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What is Hospice

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Admission Criteria

Palliative Care Guidelines

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11 Kennedy Parkway
Cortland, NY 13045
(607) 753-9105

The Hospice upholds the physician-patient relationship established prior to the patient's Hospice admission in accordance with the patient's wishes. These palliative care guidelines have been prepared to assist the patient/family and health care team in their understanding of certain medical aspects of Hospice care.

Hospice care is a specialized form of treatment and services for a patient and family experiencing advanced life threatening disease. The primary focus of care is upon pain/symptom control and other supportive measures. It is an alternative to curative medical regimes which have been shown to be ineffective or which are not desired.

In addition to patients with cancer, persons with other end-stage diseases such as cardiac, chronic lung, ALS, Alzheimer's and AIDS may be appropriate for Hospice care.

Each patient's situation is evaluated by the attending physician and assessed by the Hospice interdisciplinary team. Each Hospice team and every Hospice patient has a Patient Care Coordinator who is a registered nurse. The Hospice Medical Director is available for consultation.

For a procedure and/or treatment to be considered appropriate as palliative care, the patient, primary care person, attending physician, and Hospice interdisciplinary team examine the treatment in light of the patient's limited life expectancy and quality of life at that point in time. Treatment decision making is thus then focused upon enhancing the quality of the patient's remaining life.

According to Hospice regulations and in order to be covered by insurance, all services and medical treatments must be consistent with the Hospice interdisciplinary plan of care (i.e., reasonable and necessary for the management of the advanced disease, and pre-authorized by the Hospice).

A patient-physician decision to reactivate curative therapy or to seek long term remission through medical intervention/s will be respected. Patients are always free to withdraw from Hospice. Under such circumstances the attending physician should let the Hospice know that the patient is no longer appropriate for palliative care. Hospice will make appropriate referrals and/or effect a timely transfer to other health and social services.

Specific guidelines for Palliative Medical Care follow:

1. Health care procedures will be implemented to optimize the patient's physical functioning. Activities of daily living will be supported to the highest degree possible. The patient's family/friends will be encouraged to participate as much as they wish in planning and providing care. Teaching in appropriate care techniques will be offered.
2. DO NOT RESUSCITATE (DNR) is appropriate for Hospice patients and shall be consistent with New York State regulations. However, Hospice staff are not obligated to perform heroic measures such as cardiopulmonary resuscitation (CPR) on a patient for whom a DNR order has not been ordered.
3. Medications will be administered for the control of pain and other symptoms in order to achieve maximum comfort and relief. The expectation is to keep the patient as alert and as involved in the care as possible.
4. Diagnostic tests and other assessments are appropriate only when results are needed for palliation of symptoms. Studies to validate the expected course of disease without the expectation of changing symptomatic treatment are typically no longer appropriate.
5. Radiation therapy may be ordered for Hospice patients for specific symptom control. In order to be authorized, the course and length of treatment must be specified. Such treatment should be discontinued if the therapy is not meeting stated goals.
6. Chemotherapy may be utilized in unique circumstances when it may contribute to patient comfort. The relative risks and benfits of such treatment shall be fully discussed with the patient.
7. Surgical interventions will be utilized only when required and desired for palliation of symptoms.
8. Blood transfusions may be authorized for the patient's comfort in consultation with the Hospice team. at the time when the patient ceases to derive benefit from such intervention, the Hospice team will recommend cessation of transfusions.
9. Antibiotics may be provided in situations when they may contribute to a patient's comfort. Oral medication is the preferred route of administration.
10. Nutrition/Hydration through artificial means (intravenous fluids or clysis, nasograstric, gastrostomy or jejunostomy tubes; total parenteral nutrition) are not routinely administered to the Hospice patient. When a patient has greatly reduced fluid intake related to the normal dying process, fluids are given by mouth as tolerated. Invasive procedures such as intravenous therapy may be considered when such treatment may enhance the comfort of the patient more than non-invasive alternatives.
11. EMERGENCY care for Hospice patients is very unusual. Hospice provides an on-call service which is available to all patients and families 24 hours a day, 7 days a week to handle questions, problems and emergencies and to provide home assessment of problems. Ambulance or emergency room services are not covered unless authorized by the Hospice team plan of care.
12. Assisted suicide or voluntary euthanasia in the care of the terminally ill is rejected by Hospice.

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