Scope of Services

Lion Hospice provides a safe, coordinated program of palliative and supportive care in a variety of appropriate settings, from the time of admission through bereavement, with the focus on keeping terminally ill patients in their own homes as long as possible.

Lion Hospice defines Palliative Care as:

• Treatment which enhances comfort and improves the quality of a patient's life

The goals of intervention are:

• Pain control
• Symptom management
• Quality of life improvement
• Enhancement of spiritual and emotional comfort

These goals apply to the patient and his/her family members and/or significant others. Each patient's needs are continuously assessed and all treatment options are explored and evaluated within the context of the patient's values and belief system.

COORDINATION OF SERVICES
Lion Hospice is responsible for the coordination of all services related to the terminal illness of the patient.

CONTINUITY OF CARE
Hospice care is always available, and services continue without interruption even if the setting for patient care changes.

MEDICAL SERVICES
Medical Direction of the Program
The Lion Hospice medical director and all associate medical directors are:

• Doctors of medicine or osteopathy
• Trained in pain control and symptom management
• Familiar with the spiritual/social aspects of hospice care

Our medical director oversees all medical services coordinated by Lion's interdisciplinary team.

Lion's Medical Directors:

• Consult with attending physicians regarding pain and symptom control
• Review patient eligibility for hospice services
• Act as medical resources to the interdisciplinary team
• Act as liaisons with physicians and other referral sources in the community

Attending Physician Participation:

Lion Hospice encourages the patient's attending physician to participate in coordinating the medical care of the patient through ongoing communication between the attending physician and Lion's interdisciplinary team.

The attending physician provides at least the following to the interdisciplinary team:

• Admitting diagnosis and prognosis, current medical findings, orders for medications, treatments, and symptom management
• Direction for medical management of other conditions not related to the terminal illness
• Designation of an alternative physician to contact regarding emergency care of the patient when the attending physician is not available

NURSING SERVICES

Registered Nurse Coordination of Care

Lion's registered nurses are responsible for the coordination of all hospice services. Scope and frequency of services are based on initial and ongoing assessments of the patient's needs. Nursing services are provided in accordance with standard nursing practice and the interdisciplinary team plan of care.

Lion's nurses provide:

• Initial and ongoing assessment of the patient's physical symptoms
• Symptom management and comfort care interventions
• Support and teaching for the patient and family
• Documentation of problems and appropriate goals and intervention
• Documentation of patient/family participation in and response to the plan of care
• Coordination of all patient/family hospice services

 HOSPICE SERVICE AIDE/HOMEMAKER SUPPORT SERVICES

(Home Health Aides)

Patients whose caregivers need and want support for hands-on care or help with activities of daily living or help with light housekeeping will be supported by hospice service aides/homemakers. Hospice service aides/homemakers will meet the state and national requirements and will be specially trained in palliative care services.

Hospice service aides may provide:

• Hands-on care of the patient as needed and directed by the plan of care and under the direction of the registered nurse
• Assistance in ambulating or exercises
• Assistance in providing a sanitary environment for the patient by maintaining an orderly and clean patient room, bathroom, and meal preparation area
• Help with running errands

Homemakers may provide:

• Help with light housework
• Meal preparation for the patient
• Help with running errands

Lion's Psychosocial services are based on an initial and continuing assessment of patient/family psychosocial needs conducted by a certified social worker. Services are provided in accordance with the interdisciplinary team plan of care to assist the patient/family in dealing with the psychosocial aspect of terminal illness.

Lion's Social workers provide counseling and linkage to community services for the patient/family to assist with:

• Developing and enhancing family strategies for with grief and loss
• Accessing community resources
• Preparing for death
• Making most effective use of the health care system

COUNSELING SERVICES

Lion Hospice provides counseling services when needed and as ordered by the plan of care to assist the patient/family in coping with the terminal illness, death, and bereavement.

Counseling services are available to all patients/families. The appropriate professional will implement individual plans, which are approved by the interdisciplinary team.

Counseling professionals may include, but are not limited to:

• Social workers
• Mental health professionals
• Clergy or other religious professionals
• Dietitians

Spiritual care is coordinated by a trained religious professional who is a member of the Lion Hospice interdisciplinary team. Spiritual services are provided in a manner that is consistent with patient/family beliefs and desire for service.

Lion's spiritual professionals provide, either directly or through coordination with the patient's/family's religious organization, appropriate interventions for such issues as:

• Meaninglessness
• Loss of faith
• Failure
• Anger
• Despair
• Profound sadness
• Abandonment
• Betrayal
• Fear/dread
• Guilt
• Forgiveness
• Hope
• Promise for the future

Lion bereavement services, provided by qualified staff and volunteers, begin with the initial assessment and continue through 13 months of the bereavement period. The goal is to help the patient/family cope with grief and loss issues related to the death of a loved one.

Following the death of the patient, families are offered support, which follows an individualized bereavement care plan.

Bereavement services address such issues as:

• Family grief and loss issues
• Survivor(s) needs
• Social, religious, and cultural issues
• Risk factors
• Potential for complicated grief reactions

Lion Hospice provides volunteers in order to

• Enhance the quality of care delivered to patients/families
• Maximize program and family resources
• Encourage community participation in delivery of hospice care.

Lion volunteers serve our program in any needed capacity for which they are trained and willing to serve. Lion volunteers provide assistance with such areas as:

• Patient care
• Bereavement care
• Administrative support
• Program development
• Community relations and education

When Lion Hospice purchases services through contractual arrangement, Lion Hospice retains professional responsibility for those services.

All contracted services are furnished under the direction of Lion's interdisciplinary team, supervised by the patient care coordinator or designee, and delivered in accordance with Medicare requirements and accepted standards of practice.

Such services include, but are not limited to:

• Physical therapy
• Occupational therapy
• Speech and language therapy
• Respiratory therapy
• Radiation therapy
• Laboratory services
• Fine Arts Therapy
• Pet Therapy

PHARMACEUTICALS, DURABLE MEDICAL EQUIPMENT AND MEDICAL SUPPLY SERVICES

Pharmaceuticals, durable medical equipment and medical supplies are made available through Lion Hospice staff for Medicare/Medicaid patients through direct purchase.

Lion Hospice coordinates, but does not pay for supplies, equipment, and pharmaceutical services for patients who have no source of funding. For Medicare and Medicaid benefit patients, pharmaceuticals that are necessary for the management of the terminal illness must be purchased at participating contract pharmacies.

CARE SETTINGS

HOME CARE

Lion Hospice strives to empower and enable individuals to remain in the familiar surroundings of their own homes for as long as is possible and appropriate.

Lion Hospice plan of care reflects the efforts of Lion Hospice staff and volunteers to:

• Maximize patient/family independence
• Deliver services at the convenience of the patient/family and caregiver
• Arrange respite services for caregivers
• Bridge gaps in the patient's caregiving network
• Adapt the home environment to meet the patient's physical needs

Because a patient's home may not be his/her personal residence, Lion Hospice may offer home care services in a variety of facility settings appropriate to the patient's care needs.

Following an initial assessment of patient needs, all services that may benefit the patient, will be coordinated with the primary caregiver. If the patient lives in a facility, services will be coordinated with the facility staff .

Lion Hospice may provide continuous care in the home for benefit patients who cannot be moved, but whose acute symptoms require intense monitoring or treatment.

The care must be:

• Ordered by the plan of care
• Coordinated and managed by Lion Hospice
• For short time frames only

INPATIENT CARE FOR CONTROL OF ACUTE SYMPTOMS

When the severity of the patient's physical condition prevents appropriate care from being provided in the home, the patient may be moved to an inpatient setting for better monitoring and control of physical symptoms.

All transfers must be approved by the patient/family.

Inpatient benefits will be determined

• For Medicare/Medicaid benefit patients, Lion provides such services under a contractual relationship with an inpatient provider, which stipulates that Lion will retain professional management of the terminal illness. Lion will assume financial responsibility for the inpatient stay if it occurs in a contractual facility, is ordered by the plan of care, and treatment is appropriate for palliation of the symptoms of the terminal illness.
• The non-benefit patient may choose any facility and Lion's staff will attempt to coordinate the care. However, since no contractual arrangement exists giving Lion the professional management of the patient, Lion Hospice is not responsible for the appropriateness of treatment or payment for services.

INPATIENT RESPITE CARE

When the family would benefit from a short respite in caregiving, the patient may be moved to a facility providing such care.

• Respite care for the Medicare and Medicaid benefit patient will be provided directly under contract with a care facility and Lion Hospice assumes financial responsibility.
• For the non-Medicare and non-Medicaid benefit patient, Lion's staff may assist in the coordination of transfer to another care setting, but Lion Hospice does not assume financial responsibility.
• Respite care under a per diem benefit is at the discretion of the interdisciplinary team and must be provided in a facility, which has a registered nurse on duty 24 hours a day and must be:
• Ordered by the plan of care
• Provided by a contract facility
• Coordinated by Lion Hospice

FUNDING

Lion Hospice offers comfort care to all terminally ill patients and support to those patients and their families without regard for diagnosis, gender, sexual orientation, national origin, race, creed, disability, age, place of residence or ability to pay.

MEDICARE

Hospice care is funded 100% to any patient who is eligible for Medicare Part A and who meets the four eligibility requirements. A co-payment or supplemental insurance is not required or necessary.

Medicare will cover hospice care for as long as the patient meets the admission criteria. Eligibility is reviewed and established in benefit periods of 90 days, 90 days and 60 days thereafter.

A Medicare patient in a managed care program is free to choose any provider regardless of the provider's relationship with the managed care program.

Patients are free to revoke hospice services at any time by signing a revocation form. If a Medicare patient revokes the Hospice Medicare Benefit, his care reverts immediately to regular Medicare Part A. There is no waiting period. Should the patient subsequently choose to renew hospice services, he may do so at any time by calling Lion Hospice.

PRIVATE INSURANCE

Many private insurance companies cover some form of hospice care. Coverage, co-pays, and eligibility requirements are company specific. Lion Hospice will work with each insurance company that will result in the best possible plan for the patient.

PRIVATE PAY

Lion Hospice will accept private pay patients as long as they meet the four eligibility criteria. A financial needs assessment will be done at the time of admission to establish the patient's ability to pay. The patient/family will be informed at the time of admission what percentage they will be required to pay. Percentage could range from 0% and 100%.