Palliative Care in a Nursing Home Is

Palliative Care in a Nursing Home – Is it Possible? Integrating Palliative Care in a Nursing Home On Dulberg Vera’s Home, Vera Solomons Center Nursing Home Kfar Saba, Israel

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Vera’s Home - Nursing Home Page 3

Elderly in Israel Palliative services in israel Palliative Care & Nursing home Page 4

89 years old women End stage dementia Eating problems Pressure ulcer stage 3 Septic shock and hypothermia AND Blood tests, X-ray Fluids and AB Died 8 hours from admission Page 5

Prognosis Quality of life Satisfaction Emergency departments Cost effective Page 6

Place of death, age 65+ , Israel 2013 67% Hospitals Page 7

Precentage of elderly ( 65+ ) in israel 80 (4) 84 (10) Page 8

Medical Journals 1 201 ne Ju 4 1 t 20 c O 5 1 y 20 Ma Page 9

Alternatives? Acute care hospital Hospices Community-based palliative care Long-Term Care - nursing homes Page 10

Palliative Care & Nursing homes / Barriers Standarts & guidlines Geriatric & Palliative qualification Structures / equipment / Medications Coping with end of life Functional status Financing Page 11

Palliative Care - Israel 2005 Dying Patient Law 2009 Palliative Care in hospitals, Nursing homes and community 2011 IMC = Israel Medical Cannabis 2013 Palliative residency programs 2015 Advance medical directive & Power of attorney Page 12

Dying Patient Act Democratic Traditional Religious Values Ethical Page 13

Dying Patient Act Sanctity Quality of life Autonomy Page 14

Barriers to the Development of Palliative Care in Israel All population Equal services Palliative qualification Multidiscipilinary All stages of disease All diseases Page 15

Core Components of Palliative Care Relief pain and other distressing symptoms; Regards dying as a normal process; Integrates the psychological and spiritual aspects of patient care; Help patients live as actively as possible until death; Uses a team approach Support the family Bereavement; Page 16

Objectives Integrating principles of the palliative approach in a nursing home. Acute and chronic illness Reducing end-of-life referrals to emergency rooms and hospitals. Allow residents to die at the nursing home Page 17

Methods A strategic decision Integrating the palliative principles Medical Directives & powers of attorney Multidisciplinary team Education Support Acute care & IV treatments End-of-life situations Page 18

Methods Implementation Date (Year) Page 19

Results A strategic decision Integrating the palliative principles Preliminary instructions and powers of attorney multidisciplinary team Education Support IV treatments Acute care end-of-life situations Page 20

Advance Medical Directives and Powers of Attorney (No’) Page 21

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Emergency Room visits per year (No’) year 101% Page 24 106% 105% 101% 93% 71% Occupancy rate

Mortality Rate: Hospital Vs Nursing Home year Hospital Page 25 Nursing Home

Traditional Ceremony Page 26

Palliative Care in a Nursing Home – Is it Possible? Integrating Palliative Care in a Nursing Home On Dulberg Vera’s Home, Vera Solomons Center Nursing Home Kfar Saba, Israel Thank You !