Does a patient in a Long-Term Care (LTC) facility need to be admitted to the infirmary to be eligible for hospice care?

Hospice Admission for LTC Patients in the Idaho DOC System

No, a patient in a Long-Term Care (LTC) facility does not need to be admitted to the infirmary to be eligible for hospice care. Hospice care can be provided in various settings, including directly within LTC facilities without requiring transfer to an infirmary 1.

Hospice Care Settings and Delivery Models

Hospice care is available in four primary settings:

• Home-based hospice: Can be provided in the patient's current living environment, including LTC facilities
• Inpatient facilities: Dedicated hospice units or free-standing facilities
• Integrated hospice care: Provided within existing healthcare settings (like LTC)
• Nursing home-based hospice: Delivered directly in the LTC/nursing home setting 1

The Centers for Medicare and Medicaid Services (CMS) guidelines specifically allow for hospice care to be provided in the patient's current living environment, which includes LTC facilities 1.

Hospice Care in Correctional Settings

For patients in correctional facilities like the Idaho DOC:

• Hospice care can be integrated into the existing LTC environment
• The patient can remain in their familiar LTC setting while receiving hospice services
• The hospice team comes to the patient rather than requiring patient transfer 2

Components of Hospice Care in LTC

When hospice care is provided in an LTC setting, it typically includes:

• An interdisciplinary team approach with specialized hospice staff
• Regular visits from hospice nurses, social workers, and other team members
• Symptom management and comfort care
• Emotional and spiritual support
• Family/support person involvement when possible
• Coordination between LTC staff and hospice providers 1

Benefits of Providing Hospice Care in the LTC Setting

Keeping the patient in their familiar LTC environment rather than transferring to an infirmary offers several advantages:

• Maintains continuity of care with familiar staff
• Reduces stress of relocation for the terminally ill patient
• Preserves established relationships with caregivers
• Allows for dignity and comfort in a familiar setting
• Supports quality of life in the patient's final days 3, 1

Implementation Considerations

When implementing hospice care in an LTC setting:

1. Ensure clear communication between hospice providers and LTC staff
2. Establish protocols for symptom management
3. Provide appropriate staff education on end-of-life care
4. Create a supportive environment for the patient
5. Document the patient's preferences and advance directives 1

Conclusion

The hospice model of care is designed to be flexible and can be delivered in various settings, including directly within LTC facilities. Transfer to an infirmary is not a requirement for hospice eligibility or service delivery. The focus should be on providing compassionate, comprehensive end-of-life care in the setting that best meets the patient's needs and preferences.