The Importance of Objective Assessment in Hospice Care

Face-to-Face Encounters

A primary purpose of the face-to-face encounter in hospice care is for a nurse practitioner or the certifying hospice physician to assess the patient's health status thoroughly. The goal is to accurately assess the patient's condition, documenting the potentially terminal diagnosis and accompanying signs and symptoms with a focus on areas of health decline. The face-to-face encounter serves as a reference point for future assessments, where continued hospice eligibility is contingent upon continued health decline related to the terminal diagnosis.

Face-to-face encounters are completed when a current hospice patient is entering their third benefit period or greater and before any hospice readmission for a previously discharged patient. These assessment points are purposefully timed.

Hospice eligibility anticipates an admitted patient's life expectancy of six months or less, with the first two hospice benefit periods lasting three months each. Therefore, a current hospice patient entering their third benefit period has lived beyond the anticipated six-month life expectancy and receives another evaluation for hospice eligibility before recertification. Likewise, a patient discharged from hospice care for improved health status would require reassessment before a hospice readmission.

Nursing Shortage Implications

The United States nursing shortage has placed a strain on the nursing workforce, with limitations in the availability of nursing care affecting the country. In situations where patients and families struggle to find adequate home health care, a hospice admission can come with added benefits and provide relief for caregiver stress.

While accelerated Bachelor of Science in Nursing (ABSN) programs can potentially increase the number of nurses more efficiently than traditional four-year programs, it will take time for new nursing graduates to gain experience in the field and grow in expertise in their chosen specialty areas. For nurses of all experience levels, objectivity in hospice assessment is critical for accurately determining hospice eligibility.

Certification of Terminal Status

Hospice physicians and nurse practitioners rely on the objectivity of nursing assessments when applying critical thinking skills and clinical judgment to certify terminal status. Effective interdisciplinary collaboration requires a bedrock of trust and objectivity. Determining hospice eligibility is a certification of a terminal illness. The integrity of hospice assessments may be at risk if we begin to favor hospice eligibility as a means of additional care and allow this benefit to blur the objectivity of our assessments.

A terminal status can have far-reaching emotional effects on patients and families. Hospice care is a context where end-of-life realities can bring fear, discouragement, and vulnerability to accelerated physical decline. Nurses must be self-aware and maintain the highest ethics when completing hospice assessments so that factors unrelated to a terminal status do not impact the eligibility determination.

Teamwork in Hospice Care

As a hospice nurse practitioner, I encountered situations where patients did not meet hospice eligibility criteria and consequently did not receive the benefits that hospice would have provided. These benefits included the provision of durable medical equipment and additional hospice aide visits to help with personal care. There are also financial implications of a hospice eligibility determination that have pros and cons for patients and their families. Many factors can create ethical dilemmas, mainly when the certification of terminal status is more difficult to determine.

We need teamwork in hospice care to advocate for patients and families in need. There will be times when resources are scarce, and the best decision for helping patients gain access to care is difficult to determine. Ethical principles, honest communication, and objectivity in assessment are essential for effective teamwork.

Values of the Nursing Profession

Professionalism in nursing practice includes the application of ethics and a commitment to accountability. Empathy for patients and families must be demonstrated while adhering to regulatory requirements and maintaining alignment with nursing's mission to society. Moral courage is tested when ethical dilemmas present themselves, and nursing is truly a call for many who rise to the challenge.

When nurses collaborate around the nursing profession's values, we can support each other and encourage patient and family participation in conversations and decisions. Nurses are leaders who stand together in unity because of our professional commitment to the highest ethical standards. As nurses share their individual and collective experiences, we promote growth toward solutions and a better future for our loved ones.

About the Author:

Lauren Kempfer is a Christian informatics professional with nurse practitioner work experience and a Doctor of Nursing Practice degree. She hosts a daily live stream called "Conversations for Hospice and Palliative Care" where anyone can start a conversation at PowerfullyHealthy.org.

Lauren is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.

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