Information for providers

Below is information and guidance for providers. However, we are happy to answer questions about your patients directly if you prefer to call and speak with a doctor.  If so, please call us at:

 505-872-2300.

Refer a patient

The information provided here is based on Medicare guidelines.  These guidelines are not strict criteria. For accurate determination for hospice eligibility, an evaluation by a hospice professional is necessary.

Provider FAQ’s

Is my patient ready for hospice?

Some features are common in patients when they ready for hospice and help determine appropriateness but not all patients exhibit these findings:

  • Frequent hospital or emergency department visits
  • Decline in function – difficulties with walking or transfers, recently bedbound
  • Recurrent infections
  • Progressive weight loss
  • Declining mental function
  • Increasing dependence for most Activities of Daily Living
  • Multiple co-morbidities
Who should receive hospice care?

Patients with a condition that has created a life expectancy of 6 months or less if the disease were to run it’s natural course.

Patients who have chosen comfort care which focuses on relief of symptoms rather than curative care.

Patients who decline extreme life-saving or life-sustaining measures

Guidelines for common hospice diagnoses

Alzheimer’s Disease

  • Unable to walk without assistance
  • Urinary and fecal incontinence
  • Speech limited to a few words
  • Unable to dress without assistance
  • Complications: pneumonia, UTI, sepsis, pressure ulcers
  • Difficulty swallowing/eating
  • Weight loss

Amyotropic Lateral Sclerosis

  • Unable to walk,
  • needs assistance with ADLs
  • Barely intelligible speech
  • Difficulty swallowing
  • Weight loss
  • Significant dyspnea
  • Co-morbidities/complications: pneumonia, URI

Cancer

  • Metastases to multiple sites    
  • Weight loss
  • Patient/family chooses palliative care

Cardiac Disease

  • Optimally medically treatments in place or attempted, OR
  • Not a surgical candidate, OR
  • Pt declines surgical options
  • Pt has NHYA Class IV (symptoms of heart failure or angina at rest)

Liver Disease

  • Helpatic encephalopathy
  • Recurrent variceal bleeding
  • INR > 1.5 and Albumin <2.5
  • And one of the following:
  1. Refractory ascites or pt noncompliance
  2. Spontaneous bacterial peritonitis
  3. Hepatorenal syndrome and urine sodium <10mEq/l

Pulmonary Disease

  • Dyspnea at rest – bed to chair existence
  • FEV1 <30% predicted helpful but not necessary
  • Progression of pulmonary disease – increased medical visits, infections
  • Also helpful but not required:
  1. Hypoxemia at rest on RA or Hypercapnia
  2. Right heart failure
  3. Unintentional wt loss
  4. Resting tachycardia >100/min

Acute Renal Failure

  • One of three below:
  • Pt is not seeking or continuing dialysis or transplant
  • Creatinine clearance <10cc/min or <15cc/min for diabetics
  • Creatinine >8.0 or > 6.0 for diabetics
  • Also helpful but not required:
  1. Mechanical ventilation
  2. Malignancy
  3. Chronic lung disease
  4. Advanced cardiac disease
  5. Advanced liver disease
  6. Sepsis
  7. Cachexia, Albumin <3.5

Chronic Renal Disease

  • One of three below:
  • Pt is not seeking or continuing dialysis or transplant
  • Creatinine clearance <10cc/min or <15cc/min for diabetics
  • Creatinine >8.0 or > 6.0 for diabetics
  • Also helpful but not required
  1. Uremia
  2. Oliguris (<400ccc/24h)
  3. Intractable hyperkalemia
  4. Uremic pericarditis
  5. Hepatorenal syndrome
  6. Intractable fluid overload

Stroke

  • Karnofsky Performance Scale or Palliative Performance of 40% or less
  • Inability to maintain hydration and caloric intake:
  1. Wt loss of 10% in the last 6 mo or >7.5% in the last 3 months
  2. Serum albumin <2.5
  3. Current history of pulmonary aspiration
How to speak about hospice
  1. Patients often lose sight of the big picture

Starting with summarizing the disease process, what has been going on, what changes have been observed and what the patient may have been through can help set the stage for exploring how the patient feels about the course they have taken and what decisions they have.

  1. Most patients want to know what to expect

Often we as physicians are so accustomed to the disease process, we forget that the patient may not know what normally happens in the course of the disease. Start by asking the patient or loved one what and how much they want to know. Explaining what course the disease will take and what it will be like for the patient can help give them information they seek.

  1. Ask the patient what is important to them

Patients may feel strongly about treatment options but feel that they are not supposed to decline what is offered them by their doctor. Giving them an option: “Some people don’t want to go back to the hospital again and choose to have all of their care in the home.”

  1. Encourage the patient and family to ask questions

The more information patients and families have the less anxiety they may feel but allowing them to ask for the information and how much information they want, can help guide the conversation and lead to a positive outcome.

  1. Explain hospice as another care option

Hospice is a form of medical care that is tailored to the wishes of the patient based on what is important to them. While not curative, it’s designed to help patients live as well as they can for as long as they have left.

  1. Hospice care allows patients and families care and support in the home

Most patients prefer to be in their own home and that’s where the majority of hospice care is delivered. In rare cases, if symptoms cannot be managed at home, patients can receive in patient hospice care.

  1. Hospice isn’t about giving up or when nothing else that can be done.

It’s about living as fully and comfortably as possible with care that is focused on their wishes, for as long as they are living. Patients often live with better quality of life and for longer when under hospice care.

  1. Hospice is reversible

Even with as much as we know about diseases and their courses, patients still surprise us with changes in their course. Patients who stabilize often will graduate from hospice and can return to hospice whenever their status warrants it.

  1. Hospice of New Mexico treats both the family and the loved ones

Caring for the hospice patient is what we do, but that cannot be done properly without considering the caregivers and family. We at Hospice of New Mexico consider both the hospice patient and their loved ones as our patient. We watch out to make sure that caregivers are supported, not becoming exhausted, and understand the need to care for themselves too. The hospice Medicare benefit offers periodic respite care to allow families to get some rest of their own.

  1. Help patients and families understand the need for joy

Just because someone is at the end of their lives, doesn’t mean they cannot or should not find happiness and meaning in the days that they and their families have together.

What is covered?
Hospice care includes medications for pain and other symptoms caused by the condition for which they are on hospice, durable medical equipment (hospital bed, walker, commode, etc), and if needed, nutritional counseling, inpatient care for symptom management, respite care to relieve caregiving responsibilities of the loved ones.
Who pays for hospice?
Hospice is a benefit covered by Medicare, Medicaid and most private insurances.
Who is on the hospice care team?

Members of the Hospice of New Mexico Care team have one goal – to bring compassionate care and comfort to those facing a life-limiting illness and their loved ones. They each have special expertise in the management of physical, emotional and spiritual needs that arise during end-of-life care. 

Hospice medical director is a physician specializing in hospice care who collaborates with the patient’s attending physician and provides expert advice to the Hospice team. 

Hospice nurse provides symptom management expertise to improve the patient’s comfort. This includes empowering patients and caregivers with strategies for personal care, maintaining comfort, use of medications, and other needs as they arise.    

Hospice social worker provides emotional and anticipatory grief support along with assistance in identifying community resources for caregiving support, advanced directives and funeral home planning.   

Hospice pharmacist provides consultation to the Hospice Team regarding medication management.

Certified nursing assistant (CNA) provides scheduled visits to assist with the patient’s personal care and to instruct family members/caregivers on how to meet the patient’s day to day care needs. 

Hospice Volunteers are specially trained to support the needs of terminally ill individuals and their families. They offer companionship, compassionate presence, and practical household support (such as errands and light household chores). 

Chaplain offers in-depth listening to the hopes, fears and concerns of the patient and/or family using a non-denomination approach. 

Bereavement coordinators support families in their grief after the loss of their loved one through individual counseling, informational mailings, support groups and workshops

How may we be of help?

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