Hospice

Oakwood Annapolis Hospital (OAH) has a dedicated Hospice and Palliative Care Unit in partnership with Hospice of Michigan (HOM), the state’s original, and largest hospice provider. The opening of this unit demonstrates Oakwood’s commitment to providing high quality care for patients through the end of life.

The Hospice and Palliative Care Unit provides additional options to care for patients whose advanced illnesses are causing them physical, emotional and spiritual distress.

HOM will serve as a resource to OAH staff by providing expertise in hospice and palliative care. HOM has more staff certified in hospice and palliative care than any other hospice in the state. The partnership between Oakwood and HOM was inspired by a shared vision to provide expert, comprehensive, compassionate care for patients with advanced illness whose symptoms cause undue suffering for the patient and family.

Q. What are hospice and palliative care?
A: Considered to be the model for quality, compassionate care for people facing a life-limiting illness or injury, hospice and palliative care involve a team-oriented approach to expert medical care, pain management, and emotional and spiritual support expressly tailored to the patient’s needs and wishes. Support is provided to the patient’s loved ones as well. At the center of hospice and palliative care is the belief that each of us has the right to die pain-free and with dignity, and that our families will receive the necessary support to allow us to do so.

Hospice focuses on caring, not curing. Hospice services are available to patients of any age, religion, race, or illness. Hospice care is covered under Medicare, Medicaid, most private insurance plans, HMOs, and other managed-care organizations and requires a prognosis of six months, or less, if the disease runs its natural course.

Palliative care extends the principles of hospice care to a broader population that could benefit from receiving this type of care earlier in their illness or disease process. No specific therapy is excluded from consideration and there is no time frame for service . An individual’s needs must be continually assessed and treatment options should be explored and evaluated in the context of the individual’s values and symptoms.

Q: Why is there a separate unit for hospice and palliative care?
A: OAH's Hospice and Palliative Care Unit primarily will be for patients who qualify for hospice general inpatient (GIP) level of care. The unit may also be utilized by patients with palliative care needs, even if their illness does not make them eligible for hospice care.

Q: How many patients can be cared for in the unit, and who will provide the majority of care?
A: There are six beds in the unit dedicated to hospice and palliative care. The patients will be cared for by OAH staff, with guidance from HOM.

Q. Who qualifies for hospice GIP level of care?
A: GIP level of care is always short-term, typically a few days. Patients are evaluated on a case-by-case basis and generally may be admitted for pain or symptom that is uncontrolled despite aggressive treatment efforts or when death is imminent and symptoms are uncontrolled. Patients may also be admitted when the physician and hospice interdisciplinary team (IDT) believes the patient needs pain and symptom management that cannot feasibly be provided in other settings. Some examples of uncontrolled symptoms include but are not limited to:

Pain and/or other symptoms (i.e. dyspnea, nausea, delirium, anxiety) requiring aggressive and frequent medication titration;
Other complicated care such as frequent suctioning, dehydration, recurrent seizures, rapidly accumulating ascites or rapid fluid retention causing pain;
Continued discussion about the benefits/burdens of therapies;
Brief transition for discharge to home or other care center.

Q. What steps are taken to transition to GIP care?
A. Admissions to the unit are coordinated with the patient’s physician, Oakwood discharge, palliative care team, and the HOM team. Patients may come from home settings, another Oakwood facility or from OAH. When a patient meets criteria for general inpatient level of care, a physician writes an order for inpatient hospice care. Consent for inpatient care must be provided by the patient or representative. If the patient is already hospitalized, the patient is discharged from acute care and admitted as an inpatient hospice patient. HOM maintains professional responsibility for their patient and works with OAH staff to develop the plan of care. Interventions are focused on comfort and quality of life. Aggressive, diagnostic or life-prolonging treatment is not appropriate in GIP hospice care. The hospice H&P (history and physical) and physician orders must be completed and signed by the physician after which HOM personnel conducts initial assessments (nursing, social services and chaplain). The OAH nurses and staff on the unit continue to provide the care in accordance with hospice’s plan of care.

Q: What are the specific services provided?
A: Among its major responsibilities, the hospice inter-disciplinary team:

Manages the patient’s pain and symptoms;
Assists the patient with the emotional, psychosocial and spiritual aspects of dying;
Provides needed drugs, medical supplies, and equipment;
Coaches the family on how to care for the patient;
Delivers special services like physical and occupational therapy when needed;
Provides bereavement care and counseling to surviving family and friends.

Q. Who is the attending physician?
A. The patient’s primary care physician may continue as the attending physician or may transfer care to another OAH physician. Physicians who do not have privileges at OAH and who wish to continue as the attending physician may request temporary/emergency privileges through the Medical Staff Office. The attending physician will continue to round with the patient per hospital guidelines and be responsible for oversight of the care provided. Hospice of Michigan has physicians on staff at Oakwood facilities with consulting privileges.

Q. How are patients transported to the facility?
A. Transportation to the unit from other facilities or from home settings is coordinated through Oakwood HealthLink and Patient Transfer Center.

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