or her care.

Hospitalization and Emergency Care

Emergency care should be consistent with the individual’s stated wishes in advance directives and physician orders. Open Door should call the hospice in a timely manner for any change in condition to facilitate reassessment and revision of the plan of care. Open Door should obtain approval of the hospice prior to transferring the individual to another care setting when the transfer is related to the terminal condition. When the transfer is unrelated to the terminal condition, communication with the hospice should occur as soon as possible. All emergency care related to the terminal illness (i.e., pain and symptom management) requires approval and coordination by the hospice.

Utilization of Therapy Services

Ancillary therapies, including infusion therapies; tube feedings; IV therapies; physical, occupational, and speech therapies may be part of the plan of care for a hospice individual. Hospice is responsible for determining if these services are consistent with the individual’s palliative care needs. Hospice and the attending physician must make prior authorization for therapy services.

Last Revised: 6/6/22