CPM Fall 2019 - 20

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My advice to patients and families is to
take it one step at a time. Like any journey,
identify where you are today and where you
can safely be in the near future. This may not
be where the patient wants to be, but where
he or she needs to be based on the diagnosis.
This plan of care may continue to change
depending on how the patient responds to
factors like rehabilitation or the progression
of the disease.
The first step is a life assessment with the
patient, family members and physician to
develop a care plan based on the patient's
diagnosis and realistic goals. This often
occurs after a patient has been hospitalized.
Hospital stays can be short, making the life
assessment a critical step in planning a holistic
treatment of care.
It's not unusual for patients and families
to be surprised to learn the patient will
be discharged. Families may find comfort
knowing their loved one is safe and cared for
in the hospital and mentally put off making
the difficult decisions about next steps. Often,
patients and their families will make decisions
based on what they want, like their loved
one returning home, and not on their new
reality. Without proper support in place, a
hasty decision to return home could result in
a fall or injury causing a repeat hospitalization
and further decline in health.

Patients, families and their health care team
want to try every possible opportunity to
help the patient return to his or her former
self. This often leads to acute rehab, which
includes three hours of therapy a day to help
patients reach this goal. This type of therapy
is financially appealing as it's a covered service
by insurance providers.
Far too often, patients cannot keep up with
the intensive therapy. When this happens, the
insurance coverage ceases. Patients will be
discharged to their homes or a skilled nursing
facility to receive subacute care, which offers
limited therapy. This type of care is private
pay or paid by medical assistance.

Once the care plan is in place and implemented, the patient develops a new baseline
or "new normal" based on the successful or
unsuccessful outcome of treatment such as
rehab or medications. In a best-case scenario,
Patients and their families are once again
the patient will fully recover and can return on the rollercoaster of difficult decisions.
to his or her home.
The gravity of the patient's age and disease
progression settles in as does questions about
More often, the patient is facing greater affording long-term care. Most importantly,
physical and/or mental challenges and must families must consider the quality of life of
face difficult decisions about acute or subacute their loved one during this season of life.
rehab or hospice care. In my profession, I see
this as a defining moment for patients and
As health care professionals, we're the colfamilies. It's an emotional and overwhelming lective lifelines for patients and their families.
time to learn and understand the impact of We may not know all of the answers, but we
these choices. Often the decision is made in know who to bring to the table to answer
haste, as the patient needs to find a place to questions about prognosis, treatments and
go upon discharge from the hospital.
insurance coverage, among other important
topics. This conversation may include the
20 Fall 2019 Central PA Medicine

end-of-life journey through hospice care. The
conversation can be difficult, but the benefits
are immeasurable.
For patients who choose hospice care, it's
best to get started as soon as possible. Hospice
provides a team of support to give families
more time to absorb the emotional stress of
their new reality. This is precious time for
families to spend together as well as deal with
any unresolved issues. Most importantly, the
patient's pain and symptoms are managed.
Homeland Hospice often assists physicians
with end-of-life, advance care planning conversations. We also can be a tremendous asset
bringing comfort, acceptance and peace to the
terminally ill and their loved ones. Patients
can receive hospice care anywhere they call
home. This could be a residence or an assisted
care facility.
Planning for the final steps in our journey
or that of a loved one is overwhelming and
emotional, but it's not a journey anyone has
to plan independently without professional
guidance. No one needs to go through this
alone. When a life assessment indicates a
medical cure is no longer possible or the
decision to stop aggressive treatment has been
made, hospice may provide the most comfort
and peace for patients and their families.
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CPM Fall 2019

Table of Contents for the Digital Edition of CPM Fall 2019
