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Guidelines for End-of-Life Care in Long-Term Care Facilities

Guidelines for End-of-Life Care in Long-Term Care Facilities With Emphasis on Developing palliative Care Goals Guidelines for End-of-Life Care in Long-Term Care Facilities With Emphasis on Developing palliative Care Goals Guidelines for End-of-Life Care In Long-Term Care Facilities Emphasis on Developing palliative Care Goals Developed by missouri End of Life Coalition's End of Life in the Nursing Home Task Force missouri Department of Health and Senior Services Division of Senior Services and Regulation September 2003. missouri Department of Health and Senior Services Division of Senior Services and Regulation missouri End of Life Coalition's End of Life in the Nursing Home Task Force Post Office Box 570, Jefferson City, MO 65102-0570.

Force to provide guidance on appropriate palliative care objectives for residents in long-term care facilities. The task force and the Missouri Department of Health and Senior Services, Division of Senior Services and Regulation have produced this consensus document. Between 2001

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Transcription of Guidelines for End-of-Life Care in Long-Term Care Facilities

1 Guidelines for End-of-Life Care in Long-Term Care Facilities With Emphasis on Developing palliative Care Goals Guidelines for End-of-Life Care in Long-Term Care Facilities With Emphasis on Developing palliative Care Goals Guidelines for End-of-Life Care In Long-Term Care Facilities Emphasis on Developing palliative Care Goals Developed by missouri End of Life Coalition's End of Life in the Nursing Home Task Force missouri Department of Health and Senior Services Division of Senior Services and Regulation September 2003. missouri Department of Health and Senior Services Division of Senior Services and Regulation missouri End of Life Coalition's End of Life in the Nursing Home Task Force Post Office Box 570, Jefferson City, MO 65102-0570.

2 About Us The missouri Department of Health and Senior Services enhances quality of life for all Missourians by protecting and promoting the community's health and well being of citizens of all ages. Richard Dunn, Director missouri Department of Health and Senior Services David Durbin, , Director Division of Senior Services and Regulation AN EQUAL OPPORTUNITY/AFFIRMATIVE ACTION EMPLOYER. Services provided on a nondiscriminatory basis The missouri End of Life Coalition Mission Statement The missouri End-of-Life Coalition is committed to fostering cooperation, education, and research to promote high quality care for the dying.

3 Chairman - Steven Zweig, MD, MSPH, Professor, School of Medicine, University of missouri - Columbia Vice Chairman/Chairman Elect - Jim Duff, Diagnostic Clinic, Springfield Secretary - Debbie Oliver, PhD, Associate Professor, University of missouri -Columbia School of Social Work Treasurer - Jane Armer, PhD, RN, Director, Nursing Research, Ellis Fischel Cancer Center and Associate Professor, University of missouri -Columbia Sinclair School of Nursing Executive Secretary - Cindy Baird, missouri Hospice and palliative Care Association Past Chair - Clay Anderson, MD, Assistant Professor, University of missouri School of Medicine Disclaimer The Guidelines in this manual are not a guarantee of compliance with the regulations for Medicare/Medicaid certified Facilities and missouri licensure.

4 Before implementing these Guidelines , each facility must develop written policies and procedures, specific to each facility, and instruct their staff regarding the appropriate use of these tools. We also recommend that the facility's legal counsel review its policies and procedures prior to implementing them. Acknowledgments The missouri Coalition's End of Life Task Force gratefully acknowledges the Nursing Facility Quality of Care Fund and Incarnate Word Foundation whose generous gift enables us to provide a copy of this manual to each intermediate care and skilled nursing facility in missouri .

5 Emphasis on Developing palliative Care Goals Recognizing a continuing need to discuss critical issues related to developing and revising plans of care for patients residing in nursing Facilities at the end of life, the missouri End of Life Coalition established an End of Life in the Nursing Home Task Force to provide guidance on appropriate palliative care objectives for residents in long- term care Facilities . The task force and the missouri Department of Health and Senior Services, Division of Senior Services and Regulation have produced this consensus document. Between 2001. and 2003, the group met with key healthcare agencies and organizations throughout missouri to ensure that expertise in Long-Term care, pain and symptom management, nutrition, spiritual and psychosocial care, administration, and public health were fully represented.

6 The goals of the task force were to identify barriers to proper End-of-Life care;. increase the clarity of the value and role of End-of-Life care goals for LTC facility residents and their families;. develop clinical tools to assist in the identification of appropriate residents for End-of-Life care goals and educate care givers about these goals provide for their implementation and appropriate use;. identify common language and culture difference and provide education to develop clearer communication;. investigate barriers to providing effective hospice services in nursing Facilities by profiling existing Facilities where hospice care is provided effectively and efficiently.

7 Review the conditions of participation related to hospice in facility settings;. develop a process by which LTC Facilities are encouraged to utilize hospice to provide the benefit from hospice care for dying patients and their families;. provide education for hospices, long- term care Facilities , hospice regulators, and long- term care regulators on nursing Facilities requirements regarding hospice and End-of-Life care for LTC Facilities residents. The resulting Guidelines are a source of information for facility staff. End of Life in the Nursing Home Task Force Marlene Anderson Mary Mitchell, BS, RN.

8 Director of Operations Vice President, Resident Services missouri Health Care Association Health Facilities Management Cindy Baird Debbie Oliver, MSW, PhD. Executive Director School of Social Work, University of missouri Hospice & palliative Care missouri -Columbia Association Deborah Reynolds, LPA. Denise Clemonds Admissions Coordinator Executive Director Boone Retirement Center missouri Association of Homes for the Aging Don Reynolds, JD. Midwest Bioethics Center Charles Crecelius, MD, FACP, CMD. missouri Association of Long Term Yvonne Schwandt, RN. Care Physicians Pathways Community Hospice Ginger Farley, ACSW, LMSW, LCSW Carol J.

9 Scott Hospice Preferred Choice State Long-Term Care Ombudsman missouri Department of Health and Janet Gard Senior Services Program Director Community Hospice of America Pamela C. Shipman, RN, BSN. Tri Lakes Vice President of Operations for Delmar Gardens Enterprises Linda Grotewiel, RN. Bureau Administrator Stephen Smith, MDiv missouri Department of Health & Senior Liberty Hospital Services, Division of Senior Services and Regulation Betty Markway, RN, MSN. missouri Department of Health and Senior Services, Division of Senior Services and Regulation Review Committee Department of Health and Senior Services, Division of Senior Services and Regulation: Lisa Byergo, BS Patricia Prince, RNC.

10 Janice Frank, RN Bonnie Quick, RN. Linda Grotewiel, RN Garry Thompson, MSW. Nina Hazelton, JD Shelly Williamson, BS, MS. Betty Markway, RN, MSN. A special thank you to Rachel Reeder, Editor, Midwest Bioethics Center, for her contributions to this publication. Section: Table of Contents Page 1 of 4. Issued 09/01/2003. Guidelines FOR END OF LIFE CARE IN. Long-Term CARE Facilities . Emphasis on Developing palliative Care Goals CONTENTS. Introduction Purpose Dying in Nursing Homes Defining palliative Care Principles of palliative Care Identifying Patients for palliative Care References Goals of Care Purpose and Objectives Individualized Care Purposeful Observation and Conversations Advance Care Planning A.