Palliative Care

Michele Loos, MS, APRN, FNP-CMichele Loos, MS, APRN, FNP-CClinical Assistant Professor: University of New HampshireClinical Assistant Professor: University of New HampshireNurse Practitioner: Supportive and Palliative Care / Prompt CareNurse Practitioner: Supportive and Palliative Care / Prompt CareWentworth-Douglass Hospital and Wentworth Health PartnersWentworth-Douglass Hospital and Wentworth Health Partners

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Palliative care reduces suffering as elicitation of patient derived goals of care focus interventions at relief of physical,

psychosocial and spiritual distress.

Cure Sometimes

Cure Sometimes

Relieve Often

Relieve Often

Comfort Always

Comfort Always

Patient

Family

Team

CURERELIEVE COMFORT

CURERELIEVE

COMFORT

Extra Layer of Support

Think of us as your girdle.....

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CURERELIEVE √

COMFORT √

CureSometimes

Relieve Often

Comfort Always

Hospice

Palliative

Supportive

Palliative Care vs HospiceCharacteristic Palliative Care Hospice

Model of Care Interdisciplinary team, including physicians, nurses, social workers, chaplains, and staff from other disciplines as needed; primary goal is improved quality of life.

Interdisciplinary team, including physicians, nurses, social workers, chaplains, and volunteers, as dictated by statute; primary goal is improved quality of life and relief of suffering (physical, emotional, spiritual)

Eligibility Patients of all ages and with any diagnosis or stage of illness; patients may continue all life-prolonging and disease directed treatment.

Patients of all ages who have a prognosis of survival of < 6 mo, if the disease follows its usual course; patients must forgo Medicare coverage for curative and other treatments related to terminal illness.

Place Hospitals (most common), hospital clinics, group practices, cancer centers, home care programs, or nursing homes.

Home (most common), assisted living facilities, nursing homes, residential hospice facilities, inpatient hospice units, or hospice-contracted inpatient beds.

Payment MD and NP fees by Medicare B for IPT/OUTPT, hospital teams Medicare A/commercial insurance. Flex bundle payments Medicare Advantage, Managed Medicaid, ACOs, commercial payers.

Medicare hospice benefit; commercial payer benefit, Medicaid (varies by state); medication costs covered for illnesses related to terminal illness.

Kelley, A.S. and Morrison, R.S. (2015). Palliative care for the seriously ill. New England Journal of Medicine, 373(8), 747-755.

Where are we headed?

Source: CAPC.org

Be the change you wish to see in the world.

-Ghandi

“I thought this (dying) would be the worst trip of my life. Instead, it’s turned out to be the best”.

“Thank you for helping our father have the best trip of his life, and we are blessed to have been part of

this final journey”.

Questions?

Resources:www.capc.org

www.getpalliativecare.orgwww.aahpm.orgwww.nhpco.org

www.ihi.orgwww.rwjf.org

NEJM