VITAS Advantage: Case Study on Complex Modalities for Hospitals
VITAS Case Study: Patient with Chronic Heart Failure
AF*, a 76-year-old woman who been diagnosed with chronic heart failure, is hospitalized after a recent fall. She has been hospitalized three times in the past six months for worsening cardiac symptoms, hypertension, shortness of breath at rest or with minimal exertion, continuing weight loss/frailty, and anxiety.
Her adult son and caregiver indicates that his mother has frequently expressed a desire to die at home, not in a hospital or care facility.
During a goals-of-care conversation with the hospitalist, the patient and family opt for comfort-focused hospice care. Within 24 hours, AF has been evaluated and admitted to VITAS, and a hospital bed, oxygen supplies, and a bedside commode have been delivered to the woman’s home.
Over the next four weeks, the interdisciplinary VITAS team supports AF and her son through regular visits for symptom management and personal care, supervision of open-formulary cardiac and pain medications, fluid management, respiratory therapy, and guided relaxation sessions. For one two-day period, VITAS provides continuous bedside care at home per Medicare guidelines to manage AF’s severe respiratory distress and anxiety.
After six weeks of hospice care, AF dies peacefully at home surrounded by her family, in accordance with her wishes.
*These initials represent an anonymized patient and are used for the purposes of education only.
Home-based Palliative Care for Seriously Ill Cardiovascular Patients Can Alleviate Use of Intensive Services for Hospitals
Clinicians caring for patients with advanced cardiovascular disease are encouraged to consult with palliative care professionals to ensure patients receive optimal guidance around complex medical decision-making.
A main consideration is the patient’s preferred setting for care, according to the authors of an article published in Cardiology Magazine, a publication of the American College of Cardiology. Studies show that most severely ill patients prefer to be at home with hospice care rather than in a hospital.
This important finding is particularly relevant during COVID-19, the authors point out, with many hospitals stretched to capacity and hospitalized patients isolated from family and friends. “Palliative care can guide, educate, comfort and aid in complex medical decision-making,” they write.
The researchers suggest that clinicians can accelerate palliative care “to ease suffering and provide comfort to patients and families during the COVID-19 epidemic.”
For instance, clinicians can help patients complete advance care planning forms to document their values and preferences, and designate their healthcare decision makers, an activity that reduces unwanted/unnecessary hospitalizations and emergency room visits, and lowers overall healthcare costs. POLST (physician orders for life sustaining treatments) is a portable document that can be revised or rescinded by the patient at any time.
“Palliative care services can alleviate suffering and may prolong life for patients with serious illness,” the authors conclude. “Patients and families can be given several options for the course of care,” including the choice to be at home with palliative or hospice care for symptom management.
The VITAS Advantage
VITAS provides complex modalities for patients whose advanced illness and/or aggressive symptoms require high-acuity care that can be delivered on VITAS services. Much of this care otherwise would have to be provided in an acute or post-acute care setting. Tangible benefits to hospitals include:
- Overall lower healthcare costs, including reduced Medicare spending per beneficiary
- Reduced length-of-stay and in-hospital mortality metrics
- Fewer readmissions to the hospital, emergency department, and intensive care unit
- Higher satisfaction with care
- Provision of end-of-life care that matches and honors patients’ goals and wishes
Source: Mulrow, J. & Doherty, C. (2020) Palliative Care Considerations for Patients with Cardiovascular Disease Under COVID-19. Cardiology Magazine, April 9, 2020, American College of Cardiology “Latest in Cardiology.”