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Hospice

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					Hospice
    Veronica Southard PT MS GCS
Philosophy
 1. Accepts dying s a natural process
 2. Dying is a human not medical process
 3. Quality of life is more important than
  quantity
 4. Patient and family unit direct the care
  needs.
Types of patients on Hospice
 End Stage:
     Parkinsons
     Dementia
     Cardiacs
     AIDs
     Cancer
Goals of Hospice
 1. Promote safe and comfortable dying
 2. Empower the client to self determine life
  closure
 3. Promote effective grieving before and
  after death
 4. Support self care and independence in
  achieving these goals
Origins of Hospice
 Dame Cicily Saunders
 US programs
Core staff required
               RN
               SW
               MD
            CHAPLAIN
Why involve therapists?
 Mobility issues
 Functional decline
 Provide support
Role of the therapist
 Provide our skills to the team
 Develop skills relevant to terminal care
Clinical PT for hospice pts.
   Challenge is that some will improve
   Your program may be “Rehablyte”
   Rehab in reverse
   Educate caregivers
What to do?
 PT.s may incorporate:
     TENS, Biofeedback, Massage, Ther Ex
     Bed mobility, Transfers
Focus on Function
 Achieve best result with the least amount of
  energy
 Make biomechanical adjustments to
  equipment
 Enable pt. to achieve a functional desire
 Allow them to decide what they want to do
EXERCISE
   Don’t place your values on these pts.
   Limited reserves
   1-2 exercises may be adequate
   Prioritize what is most important
Caregiver Training
 You’re only there for an hour.
 Instruct and give feedback to responsible
  caregiver.
 Break down tasks to make them easier
Commitment
 See the pt. less frequently but try to stay in
  longer.
 They have already lost the surgeon, PCP,
  even the oncologist sometimes
Communication
 Make sure the team knows how important
  you are.
 Each pt. is reviewed every 2 weeks
 Talking with other team members affords
  support for you
 PTs are often called in to train volunteers
  and staff
Reimbursement
 Medicare hospice benefit is about $100./
  day
PT GOALS
 Maximize function
 Provide comfort measures
 Train caregivers
Communication
 Most difficult part
 Listen to their story, validate them and their
  experience
 It’s OK we don’t have the answers
 Provide support
Comfortable Communication
   PT related issues
   Disease process education
   Pathology of the disease
   Exertion
5 things people can do to have
closure
   1.   Ask for forgiveness from someone
   2.   Give forgiveness
   3.   Be able to say thank you
   4.   Be able to say I love you
   5.   Be able to say goodbye
Why work in Hospice?
 We have empathy for the dying
 Within ourselves we can struggle with other
  people’s fears
 We can enter that house with unconditional
  love, no baggage, use our skills, and
  acknowledge their courage.
 The family can emulate some of the above

				
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posted:11/23/2011
language:English
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