Palliative Care

Home-based Palliative Care is a covered benefit by many insurances. For more information regarding your particular insurance please contact us.

You have the option of refusing any service or care you are not happy with. The Palliative Care Team will work with you to personalize your care to fit your specific wants and needs.

The Palliative Care Team will provide on-going assessments of each person’s needs. A person’s insurance and their individual needs will determine how long care is provided.

The non-denominational chaplain is available to you only if you want or need him or her to visit you. If you do not want a chaplain, you can refuse this service.

Holistic Care Palliative Care collaborates with your primary care or specialist physician to provide you the best care possible. You will continue to see your current physician and health care team. Palliative Care is provided in addition to all of your usual health care services and our Medical Director is there only as an extra layer of support when your physician in not available.

Sometimes it can be hard to identify when it is the right time for extra support. Here are some signs that it may be time to consider Palliative Care: Frequent Hospitalizations/ Emergency Room Visits Profound weakness or fatigue Frequent or recurrent infections Uncontrolled or increased pain Wounds that are not healing Difficulty breathing / dyspnea with minimal exertion Frequent falls or unsteady gait Change in mental status/ decreased cognitive ability Difficulty in swallowing Uncontrolled nausea or vomiting Loss of appetite or refusing food Progressive weight loss or sudden unexplained weight loss Medically frail/ co-morbid conditions Other side effects from aggressive treatment such as chemotherapy or dialysis

Yes. Holistic Care Hospice and Palliative Care has a special distinction in Palliative Care that is separate than both our Hospice Care programs and our Home Health Care programs. This means that Holistic Care’s Palliative Care program is a true medical model that is truly independent from our other programs. We are proudly accredited by the Accreditation Commission for Health Care (ACHC).

You may benefit from improved pain and symptom control and receive extra emotional support. You also will have access to a a nurse 24 hours per day, 7 days a week through a telephone Palliative Care Hotline. If you need help with obtaining community services such as meals on Wheels or a home care aid, the Palliative Care social Worker will provide appropriate referrals and assist you in obtaining such services. A Nurse can provide you or your caregiver with education in such tasks as administering medications, preventing infections, using home medical devices, etc. Services Include: Provide support so that patients can avoid unnecessary emergency room visits 24/7 Nurse Hotline Collaboration with your primary care or specialist physician Home visits by our Palliative Care Team Coordination of any diagnostic services in your home Advance Care Planning Problems that Palliative Care can Help Address: Pain Nausea Loss of appetite Fatigue Difficulty breathing Anxiety Confusion Constipation Depression Weakness Weight loss Diarrhea Advance Directives Family concerns, stress and fear Financial matters Legal issues Medical and insurance forms Questions of faith Sleeps problems

Holistic Care Palliative Care collaborates with your primary care or specialist physician to provide you the best care possible. You will continue to see your current physician and health care team. Palliative Care is provided in addition to all of your usual health care services and our Medical Director is there only as an extra layer of support when your physician in not available.

Home Health Care is skilled intermittent care for people that are considered home bound. This means that insurance only covers Home Health Care for a short period of time for people with a skilled need that have difficulty leaving their home. Examples of skilled needs are: physical therapy, speech therapy, wound care, IV therapy, etc. Palliative Care is on-going support for people with a serious illness by experts at symptom management. Palliative care can be provided in conjunction with Home Health Care if, for example, a person also needed therapy. Home Health Care and Palliative Care can be complimentary services.

The Palliative Care Team provides patient-centered care that is tailored to your needs. Your personal plan of care will determine how often you will receive visits from our clinicians, but our minimum nursing visit is once per month.

No, you can continue to receive all of your usual care and any treatments recommended by your doctors. Palliative Care is provided in addition to your current treatment.

Palliative Care is an extra layer of support for people living with serious illness. It is provided in addition to all the care you receive from your doctors and other healthcare providers with the focus of relieving the symptoms and stress of a serious illness. It is appropriate at any age and at any stage of a serious illness and can be provided along with curative treatment. The goal is to keep you healthier and more supported at home and to improve quality of life for you and your family members. Home-based Palliative Care is provided in your home by a team that includes a doctor, nurse, social worker, and chaplain/spiritual care provider. The Palliative Care Team meets with you in your home to personalize care services to meet your individual needs and the needs of your family and caregivers.

It can be difficult to identify when it is the time to begin Hospice Care. There are many signs and symptoms that an individual could benefit from all the extra care hospice provides. These symptoms alone may not qualify a person for hospice, but could indicate that there is an underlying illness that should be considered: •There is a terminal disease or a life-limiting illness •A person is no longer seeking aggressive treatment •Decreased mobility or there is a reduction of Activities of Daily Living. Activities of Daily Living include bathing, dressing, toileting, transferring, continence, and feeding. •Recent or frequent hospitalizations or trips to the emergency room •Progressive or unexplained weight loss or a reduced desire/ ability to eat Increasing weakness, fatigue, and somnolence •Change in mental status or decreased cognitive and functional abilities •Frequent or recurrent infections •Wounds that aren’t healing •Frequent falls •Increased Edema or swelling •Continuous use of Oxygen •Difficulty swallowing •Uncontrolled or increased pain •Difficulty in breathing •Progressive renal insufficiency •Uncontrolled nausea or vomiting •Emotional, social or spiritual distress •Progressive decline in health despite therapy •General decline

24/7 Hospice Care Hotline for nursing support anytime you have symptoms or questions. Nurse Care Coordinator in our office assigned to each patient. Regularly scheduled home visits from the Hospice Care Team. After-hours nursing visits available for emergent needs. Bereavement services Medications related to Hospice Diagnosis and medications to provide comfort medical equipment such as: Hospital Bed Wheelchair Walker Commode Bedside Table Oxygen Nebulizer Suction Machine CPAP / BiPAP Hoyer Lift Supplies such as: Diapers Wipes Gloves Barrier Cream Under Pads

Private residence Assisted Living Facility Board and Care Independent Living Facility Skilled Nursing Facility ○A person must be done with rehab ○The person must pay privately or have a Medi-Cal insurance that will pay for room and board while on Hospice. Hospital - some Hospitals allows Hospice Care under special circumstances

The healthcare professionals of the Holistic Care Hospice Care Team work together to ensure that each person’s unique needs are met. The responsibilities of each member of the team, also called an Interdisciplinary Team are: PHYSICIAN The patient’s primary care physician may be responsible for identifying when they may benefit from hospice care. Holistic Care Hospice encourages physicians to remain involved as a member of the patient care team. Each physician prefers a different level of involvement. HOSPICE MEDICAL DIRECTOR The Holistic Care Hospice Medical Director provides oversight of patient care and support to the hospice care team. The hospice medical director attends a weekly team conference to discuss the plan of care of each patient, establishes goal sand participates in all medical decisions. REGISTERED NURSE (RN) The RN coordinates the plan of care with the Hospice Medical Director through initial and ongoing nursing assessments. The RN supervises all care provided by the licensed practical nurse (LVN) and home health aide (CHHA), and coordinates care with the other members of the hospice care team to ensure patient and family spiritual and psychosocial needs are met. LICENSED VOCATIONAL NURSE (LVN) The LVN makes regularly scheduled and emergent visits to patients under the supervision of the RN and the Hospice Medical Director. NURSE CARE COORDINATOR Holistic Care Hospice added this role to enhance the experience of our patients and families. The Nurse Care Coordinator is a Nurse that works in our office and is assigned to each patient. The role of this Nurse is to be an extra layer of support and an added resource when patients or families call our office and to assist the care of our field nurses. MEDICAL SOCIAL WORKERS The Medical Social Worker provides initial and ongoing psycho-social assessments (mental, emotional, social, and spiritual dimensions of the patient) and establishes a psycho-social plan of care. The Medical Social Worker typically sees each patient once or twice a month to provide emotional support and ensure patient and family psychosocial needs are being met. The patient/family or any member of the hospice care team can request additional psychosocial visits as needed. The social worker can provide assistance with finding community resources, help with Advance Care Planning, assist with placement and much more. The hospice social worker can also provide counseling to the patient or family, if needed. CHAPLIN The Hospice Chaplain, also sometimes referred to as a Spiritual Care Counselor, provides nondenominational spiritual support to the patient and family as needed. The Chaplain visits once or twice per month or more often, if requested. The care provided by the Hospice Chaplain can address religious issues, however the focus of care is more spiritual, in nature, than religious. CERTIFIED HOME HEALTH AIDE (CHHA) The Hospice Volunteer can provide companionship and social support to a patient. All Hospice Volunteers are required to attend training prior to being assigned to patients. Hospice Volunteers do not provide any hands-on care and may be available for a few hours per month. HOSPICE VOLUNTEERS The CHHA assists the patient and family with personal care needs such as bathing and grooming. The CHHA can assist with light housekeeping such as changing bed sheets, but the care is not for other housekeeping or meal prep. BEREAVEMENT COORDINATOR The Bereavement Counselor can help a patient deal with the grief associated with declining health and guide the family through bereavement before and after the loss of a loved one. The Bereavement Counselor can provide bereavement services to the family up to a year, or longer, after a loved one passes.

•To affirm life physically, mentally, emotionally, and spiritually. •To empower our patients and families with the knowledge that their decisions and choices will be treated with the utmost respect. •Delivering state-of-the-art medical care with thoughtful consideration of each person’s personal beliefs and values. •The continued pursuit for excellence to provide the highest quality service. •Honestly and integrity in each and every member of our team. Holistic Care as a Hospice Care provider?

Holistic Care Hospice is accredited by the Accreditation Commission for Health Care (ACHC) and is Medi-Care and Medi-Cal certified. Our Hospice Care is 100% covered by Medicare, MediCal and many private insurance plans. Electing Hospice Care can help alleviate the heavy financial burden that the cost healthcare can have on patients and families. While under the care of Holistic Care Hospice, a patient retains full coverage for healthcare not related to their hospice diagnosis. An individual should continue to pay applicable deductible and coinsurance amount for those unrelated services. Additionally, a person’s social security benefits are not affected when receiving Hospice Care.

You can rely on Holistic Care Hospice and Palliative Care to be experts at symptom management, patient-family communication, medical crisis prevention, urgent response and genuine coordination of care across medical settings to ensure continuous communication between providers during times of transition or changing needs. •Holistic Care Hospice and Palliative Care delivers expert medical care with thoughtful consideration of each person's beliefs and values. •Offices throughout Southern California to care for patients in Riverside, San Bernardino, Los Angeles, Orange and San Diego Counties. •Member of the National Hospice and Palliative Care Organization (NHPCO) "We Honor Veterans" program. Our Veterans deserve extra care and special attention to their unique needs. •More nursing visits than other providers. •More Home Health Aid visits than other providers. •Give Back Campaign - We are committed to supporting local non-profit organizations by choosing an organization each month that will receive a monetary donation. For more information about this program please see that Give Back Campaign section of our website. •Disadvantaged Seniors' Assistance Program - Removal of caregiver burdens through a partnership with a local non-profit organization, RLOVE Seniors. For more information see www.rloveseniors.org

Hospice care is specialized treatment that prioritizes physical, psychosocial and emotional comfort for individuals and their loved ones when curative therapies are no longer effective or wanted. Hospice is considered the model for quality care for people facing a life‐limiting illness. Holistic Care Hospice provides expert medical care, pain management, personal care, and emotional and spiritual support individually tailored to the patient’s needs and wishes. We focus on quality of life by keeping a person comfortable in their home environment, promoting dignity and independence and providing support to both the person needing care and their loved ones.

Hospice patients may require differing intensities of care during the course of their disease. The Medicare Hospice Benefit affords patients four levels of care to meet their clinical needs: Routine Home Care, General Inpatient Care, Continuous Home Care, Inpatient Respite Care. The insurance benefit for hospice typically covers all aspects of the patient’s care related to the terminal illness, including all services delivered by the Interdisciplinary team, medication, medical equipment and supplies. ------------------------------------------------------------------------------------------------------------------------- Routine Hospice Care is the most common level of hospice care. With this type of care, an individual has elected to receive hospice care at their residence, which can include a private residence, assisted living facility or nursing facility. Nearly ninety- seven percent of hospice care is provided at the routine home care level. General Inpatient Care is provided for pain control or other acute symptom management that cannot feasibly be provided in any other setting. General Inpatient Care has very specific Medicare criteria and begins when other efforts to manage symptoms have been ineffective. General Inpatient Care can be provided in a Medicare certified hospital, hospice inpatient facility, or nursing facility that has a registered nursing available 24 hours a day to provide direct patient care. Continuous Home Care is care provided for between 8 and 24 hours a day to manage pain and other acute medical symptoms. Continuous home care services must be predominately nursing care, supplemented with caregiver and hospice aide services and are intended to maintain the terminally ill patient at home during a pain or symptom crisis. Inpatient Respite Care is available to provide temporary relief to the patient’s primary caregiver. Respite Care can be provided in a long-term care facility that has sufficient 24-hour nursing personnel present on all shifts to guarantee that patient’s needs are met. Respite care is provided for a maximum of 5 consecutive days.

There is no limit to how long a person can receive hospice care, as long as they continue to meet eligibility criteria required by their insurance. At times, a terminally ill person’s health may improve, stabilize, or their illness goes into remission. If the Hospice Medical Director and Hospice Care Team no longer believe a person can be certified as terminally ill, that person would no longer be eligible for the Hospice Benefit. A person can return to Hospice Care when there is a time that their condition worsens, and they again meet eligibility criteria. A person receiving Hospice Care also has the right to choose to stop services at any time, for any reason.

Patients may request to disenroll or to be discharged from hospice at any time. Occasionally, a patient may decide to seek aggressive treatment for their disease or illness, or the condition of some patients will stabilize or improve and they may no longer need the support of hospice. If a patient does disenroll from hospice, they may again choose hospice at any time that their health condition meets the required criteria.

Patients can keep their primary care physician while receiving hospice care if they choose and if the physician agrees. Holistic Care Hospice maintains working relationships with a wide base of referring physicians in our community so our patients can continue to maintain that continuity of care form their own provider.

Hospice care is a cost effective and valuable healthcare resource that is covered 100% by most insurance providers, including Medicare and Medi-Cal. Hospice care may actually be a cost savings to patients and families because of all the care, medications, medical equipment and medical supplies that are included.

Hospice is not a place; it is a philosophy of care for people who are living with an advanced or live- limiting illness. The Hospice Care Team staff cares for patients in their home environment, such as private residence, independent living facility, residential care communities, assisted living facility, board and care homes, skilled nursing facilities and in certain circumstances hospitals.

Holistic Care Hospice believes that our patients deserve state-of-the-art medical care delivered with thoughtful consideration of their individual personal beliefs and values. Hospice is designed to provide medical, social, psychological and spiritual support and focus on the quality of life our patient and family. Often the most common feedback from patients and families is that they wish they had enrolled with Holistic Care Hospice earlier.

Hospice does not mean "giving up hope". Hospice focuses on quality-of-life based on an individual's choice so that the person may live life as fully as possible. The goals for hospice are to relieve suffering, promote dignity and independence as well as to provide support for patients and their loved ones.

Medicare does not limit the hospice benefit to six months. Patients have access to the hospice benefit for as long as the primary and/or the hospice medical director certify that there continues to be a clinical need and the illness continues to be considered "terminal". A person's health condition may stabilize or improve and of that occurs, a person may discharge from hospice until their condition again worsens.

Home Health Care services include: Nursing Services: home nursing Medication administration, reconciliation, management and compliance In-home infusion therapy, venous access line maintenance Enteral/ Parental Nutrition Disease Management and education for chronic conditions such as: ○Cardiac Disease ○Congestive Heart Failure ○Respiratory Disease ○Neurological Disorders such as Alzheimer’s, Parkinson’s and Dementia ○Diabetes Wound care and management- WOCN team: Surgical, Ostomy, Foot and Leg ulcers, Pressure ulcers Pain management Catheter/ Ostomy Care Incontinence Vital monitoring Lab draws Injections

Home Health Care is a wide range of health care services that can be given in your home for an illness or injury. Home Health Care is usually less expensive, more convenient, and just as effective as care you get in a hospital or skilled nursing facility. It is a benefit covered by Medicare and many other insurance plans for people that have difficulty leaving their home. Our in home care is provided by a team of highly skilled and dedicated health care professionals that work under the direction of your physician.

The goal of Home Health Care is to treat an illness or injury. Home Health Care helps you: Get better with home nursing Regain your independence Become as self-sufficient as possible Maintain your current condition or level of function Slow decline

Home Health Care is for: People who need Post-acute in home care People that are recovering from serious illness, surgery or accidents People coping with life-threatening or life-limiting conditions

Focus on improving speech and language Help patients regain abilities following a stroke Help patients who have difficulties swallowing as a result of a medical event

Strengthening to improve endurance and mobility In-home Safety Evaluation Post-op rehabilitation Activities of daily living: helping patients learn to safely complete tasks such as showering, eating and dressing. Ambulation/ Gait training / Transfer training Fall risk prevention Home safety evaluation

An order from your Physician is needed to start services. Once an order from your doctor is received, we will schedule an appointment with you to meet with one of our clinicians. Based on your healthcare needs, we will form a plan of care and send that plan to your Physician for their approval. Home Health Care is skilled, intermittent care, provided for a short period of time. This means that your services and the number of visits you have will depend on your needs. You may receive just a few visits, or your care may continue for a few months. You must be temporarily or permanently homebound- which means that it is a taxing effort to leave your home.

Provides emotional and psychosocial support Assistance with accessing community resources Advance Directive assistance and resources Education regarding healthcare options Home Health Aide: assistance with personal care