General Inpatient Hospice, often called GIP, is a crucial but frequently misunderstood aspect of hospice care. This level of care is provided to patients in an inpatient setting, typically in a Medicare-certified hospital, inpatient unit, or skilled nursing facility. It is designed for short-term, acute situations requiring intensive skilled nursing care management. This article will clarify the basics of GIP for hospice, including eligibility requirements, settings, doctor’s orders, care plans, documentation, and education. Additionally, we will provide real-life cases to illustrate the application of GIP in hospice care.
Misunderstandings about GIP in Hospice
GIP, or General Inpatient Hospice, is an often misunderstood aspect of hospice care. Both hospital staff and families sometimes have misconceptions about GIP. Families may assume it’s readily available upon request, while hospital professionals may believe it allows patients to remain in the hospital indefinitely, even when death is weeks away. This article will clarify the basics of GIP for hospice, including eligibility requirements, doctor’s orders, care plans, documentation, and education. We’ll conclude with two real-life cases to illustrate these points.
Hospice Appropriateness: The patient must have a prognosis of six months or less to live, certified by a medical provider via a certificate of terminal illness (CTI).
Symptoms Requiring Hospital Setting: The patient should have symptoms that necessitate a hospital environment. These may include:
Oral or topical medications do not manage uncontrolled pain.
Intractable nausea/vomiting requiring IV medications and fluids.
Advanced open wounds need specialized care.
Respiratory distress requiring BiPap, intubation, or high-flow oxygen.
Delirium with behavior issues demanding frequent medication adjustments.
Imminent death, but only if skilled nursing care is required.
A patient is not eligible for GIP if it’s solely for caregiver respite, the patient lives in an unsafe environment, or simply because they are expected to pass away soon. GIP is reserved for situations requiring intensive management by skilled nursing care.
GIP Settings
The setting for GIP is typically a Medicare-certified hospital or a certified inpatient unit (IPU).
Doctor’s Order for GIP
Once eligibility for GIP is confirmed, orders must be obtained from the attending physician at the GIP location and the hospice medical director, who addresses the level of care.
Plan of Care Requirements
GIP is designed for acute situations, so a plan must be in place to discharge the patient to a lower level of care. This plan includes:
Daily visits by one or more Interdisciplinary Group (IDG) team members.
The hospice RN Case Manager (RN CM) oversees the patient’s care and works with the hospital team to transition the patient to a home setting. The RN CM collaborates with the family and ensures that necessary equipment (DME) is set up in the patient’s target environment.
The social worker assists with discharge planning and transportation.
Daily nursing notes from the GIP location are crucial to track adjustments and progress toward discharge.
Documentation Requirements
All IDG members involved in the patient’s care should document their actions and results. Frequent documentation is essential to demonstrate progress toward discharge.
Education Recommendations
Education is a crucial part of hospice care. Every interaction with the patient’s family should include educational moments. If a family requests GIP in a home setting, but it’s inappropriate, educate them on managing the situation and explore their needs. If GIP is appropriate, ensure the family and hospital staff understand the GIP requirements regarding a discharge plan to home.
Real-Life Case Examples
These are cases that I managed in the past.
Case 1: Respiratory distress
The patient was on a 45-liter high-flow BiPap at the hospital, with attendings at the hospital and the family desiring the patient to be on hospice and to start GIP. Since home DMEs typically don’t provide such high-flow devices at a reasonable cost, there is a go for GIP if the team can provide a pathway to discharge.
The hospital respiratory therapist was consulted to investigate options that would work in a home setting (priceless pearl: you don’t need to be an expert in all areas; remember to use your resources!). Given the goal of 10 to 15 liters for DME equipment, the respiratory therapist produced a solution that involved a specialty canula, which they provided.
The main barrier to GIP was the family initially thought the patient would remain in the hospital until death; this was resolved via education and providing options such as local skilled nursing homes (SNF).
The family wanted hospice for their loved one who was in the hospital with extreme restlessness, which the hospital care team was not sure how to manage effectively. Hospice was called in to evaluate, admit under GIP, provide treatment recommendations, and work on a discharge plan home.
Medication recommendations were given and applied, and in 12 hours, the patient was comfortable and ready for discharge home. The patient expired several hours after coming home in the presence of their loving family.
Conclusion
Understanding GIP in hospice is vital for providing appropriate end-of-life care. By meeting eligibility requirements, obtaining doctor’s orders, developing a care plan, maintaining documentation, and offering education, we can ensure that GIP serves its intended purpose effectively.
