What led you to consider hospice care?

This question is an opportunity to show empathy and to the patient and their family. You can start by acknowledging their feelings and validating their decision to explore . For example, you can say:

“I know this is a difficult time for you and your family. You have been through a lot, and you deserve to have the best possible care. I'm here to help you understand and how it can benefit you.”

Then, you can ask them to share their reasons for considering hospice care. You can use open-ended questions and reflective listening to encourage them to express their thoughts and feelings. For example, you can say:

“What made you think about hospice care? How do you feel about it? What are your hopes and fears?”

You can better understand their condition, goals, and expectations by listening attentively and respectfully. You can also identify any gaps in their knowledge or misconceptions about hospice care. You can then provide accurate and relevant information to address their concerns and educate them about the benefits of hospice care.

How has the patient’s condition declined over the past two weeks?

This question is important for gathering objective and subjective data about the patient's decline. You can start by asking the patient, the family, or the caregiver to describe the changes they have noticed in the patient's condition over the past two weeks. You can use specific prompts to elicit more details, such as:

“Can you tell me more about how the patient's pain, appetite, breathing, or sleep has changed? How often do they need help with daily activities, such as bathing, dressing, or eating? How do these changes affect their mood, energy, or quality of life?”

You can also use your observations and clinical judgment to assess the patient's decline. You can use tools such as the Palliative Performance Scale (PPS) or the Functional Assessment Staging (FAST) scale to measure the patient's functional status and compare it with previous assessments. You can also review the patient's medical records, laboratory results, or imaging studies to look for evidence of disease progression or complications.

By collecting and analyzing this information, you can determine the extent and rate of the patient's decline and compare it with the hospice eligibility criteria for their diagnosis. You can also use this information to tailor your and interventions to the patient's needs and preferences.

What negative changes have occurred in the patient’s condition over 30, 60, and 90 days?

This question is useful for establishing a timeline of the patient's health decline and documenting their prognosis. You can ask the patient, the family, or the caregiver to recall the negative changes they have observed in the patient's condition over the last 30, 60, and 90 days. You can use specific examples to jog their memory, such as:

“Can you remember when the patient started losing weight, having trouble swallowing or needing oxygen? How about when they stopped driving, working, or socializing? How have these changes affected their daily life and well-being?”

Using your records and assessments, you can also track the patient's decline over time. Tools such as the Karnofsky Performance Status (KPS) or Palliative Performance Scale (PPS) can quantify the patient's performance and survival. You can also review the patient's history of hospitalizations, emergency visits, or treatments to look for patterns of deterioration or failure.

By creating and reviewing this timeline, you can demonstrate the patient's decline and eligibility for hospice care. You can also use this timeline to communicate the patient's prognosis and expectations to the patient and their family.

Has the patient experienced multiple hospitalizations or emergency department visits recently?

This question is relevant for highlighting the patient's need for comfort-focused care and reducing unnecessary or burdensome interventions. You can ask the patient, the family, or the caregiver to report the number and frequency of hospitalizations or emergency visits they have had in the past few months. You can also ask them to share their experiences and feelings about these events, such as:

“How did you feel when the patient was hospitalized or taken to the emergency department? What did they do for the patient there? How did it help or harm the patient? How did it affect your family?”

You can also use your records and sources to verify the patient's history of hospitalizations or emergency visits. You can use tools such as the Hospitalization Risk Profile (HRP) to measure the patient's risk and impact of hospitalization. You can also review the patient's discharge summaries, medication lists, or advance directives to look for indications of over-treatment or under-treatment.

By exploring and evaluating this information, you can identify the patient's need for hospice care and avoid unnecessary or harmful interventions. You can also use this information to educate the patient and their family about the benefits of hospice care and the drawbacks of aggressive care.

Has the patient experienced a decrease in tolerance to physical activity?

This question is significant for providing evidence of and supporting the eligibility for hospice care. You can ask the patient, the family, or the caregiver to describe the changes they have noticed in the patient's ability to engage in physical activities. You can use specific examples to elicit more information, such as:

“Can you tell me more about how the patient's endurance, strength, or balance has changed? How often do they need to rest, use a walker, or stay in bed? How do these changes affect their hobbies, interests, or enjoyment?”

You can also use your observations and measurements to assess the patient's tolerance to physical activity. You can use tools like the Timed Up and Go (TUG) test to measure the patient's exercise capacity and mobility. You can also review the patient's , oxygen saturation, or dyspnea score to look for signs of distress or impairment.

Collecting and analyzing this information can provide important evidence of and support the eligibility for hospice care. You can also use this information to plan and implement appropriate interventions to improve the patient's comfort and safety.

Have there been any significant changes in the patient’s cognitive abilities?

This question is essential for detecting cognitive decline and supporting the eligibility for hospice care. You can ask the patient, the family, or the caregiver to describe the changes they have noticed in the patient's cognitive abilities. You can use specific examples to elicit more details, such as:

“Can you tell me more about how the patient's memory, attention, or orientation has changed? How often do they forget names, dates, or events? How do they cope with confusion, , or ?”

You can also use your tests and evaluations to assess the patient's cognitive abilities. For example, you can use the Mini-Mental State Examination (MMSE) or the Confusion Assessment Method (CAM) to measure the patient's cognitive status and delirium. You can also review the patient's medications, , or metabolic disturbances to determine causes or contributors to cognitive decline.

By gathering and analyzing this information, you can detect cognitive decline and support the eligibility for hospice care. You can also use this information to provide and coordinate appropriate interventions to manage the patient's symptoms and behaviors.

Have any significant comorbid conditions been impacting the patient’s health?

This question is important for understanding the patient's overall health status and supporting the eligibility for hospice care. You can ask the patient, the family, or the caregiver to report any additional medical conditions the patient may have that affect their health. You can use specific examples to elicit more information, such as:

“Can you tell me more about how the patient's , heart disease, or kidney disease has changed? How often must they check their blood sugar, blood pressure, or urine output? How do these conditions affect their pain, appetite, or mood?”

You can also use your records and sources to verify the patient's comorbid conditions. You can use tools like the Cumulative Illness Rating Scale (CIRS) to measure the patient's comorbidity and mortality. You can also review the patient's laboratory results, imaging studies, or consultations to look for evidence of organ failure or complications.

By exploring and evaluating this information, you can understand the patient's overall health status and support the eligibility for hospice care. You can also use this information to provide and coordinate comprehensive and holistic care to the patient and their family.

Conclusion

As you can see, hospice care is a valuable service that can improve the quality of life for patients with a terminal illness and their families. However, not everyone who needs hospice care receives it promptly. That's why admission nurses play a crucial role in assessing patients and confirming their eligibility for hospice care. By asking the right questions, you can gather valuable information that supports the patient's terminal status and helps them make informed and compassionate choices about their care. You can also supplement your assessment and documentation using various tools and sources. Remember, these questions are meant to your assessment process and ensure that patients meet the criteria for hospice eligibility. They are not meant to replace your clinical judgment or the collaboration with the interdisciplinary team. As an admission nurse, you have the opportunity and responsibility to educate and empower patients and families to access the benefits of hospice care. Thank you for your dedication and commitment to this noble work.

Resources

Tips for new nurses — EOL determinations for newly admitted patients

Confusion Assessment Method (CAM)

Cumulative Illness Rating Scale (CIRS)

Edmonton Symptom Assessment Scale (ESAS) and ESAS Form (PDF)

FAST Scale for Alzheimer's

The Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being (FACIT-Sp)

Hospitalization Risk Profile (HRP)

Karnofsky Performance Scale

Mini-Mental State Examination (MMSE)

Palliative Performance Scale

Timed Up & Go (TUG) Assessment Test

Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)

Preparing the patient, family, and caregivers for a “Good Death.”

Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)

The Dying Process and the End of Life

The Last Hours of Life

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