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By AccentCare
When you have a dying patient with complex clinical needs who may be wary of hospice, you need an experienced partner you can trust to provide excellent care and support.
All ‘Mildred’ wanted was to smell the salt air.
She had been on a ventilator, and with COVID protocols limiting visitors to the hospital she couldn’t see her family. She knew she was dying, and all she wanted was to get back home, have her windows open, and smell the salt air of the Pacific.
Getting a patient back home, on a vent, in the middle of a COVID-19 pandemic is a tall order. Many healthcare professionals balk at the concept of managing that level of acuity in a home setting. But if it’s what the patient wants, there is a way to honor these wishes, increase the quality of life, and provide better health system outcomes and CAHPS scores.
Open Access Hospice
You might see patients on a daily basis who would benefit from and are eligible for the care hospice can provide. However, one of the biggest barriers for healthcare professionals and patients and families to hospice is the fear of giving up. To receive the Medicare Hospice Benefit, patients must forego curative care. In the case of highly acute or very ill patients, this decision can be even more difficult.
If Mildred wanted to get home on a vent, it’s hard for a clinician to arrange that outside of the walls of their hospital. But the right hospice can help you do this.
If you have a patient who is eligible for hospice but may have high needs or complex care, Open Access is an innovative program that clinically advanced hospices can provide. It allows for a bridge to hospice for eligible patients with high acuity needs such as:
- Ventilator support and compassionate weans
- IV antibiotics
- IV nutrition and IV heart medications
- Cardiac drips
- Chest tubes
- Hemo/peritoneal dialysis for hospice diagnosis
- Palliative radiation
- Biological response modifiers i.e., Procrit®, Neupogen®, Epogen®
- Patients who need additional time to complete the discharge planning from the acute care setting
A robust open access program can free up much-needed hospital beds and help patients like Mildred get home and weaned from a vent where she wants to be: not in a hospital that may have restrictive visitation policies in place due to COVID-19, but instead surrounded by family in the comfort of her own bedroom.
Additionally, because Mildred elected hospice, she’ll not only be supported by expert clinical staff who can facilitate a complex procedure like transportation on a vent with weaning in the home, but also:
- Durable Medical Equipment delivery and setup
- Comfort pack medications
- Strong psychosocial support, including special team members such as Board-Certified Music Therapists who can help ease pain and anxiety during an extubation.
And Mildred’s family will receive at least 12 months of bereavement support after she dies, regardless of how long she was on hospice. Hospices are now offering virtual grief groups to meet bereaved families’ needs during the pandemic.
Who pays for Open Access?
Open Access is covered under the Medicare Hospice Benefit with no copays or premiums. Hospices manage any associated costs with covered Open Access needs.
What does it take to provide Open Access?
Not all organizations have the sophistication and ability to offer transitions to hospice for high-needs or acute patients. Ensure your hospice partner has the experience and resources to offer an Open Access program. Some questions to consider would be:
- Do they have expert clinical staff and national resources to draw upon?
- Are they able to provide the general inpatient level of hospice care, or continuous care?
- Can they provide you with case studies of patients with acute needs that they’ve served?
See firsthand how our patient Kay got to experience the end of life at home,
just how she and her family wanted.