3 Tips to Successful Therapy in Hospice and Palliative Care
Hospice and palliative care is a unique and growing niche of rehabilitative therapy practice. We realize that end of life is, by nature, a time of decline. How do we apply our knowledge and expertise in a way that meets the needs of the person, their family and caregivers, and the provider agency?
If we consider what we do in therapy, the essence of our interventions is almost exclusively palliative, not curative. We maximize physical performance to enable function with mobility, ADLs, and communication. This is essential to enhance quality of life, safety, and ease this transitional time at end of life.1
1. Understand How Hospice Care Works
More than 80% of people on hospice are covered by Medicare, which requires that a PT, OT, and SLP are available. The hospice agency earns a per diem rate, which is then managed like a HMO at the local level by the interdisciplinary team (IDT) and management to cover professional services, medications, and equipment. This financial model and the nature of serious illnesses dictates that therapy services are provided in a different fashion than the traditional high frequency and high intensity rehab models.
2. Learn These Five Palliative Models of Therapy Practice
These five models meet the variable needs of patients and families, and the financial considerations of hospice care:2
- Rehab Light applies low intensity and low frequency practice to early admissions with some short term potential for improvement.
- Case Management uses intermittent reassessment and training to enhance safety and function during periods of stability or mild decline.
- Rehabilitation in Reverse provides skilled care and training during progressive decline, as new goals are dictated by functional changes at each new level, to assure safety and confidence of both patient and caregiver.
- Skilled Maintenance maximizes function and quality of life.
- Supportive Care aids in physical comfort as well as psychosocial and spiritual support.
3. Work Together
The interdisciplinary team consists of the physicians, nurses, social workers, therapists, home aides, spiritual supporters, volunteers, and pharmacists. It is essential to our success that communication about our evaluations, interventions, and care plans with all team members happen in an effective and timely manner. This can occur at team meetings where we discuss care plans for new and ongoing patients, or via electronic communication. The sharing of practice is educational for all team disciplines and builds the trust needed for successful end of life therapy practice.
By understanding the hospice setting, taking advantage of variable palliative care methods, and working together with our interdisciplinary team we can ensure enhanced quality of life for our patients at this time of end of life care.
- Briggs R. Preface: Palliative Care. Topics in Geriatric Rehabilitation. 2011; 27(3): 169-170).
- Briggs R, Mueller K. Hospice and End of Life” Chapter 27 in Geriatric Physical Therapy 3rd Edition Ed. Guccione, Avers, Wong 2010.
