Mr. Termine Revisited
Mr Termine is a 76-year-old man with Stage IV lung cancer with metastases to his ribs. All chemo options have been stopped. His only medication is two tabs of acetaminophen 325/oxycodone 5 every four hours. At this point, he spends almost all day in bed, taking sips of water only. His daughter – his only care-giver – is exhausted.
You identified needs in the area of:
- pain
- constipation
- nausea
- anxiety
- care-giver burnout
He says: “I just want to go home. What can you do for me, doc?”
- What would you do for his pain?
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- What can you do for his constipation?
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- What can you do for his nausea?
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- What can you do for his anxiety?
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- What can you do to address the care-giver burnout his daughter is experiencing?
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Discussion: Mr. Termine Revisited
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have a social worker on this case
consultation with the palliative care team
CCAC can do assesments
Palliative care, MSW, CLU
Home care as access point with specialty palliative home care
palliativd care
Social work and case management
really depends on his wishes. could do anything from prescribing all the discussed meds frmo the ED and sending him home w them and palliative referral to admitting for both acute palliative eval and also to let daughter get a break to something in between (ie let him stay overnight in ED while daughter gets night of relief and then sending him to palliative clinic or pcp clinic in the morning)
We have an elder care program where a caregiver is assigned after an assessment has been made
Manejo integral es la palabra clave
Manejo integral
case manager, palliative consult, home health
hospice referral, expedited OP pall care f/u or ED pall care consult
community palliative care service
Combination of CCAC care and Freeman centre palliative outreach home visiting NP + physician
ok
Hha
comminunity pallcare referral
discuss dc destination options
CCAC referral for palliative care management; we can also ask for a palliative care assessment in hospital during weekdays/daytime hours. Add extra home care support to help daughter with daily care.
Patient would have a needs assessment and the carer a carer’s assessment. Refer to palliative team
ok
referral to hospice
We can either place a CCAC referal /palliative care referal for support needs to be assessed re PT/OT/PSW. Or a short admission to get things sorted.
hospice
Involve SW, CML, outpatietn palliative care
GEM nurse or SW or ED1 one team
CACC
I work at a suburban district health facility in the Caribbean.Indeed; there is a lack of resources at the health institution and in the community.A palliative care unit is nonexistent.The social worker services can be a lengthy process.However there are private nursing homes and hospice care if the client and families could afford.My personal opinion is a lot needs to learnt of management and care of the elderly diaspora and not enough attention and resources are directed and available to fulfill their needs.I have experienced care giver burnt out before medical schooling and it is very exhausting unless you could afford help.The Government services are very limited.
The home-visiting palliative care team, community care services (LHIN), respite, consult with GEM nurse and social work to look into additional paid and free services.
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Hospice
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Referral to hospice, consult in hospital or facilitate at home initiation if appropriate for dc.
Could do palliative homecare vs referral on to hospice. Depending on wishes of patient and family
This patient could have a hospice evaluation in the ED and care arranged from there
Home based palliative care servies
use of a home health care agency nurse is important
Inter and intraprofessional team, collaboration; i.e. palliative care team to assess medications, provide counselling, etc.
yes
collaboration with various professions
agreed
h
k
interprofessional team collab
set up home care, in this patient’s case, by consulting Hospice. The Hospice company would take over all aspects of the patient’s palliative care needs.
ok
…. 😀
we don’t have a these add on support teams, so he would be managed outpatient primarily, ED visits for pain management when its unbearable and family would primarily take over home care.
ok
the same
I would involve case management. Discuss palliative care vs hospice with patient and his daughter and get the appropriate specialty involved at that point.
If admitted from the ED, there is palliative care service. Also engage home and community care for services on discharge.
adietrich
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Palliative care team will be looking after him and organise all aviable servicess
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older age group clinics
direct for all to palliative care team made through the EMR or by calling directly
.
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Here in the UK, we would have the hospital discharge team sort out on-going care. He would have the loan of a hospital bed and a pressure relieving mattresses. There is a community team that would monitor at home for the first 1-2 weeks and short-term, state-funded care visits up to 4 x day if needed. District nurses would be aware as would the community palliative team – one of those would pick up his care for the long term.
Home health and palliative care team referral
Case management
ok
ok
ok this is too much discussion
consult palliative medicine to help arrange resources such as hospice
There is a palliative care physician/nurse/PSW team but they have a high case-load. May be challenging to arrange rapid follow up. If not possible, I would attempt to arrange hospice care or palliative care in hospital.
social worker would be involved
A caregiver would be assigned to his house to assist family or he would be placed in a nursing house
dsdfs
social services arrange for further care
social service asistance
hospice, palliative care
ok
case manager
okay
Our community has some homecare supports, but this option might not be enough for his medical needs and his daughter’s caretaker burnout. We’ve got a palliative suit in hospital that might be a more appropriate option for their needs. We can always call for palliative care personnel support, but they would only be able to provide over the phone advice (which is still often very helpful).
arrange for in home palliative care with assistance from case management
via case management to arrange for in home palliative care
referral to home care who would work through the hospice/pallative care portion
pall care
contact the on call hospice staff for a consult, intake and medication recommendations
Home Palliative care
Add home health aide or inpatient hospice
palliative care team
.
suggest hiring a personal support worker to take care of him at home
Suggest palliative care consultation and referal to a home psw
referral to CCAC
Cv
community palliative care
hospice would be an option, or in-home palliative care services (PSW, nursing, companion care)
given symptom burdens probably need to admit short term with palliative team/home health palliative referral – titrate symptom concerns and plan for discharge, Pall SW/spiritual care referral
Likely admission to GIM with palliative care consult, social work consult for discharge planning with CCAC in place to provide support to caregiver
Referral to GIM for inpatient initiation of care and palliative care organization
CCAC and palliative care
CCAC and PSW support at home with palliative care support
home care nurse
Community programs
CCAC
we donot have such support
respite with palliative care involvement
family or ED physician would refer to the palliative program to provide assistance to patient to be able to stay home and review his medications to prevent pain constipation anxiety etc.
direct call,
k
case manager, home care service order and they contact the patient, outside agencies have options, local hospice agencies, ADRC
social worker/case manager and palliative care consult of hospice liaison
community pall care
aset
Home care program
hospice
hospice
Call supports
getting GEM involved
We have an ASET team whose role is to access help in the home
same as delineated in the above module
agreed
OT
community programs
ccac
helpful information
palliative care team
agreed
refer to palliative care
helpful
k
refer to palliative care
Always difficult from the ER
Refer to local services, note the family physician, meet social worker
Have an appointment scheduled with palliative care
we would utilize social work to start home help evaluation, give resources to the daughter
agree
optimize in hosp then transfer out
Discuss palliative care home, have nurse arrange home care on discharge
Home palliative care team
not sure
Consult palliative care.
Extra Mural Hospital services
Referral to palliative, engage social work
ok
palliative care
palliative care in charge
Palliative care CNC + ASET nurses in the first instance. Perhaps an overnight-two day admission to ensure more settled before returnign home.
referral
The palliative care team would have been consulted in the ED to help manage his multiple-system problems.
palliative care consult
We are lucky to have excellent aged care nurses in our ED who are expert in arranging home care
very challenging in our setting
counsel of relatives
follow up with onco team
palliative team referral
.
palliative care team
yes I agree
CCAC , palliative NP and palliative MDs in the community
Palliative home care would be in order or possibly PCU application
Our outpatient palliative care team will do a home visit if he is connected. OUr continuing care service can also augment personal care and provide EOL care. Our paramedics also provide EOL services to prevent return to the ED
palliative care
Palliative care team in conjunction with home care.
referral
referral
CCAC
ccac
Social services; Age Concern; Rapid response team.
Palliative care team would have to be involved as well as medical social workers
con grupos de trabajo
team interventions
no hay red de ayuda
Team consultation
Clinicas de Cuidados paliativos
We would notify the hospice center at our hospital or the provider of the pt. choice. They would then assess the pt., speak to the family about goals and arrange to have equipment and the pt. transferred home.
The hospital social worker would contact palliative nurse as well as H/C office to set up the support and the services he need before discharging him from the hospital.
Referral to palliative care would be my first step who could arrange all other home supports like CCAC.
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CCAC and palliative care team to follow
If the family is willing to provide a lot of the care, home nursing will support them
often if family is burnt-out or unable, will go to hospital or hospice
CCAC and palliative care referal
CCAC to be involved
CCAC to be contacted
CCAC Case manager and palliative care home visiting team, along with shared care by family md
palliative care is the best option for a death at home
I think my plan was much more extensive and appropriate than the “expert” opinion in each case, even though i had fewer characters to write it.
CCAC/Palliative care team consult.
contact the palliative care team in hospital re symptom management and counselling also link with both in hospital and out of hospital palliative care