临终关怀
Hospice – or “comfort” – care helps patients and their families navigate the complex issues associated with a prolonged illness, 包括医疗护理, financial concerns and living arrangements.
Hospice can be offered in a person’s home or a care facility. It is designed to provide emotional support to patients and families, and to educate caregivers so that they are able to provide physical care to their loved one.
Hospice team members can include a registered nurse, 医务主任, 家庭健康助理, 社会工作者, 精神关怀协调员, a volunteer and your attending physician, if they remain involved in the person’s care. Other team members may include a music therapist, 物理治疗师, speech therapist or occupational therapist.
过渡到临终关怀
不像其他医疗保健, hospice focuses on treating symptoms, such as respiratory distress and pain, rather than trying to cure the illness.
For heart and stroke patients, a hospice referral may come from the cardiologist or neurologist.
A person being moved into hospice care must have a life threatening or terminal illness with a prognosis of 6 months or less to live.
For heart patients, additional symptoms may include recurrent 充血性心力衰竭, an inability for the heart to adequately move blood out of its chambers, 胸部疼痛 在休息的时候, history of cardiac arrest and/or resuscitation, history of unexplained fainting due to loss of blood to the brain (晕厥), and irregular heart rhythms that are resistant to therapy (心律失常). Stroke survivors referred to hospice may have severe lack of consciousness or coma greater than three days duration, difficulty chewing or swallowing (吞咽困难) leaving them unable to eat enough to sustain life and 中风后痴呆.
护理水平
There are four levels of care in hospice.
- 例程: The person is cared for at home or a care facility. Reimbursement to hospice is at a daily rate and all of the members of the team are available to the patient and family as needed.
- 缓解: The patient goes to a facility for short-term care to provide relief to the caregiver. The patient is seen by hospice team members just as they were at their home.
- 连续护理: This type of care is used when the patient is in crisis, with pain or other symptom(s) out of control, and needs to be monitored closely by a nurse. The hours of the nurse and home health aide are counted toward the continuous care hours for reimbursement.
- 住院合同: The patient is placed into a hospice-contracted facility that has a registered nurse on site for 24 hours a day. 对于这种程度的护理, 病人一定处于危急状态, with pain or other symptoms out of control, 不能呆在家里.
金融问题
临终关怀由医疗保险支付, Medicaid and most insurance companies, and will cover medications related to the primary hospice diagnosis, and all equipment and supplies related to the disease needed to care for the patient. 医疗保险 Part A and Medicaid cover 100% of hospice care; however, payment levels vary for private insurance companies.
References: National Hospice and Palliative Organization
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