Transitions in End of Life - University of Utah - School of Medicine

Transitions in
End of Life
Carole Baraldi MD
Assistant Professor, University of Utah Division of Geriatrics;
Medical Director, Emeritus Skilled Nursing Facility
Katherine Supiano PhD, LCSW
Associate Professor, University of Utah College of Nursing
Peter Taillac MD
Associate Professor, University of Utah Emergency Medicine
Shaida Talebreza MD
Assistant Professor, University of Utah Division of Geriatrics;
Medical Director, Haven HealthCare
Leaving the Hospital – the “Why”
• Continuity of Care
• Emotions Run High
• Preventing Re-admission
Daniel Alford, MD, MPH 1

Leaving the Hospital – the “What”
• Discussions and Decisions
• Code status
• POLST
• Palliative Care Consult
• Hospice
• Decision Makers
• Patient
• Health Care Agent
• Family Spokesperson
• Medications
• For Symptoms
• For Disease
• Discontinued
Leaving the Hospital – the “How”
• Paper
• Person
• E-mail
• ePOLST
• EMR
Daniel Alford, MD, MPH 2

Leaving the Hospital – the “Who”
• SNF
– Admitting MD
– DON
• Home
– PCP
– Home Health CM
– Hospice MD or CM
Arrival to ED – the “What”
• Reason for transfer to ER – WESPER?
• Advance Directives
– POLST
• Who speaks for patient?
• Hospice Enrollment
Daniel Alford, MD, MPH 3

Leaving the Hospital – the “Where”
• Sites of Care
– Source of Payment
– Location
– Services Provided
Sites of Care: Private Pay
Location
Home Care Aides
Senior Citizen Housing
Services Provided
ADL or IADL Assistance: bathing,
dressing, toileting, meals,
housekeeping, medication reminders
Housing, may provide meals
Assisted Living
Facilities
Skilled Nursing Facility:
Long-term Care
ADL and IADL assistance: bathing,
dressing, toileting, meals,
housekeeping, medication reminders
ADL and IADL assistance and/or skilled
nursing care, medication
administration
Daniel Alford, MD, MPH 4

Sites of Care: Medicare A
Location
Home Health
Hospital Chronic Care
Hospice (Home or
Facility Based)
Services Provided
Short-term skilled nursing and/or
rehab services when patient is
homebound and has a skilled need
Chronic skilled care (e.g. chronic
ventilator)
•Life expectancy

Sites of Care: Medicaid
Location
Assisted Living Facilities
Hospital Chronic Care
Hospice (Home or Facility Based)
Skilled Nursing Facility: Long-term Care
Sites of Care: Resources
WWW.Payingforseniorcare.com
Daniel Alford, MD, MPH 6

“The Silver Hour”
"Do not be daunted by
the enormity of the
world's grief. Do justly,
now. Love mercy, now.
Walk humbly, now.
You are not obligated
to complete the work,
but neither are you
free to abandon it.”
Talmud (attributed)
Daniel Alford, MD, MPH 7