Name of the Procedure:

Hospice Care Provided in Inpatient Hospital (HCPCS Code: Q5005) Common Name(s): Inpatient Hospice Care, Hospital-Based Hospice

Summary

Hospice care provided in an inpatient hospital setting focuses on offering compassionate care to terminally ill patients who have a life expectancy of six months or less. This care aims to improve the quality of life for the patient by managing pain and other symptoms, providing emotional support, and addressing the spiritual needs of both patients and their families.

Purpose

• Medical Conditions Addressed:

  • Terminal illnesses such as advanced cancer, heart failure, chronic obstructive pulmonary disease (COPD), and other progressive, life-limiting conditions.

• Goals or Expected Outcomes:

  • Alleviate pain and discomfort
  • Enhance the quality of life
  • Provide holistic support to patients and their families
  • Facilitate a peaceful end-of-life experience

Indications

• Specific Symptoms or Conditions:

  • Severe, unmanageable pain
  • Advanced, progressive illness
  • Frequent hospitalizations with little to no improvement
  • Significant decline in physical or cognitive function

• Patient Criteria:

  • Life expectancy of six months or less
  • Desire for comfort care over curative treatment
  • Comprehensive needs that cannot be managed in an outpatient setting

Preparation

• Pre-Procedure Instructions:

  • Consultation with the hospice care team
  • Discussion of patient’s and family’s wishes and goals
  • Completion of necessary paperwork, including advance directives

• Diagnostic Tests or Assessments:

  • Basic health assessments to determine the current state of the patient’s condition
  • Review of medical history

Procedure Description

1. Admission:

   • The patient is admitted to an inpatient hospice unit within a hospital.

2. Assessment:

   • Comprehensive assessment by a multidisciplinary hospice team including doctors, nurses, social workers, and chaplains.

3. Care Plan Development:

   • Creation of a personalized care plan focusing on symptom management, pain relief, emotional and spiritual support.

4. Ongoing Care:

   • Continuous monitoring and adjustments to the care plan as needed.

   • Provision of medications, therapies, and counseling services.

   • Tools, Equipment, or Technology:
   • Hospital bed, monitoring devices, intravenous therapy equipment, medications.

• Anesthesia or Sedation:
  • Generally not applicable unless used to manage severe symptoms or pain.

Duration

The length of stay can vary significantly, ranging from a few days to several weeks, based on the patient's condition and care needs.

Setting

Inpatient hospice care is provided within a hospital, often in a specialized hospice or palliative care unit.

Personnel

• Healthcare Professionals Involved:
  • Hospice physicians
  • Registered nurses
  • Social workers
  • Chaplains or spiritual care providers
  • Counselors and volunteer support staff

Risks and Complications

• Common Risks:

  • Potential for drug interactions
  • Management of symptoms can sometimes lead to side effects (e.g., constipation from pain medication)

• Rare Risks:

  • Unforeseen medical complications related to the patient's underlying conditions

• Possible Complications Management:

  • Regular monitoring and prompt adjustments to treatments to address any complications

Benefits

• Expected Benefits:

  • Relief from pain and symptoms
  • Emotional and psychological support
  • Improved quality of life
  • Peaceful and dignified end-of-life experience

• Realization of Benefits:

  • Benefits are typically realized immediately after initiating care, with ongoing adjustments to improve patient comfort.

Recovery

• Post-Procedure Care:

  • Continued care and monitoring
  • Emotional and bereavement support for the family

• Expected Recovery Time:

  • Not applicable, as hospice care focuses on comfort rather than recovery

• Restrictions or Follow-Up:

  • Regular reviews and updates to the care plan as the patient's condition evolves

Alternatives

• Other Treatment Options:

  • Home hospice care
  • Palliative care in outpatient settings
  • Curative treatments with less focus on comfort

• Pros and Cons of Alternatives:

  • Home hospice care allows for a familiar environment but may lack the immediate availability of medical interventions.
  • Outpatient palliative care can manage some symptoms but might fall short for patients with advanced, complex needs.
  • Curative treatments may extend life but often come with increased discomfort and a lower focus on holistic quality of life.

Patient Experience

• During the Procedure:

  • Patients can expect frequent visits from healthcare providers.
  • Care is focused on comfort, so pain management and symptom relief are prioritized.

• After the Procedure:

  • Patients typically feel a reduction in pain and discomfort.
  • Emotional and psychological support helps in coping with the end-of-life process.