Hospice is an all-encompassing service available for patients with a prognosis under 6 months. Under the Medicare hospice benefit, patients eligible for hospice are greater than 65 years or receiving Medicare disability payments. At the start of care, two physicians must sign a statement certifying that the patient’s life expectancy is six months or less based on their best estimate of the patient’s medical prognosis. While hospice benefit was originally designed for Medicare recipients, most insurance providers cover hospice care for patients not eligible for Medicare. But hospice eligibility depends on more than only a physician determining a prognosis of six months or less until death.
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Determining Prognosis: Patients with End-Stage Cardiac Disease (Reading & Sharing)
The principles for determining when patients with end-stage cardiac disease require end-of-life care, are actually similar to those for determining prognosis of patients with advanced pulmonary disease.
- Dyspnea or chest pain with rest or minimal exertion and can therefore classified as New York Heart Association class IV (NYHA class IV)
- Ejection fraction less or equal 20%, if available
- Persistent symptoms despite optimal medical management with vasodilators and dialectics, or
- Inability to tolerate optimal medical management due to hypotension and/or renal failure
Euthanasia- Good Death vs Killing on Request (Reading & Sharing)
The increased interest in physician aid in dying/assisted suicide is one of the reasons for the growth in palliative care and hospice care.
The word euthanasia is combination of the Greek eu= good, and thanatos = death. Literally and etymologically it therefore means “good death”. Historically and scholarly, euthanasia in the strict- and in the Dutch context the only proper- sense refers to the situation in which a doctor kills a person who is suffering “unbearably” and “hopelessly” at the latter’s explicit request (usually by administering a lethal injection)… and euthanasia is in the Netherlands reserved for killing on request. In concrete terms, euthanasia invovles injecting the patient with two types of eubstances: barbiturates to induce coma, followed by neuromuscular blockers which cause respiratory muscle paralysis. The consequent anoxia and cardiac arrest bring on immediate death.
Continue reading “Euthanasia- Good Death vs Killing on Request (Reading & Sharing)”Dementia 老年痴呆症 (Reading & Sharing)
As the U.S population ages, the risk for age-related illness such as dementia increases. Dementia is a neurocognitive syndrome with persistent intellectual and functional decline. There are three main sets of symptoms: debilitating cognitive decline, decreased independence in activities of daily living, and behavioral changes. Patients with advanced progressive dementia due to Alzheimer’s or multiple infarcts can live a long time until they finally develop complications that take their lives. They are considered close to death when they are functionally incapacitated and complicating conditions develop.
Continue reading “Dementia 老年痴呆症 (Reading & Sharing)”“NURSE” -the American Association of Critical Care Nurse’s Therapeutic Communication Tool
The American Association of Critical Care Nurse’s therapeutic communication tool “NURSE” is an empathy tool when having emotional conversations to help guide the conversation to convey empathy and to elicit more information:
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