Unit
- Hospice philosophy: Hospice care focuses on comfort and quality of life for patients with life-limiting illnesses, neither hastening nor postponing death. The interdisciplinary team addresses physical, emotional, social, and spiritual needs, with the patient and family as the unit of care.
- Levels of care: Medicare defines four levels: routine home care, continuous home care, inpatient respite care, and general inpatient care. Hospice houses typically provide routine home care in a homelike setting, with occasional use of general inpatient care for symptom management.
- Interdisciplinary team roles: Core team includes the medical director, registered nurse, social worker, chaplain, and volunteers. The manager coordinates these roles, ensuring communication and compliance with the plan of care.
- Patient eligibility: Medicare requires a prognosis of six months or less if the disease runs its normal course, certified by two physicians. The manager oversees the certification process and recertification every 60 days.
- Informed consent: Patients must choose hospice voluntarily and understand that curative treatments are discontinued. The manager ensures that consent forms are properly documented and that the election statement is signed.
- Plan of care: A written plan is developed within two days of admission, updated every 15 days, and signed by the attending physician and medical director. The manager monitors compliance and coordinates updates.
- Regulatory foundation: The Medicare Hospice Benefit (Title 42 CFR Part 418) governs all certified hospices. Managers must know conditions of participation regarding patient rights, quality assessment, and reporting requirements.
- Ethical considerations: Autonomy, beneficence, non-maleficence, and justice guide decision-making. Common ethical issues include advance directives, do-not-resuscitate orders, and withdrawal of artificial nutrition. The manager facilitates ethics consultations when needed.
- Symptom management protocols: The interdisciplinary team follows evidenced based guidelines for pain, dyspnea, nausea, and agitation. The manager ensures that standing orders are current, that medications are available in the house, and that staff document symptom reassessment within established timeframes.
- Bereavement support services: Hospice provides bereavement counseling to families for at least 13 months after the patient's death. The manager coordinates the bereavement program, tracks contact with surviving family members, and ensures that volunteers receive appropriate training for grief support visits.
- Volunteer management requirements: Medicare mandates that volunteers provide at least 5 percent of total patient care hours. The manager recruits, trains, and schedules volunteers, maintains records of service hours, and ensures that volunteers are assigned to meaningful roles that supplement the clinical team.
- Quality assessment and performance improvement: Hospices must have a QAPI program that identifies areas for improvement and tracks interventions. The manager collects data on patient satisfaction, adverse events, and compliance indicators, then leads team discussions to implement corrective action plans based on findings.
Scope of Practice
Role: Hospice House Manager (Non-Clinical Administrator)
Within scope:
- Overseeing daily operations and staff scheduling.
- Ensuring compliance with Medicare CoPs and state licensing.
- Coordinating interdisciplinary team meetings and care plan reviews.
- Managing patient intake, admissions, and discharge processes.
- Implementing quality improvement initiatives and tracking outcomes.
Outside scope:
- Diagnosing medical conditions or prescribing treatments.
- Providing direct clinical care such as wound management or medication administration.
- Making medical decisions about patient eligibility or level of care changes.
- Performing spiritual counseling or chaplain services.
- Altering the plan of care without team input and physician order.
Terminology
- Medicare Hospice Benefit
- Federal program covering hospice services for eligible Medicare Part A beneficiaries with a terminal illness.
- Conditions of Participation (CoPs)
- Federal regulations hospices must meet to participate in Medicare and Medicaid programs.
- Plan of Care
- Comprehensive document outlining patient needs, interventions, and goals; reviewed periodically by the IDT.
- General Inpatient Care
- Short-term care for symptom management that cannot be managed at home; typically provided in a Medicare-certified unit.
Quick Revision
- Hospice philosophy centers on comfort and quality of life, with interdisciplinary team support for patient and family.
- Four levels of care exist under Medicare: routine, continuous, inpatient respite, and general inpatient.
- Core team includes medical director, RN, social worker, chaplain, and volunteers; manager coordinates these roles.
- Patient eligibility requires a six-month prognosis certified by two physicians; consent and plan of care documentation are critical.
- Ethical principles guide decision-making; manager facilitates ethics consultations as needed.