Life and the disease process have three phases. We are born in the Curative Phase we move to the Disease Management Phase and then to the Life Limiting Phase.
In the Curative Phase when the person has a disease they are treated by their Physician which in most cases is the Family Physician or Primary Care Physician (PCP). If the curable disease symptoms becomes exacerbated the person is admitted to a hospital where their PCP has admitting privileges.
The hospital is considered an acute care facility. In the acute care setting of a hospital the patient is not cared for by their physician but by a “hospitalist physician” that is contracted by the hospital to manage the patient’s curable disease and the course for full recovery. The hospitalist will ensure to maximize the profitability for the hospital and reducing the cost.
Long Term Acute Care
The LTAC is designed to move the patient from the acute care setting (hospital) into a facility with lower acuity and they will manage the care plan started in the hospital. The patient must stay in the LTAC for at least 25 days or they will not maximize the LTAC’s profit.
If the patient still needs nursing care the family will have two choices:
The Home Health is designed to provide care in the patient’s home. The care is ordered by the patient’s PCP and provided by a home health company using a Registered Nurse. The RN will visit the patient several times during the course of recovery. The family will provide most of the non skilled (RN) care. If the patient has an exacerbation the PCP will advise the family to take the patient to the Emergency Care (ER). Here the process begins all over again.
Skilled Nursing Facility
The SNF will complete the plan of care started at the hospital, and partially treated at the LTAC. The SNF registers the number of the Medicare beds and Medicaid beds with the State department of Aging and Disability Service. (DADS) The Medicare benefit for SNF is 100 days. When the patient gets closer to using all of their Medicare days the process to apply for Medicaid begins. The long term care in a SNF will be funded by the patient and Medicaid.
Disease Management Phase
In the Disease Management Phase the person is now past the curable phase. In this phase the disease cannot be reversed and must be managed to give the patient the best quality of life possible. Each disease is managed differently; some can be managed with oral medication taken on a schedule while other diseases require periodic visits to an outpatient clinic or infusion suite for invasive therapy. Invasive therapy can be IV therapy, or accessing fluids to drain them or some not so invasive like palliative radiation.
This phase can last for many years all depending on the disease and therapy.
Life Limiting Phase
In the Life Limiting Phase the person moved to the beginning of end of life (EOL). This phase normally associated with Hospice is generally thought that if the disease process takes its normal course the person will die in 6 months. I use the word “die” because it has finality to it. Once the “body” begins the end of life journey it begins preparation for the death. The nine body systems that work together to produce the life we experience in a balanced form now begins to have failures. Sometimes all systems fail at once but most times the systems begin to slow down. This happens to all the systems and sometimes the systems slow down differently. We must remember that we are individual human beings and just as we were individual during our prime we will be reach EOL as individuals.
Hospice is the type of care provided in the home at the EOL. The “home” can be the patient’s actual home, an Assisted Living Facility, a Personal Care home, a nursing home, or where ever the patient calls home.
The philosophy of hospice care is to maximize the quality of life for the patient and family. While maximizing the quality of life the Hospice will manage the symptoms of the disease that make the patient uncomfortable. The symptoms can be pain, shortness of breath, nausea, vomiting, constipation, or diarrhea. It is the goal of Hospice to keep the patient comfortable during the EOL journey.