Patients who are diagnosed as end-stage HF will need home care and hospice depending on their current situation. However, providing this is not easy by a person who is not adequately trained and skilled in such practice. It is for this reason you will need a professional agency who know a lot about home health care, inotropic infusions as well as palliative treatment.
Ideally these treatments should be aimed at reducing the symptoms and the exacerbations that would need hospitalization otherwise. Though these types of care are considered to be palliative, most of the treatments provided by most of the hospice agencies do not provide all types of therapies.
- This may be due to the reason that inotropes are also commonly used as curative and life-sustaining treatments especially in circumstances that are typically different from the end-of-life situations.
- It is also due to the reason that intravenous inotropic drugs are more expensive as compared to its oral counterparts.
It is for this reason hospices are required to cover all necessary care and therapies that are allotted from one pool of hospice benefit dollars to another. This includes different costs and aspects such as:
- Nursing care
- Medications
- Durable medical equipment and
- Wound care supplies.
Costs for such care should be considered along with the hospice benefits that are provided to ensure that it is under Medicare Part A.
Benefits Of Hiring An Approved Agency
However, when you hire an approved home care agency,they will ideally charge you 5% of the reasonable cost and up to a maximum of $5 for each biological for pain relief or prescription for outpatient drugs or symptom management that is typically associated to the terminal illness.
This ideally can be a hurdle to the patients who wish to have hospice services, especially those patients suffering from terminal HF. Typically, these are the patients who prefer to age, suffer and die at home. However, the majority of them die in hospitals though it is found that patients with HF who took part in a home inotropic support program typically wanted to remained at home during their final stages of life. These are the patients who are less likely to die in the hospitals.
This, in fact makes such therapies and palliative care option for the patients who prefer to die at home more likely to be reimbursed, provided that the plan of the patient offers a palliative care option that includes the inotropic infusions.
- Typically, the HF patients who are at the end of their life require proper dosage titrations.
- They also require proper supervision of diuretics in addition to the infusion of inotropic agents.
- They will also need to use potent analgesics as well.
According to the research it is found that there have been a few recent accounts that show the nonstop and subcutaneous infusion of furosemide.
- This is ideally far less expensive than the intravenous inotropes.
- It also offers a separate option for patients who are at the end of life to avail hospice and palliative care benefits.
- It is also reimbursed in a different way as compared to the traditional insurance plans.
Another requirement of it is that the home care and hospice nurses must work closely with the agency and the authorization staff of it so that they can assist the patients and their families in the best possible way to make a difficult transition from one course of treatment to another look simple.
However, all these cases need to be reviewed periodically and individually so as to optimize the care provided to the patients. As far as the treatment options are concerned, all of it along with the risks and benefits must be weighed.
Risks Versus Benefits
The clinical outcomes can only be weighed when you weigh the risks of a treatment option with the benefits of the therapies. The benefits include:
- A better quality of life
- Improved symptoms and
- Increased exercise tolerance.
There are different symptoms that can be dealt with successfully with home and hospice care such as:
- Shortness of breath
- Dyspnea on exertion
- Orthopnea
- Paroxysmal nocturnal dyspnea and
- Pulmonary or lower extremity edema as well.
As for the risks it also includes different aspects such as:
- The potential for line infection
- The development of arrhythmias
- Chances of hypotension and even
- Sudden death of the patient succumbing to the treatments and its effects.
However, the development of such risks can be reduced only if you have a trained home care professional who will educate you as well as the patient to be treated as to how you can adhere to the strict regulations of home care practices as well as the procedures to ensure hygiene and prevent chances of infection.
There is another significant consideration to make for the nurse. This is to be well aware of the factors that may lead to central line placement in patients suffering with HF. This is even more required if the patient has an implantable pacemaker and defibrillators, commonly known as ICDs.
This is because the care treatment for these patients should be provided after considering the needs of the patient with regards to the use and need of inserting the central lines. This will ensure that the ICD leads are not disrupted. For this sometimes it is required to turn off these devices temporarily during line placement so as to avoid any unintended shock from any of the guide wires. It is for this reason a proper evaluation of the ICD functioning pre and post line placement is essential.
 To Sum It Up
Therefore, it can be said that both hospice and palliative care needs a lot of care and concern from the professional providing such services. Since HF is a common disease in the United States that leaves the patients with a very few options in the end stages of the disease, home inotropic infusion is the only nonsurgical option that can improve both the symptoms of the disease as well as the quality of life of the patients. However, it needs professional home care for medications and advanced planning.
