Patient Transition into Hospice Care

I. Introduction

The patient presented in this paper is Ms. H an 83 year old African American woman that appears younger than stated age with a history of Multiple Myeloma. The patient chart was reviewed and an interview conducted. Interestingly the patient had retained every note, lab, hospital H&P and discharge summary in a file folder in her possession. Ms. H was diagnosed with Multiple Myeloma in April of 2008 when she was being worked up at her dentist for a toothache. X-rays performed revealed she had bone lesions in her zygomatic process and in her skull above her right eye. She was referred to Oncology Hematology Care for further work-up. A bone marrow biopsy revealed she had Multiple Myeloma. During the course of treatment the patient received Thalidomide, Revlimid, Velcade, Aredia, Zometa, and Decadron. Remission was achieved and the patient underwent stem cell transplant in February of 2009. The transplant was successful and the patient was cancer free until August of 2012 when she received news that her cancer had recurred.

Current meds are Lisinopril 20 mg PO daily for HTN, Omeprazole 40 mg PO for GERD, Topamax 25 mg BID for headaches, Calcium 500 mg PO TID for osteoporosis, Zofran 4 mg every 6 hrs/prn for nausea, Vicodin 5/325mg every 4 hours/prn for pain control.

Ms. H has 3 adult children and 4 grandchildren that are in their early 20’s. During the initial treatment phase Ms. H was employed part time at J.C. Penney. Once she was sent to Jewish for bone marrow transplant, she retired. She is on traditional Medicare with Medicaid due to reaching the cap on her secondary Humana plan. Ms. H is divorced but has a supportive friend Mr. P that has been at her side throughout her diagnosis and treatment. He...

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... benefit.

V. Analysis of Transition Admission Forms

Admission forms include Consent, HIPPA Acknowledgement Form, Patient and Family Rights Statement Receipt, Permission to Bill Medicare. Forms required for hospice admission are few and concisely written to reflect the Medicare Hospice Benefit. Patients who are compromised enough to sign their own forms are usually ill enough that the number of forms needed are appreciated. Ms. H and family were amazed and happy with the need for fewer signatures to admit.

References

(1.)Blood. 2008 March 15; 111(6): 2962–2972. doi: 10.1182/blood-2007-10-078022 PMCID: PMC2265446

(2)ASH 50th Anniversary Review Article on Multiple Myeloma…(look up)

(3)Publication Date: 2008-03-18Medicare Benefit Policy Manual Chapter 9 - Coverage of Hospice (4) JOURNAL OF PALLIATIVE MEDICINE

Volume 9, Number 6, 2006