The Role of the Hospice Team: What Does the Patient/Family Need? (Enhabit 2024)

1. The Hospice Team Defined

The Medicare hospice regulations define the structure of the hospice interdisciplinary team and why this type of approach to care is preferred for seriously ill patients at the end of life. This chapter discusses the foundation for utilization of an interdisciplinary team approach in care and how it benefits a patient/family at the end of life.

2. Who Are Part of the Hospice Team?

Medicare regulations require specific disciplines be part of the hospice interdisciplinary team so that the patient/family is provided with holistic care. Core professional services within the Medicare Hospice Benefit include the physician, nurse, social worker, spiritual counselor, and bereavement counselor. This chapter will describe each member of the hospice team, their role, and their responsibilities to the rest of the team and to the patient/family.

3. Identifying Patient and Family Needs

The hospice team is focused on accurate and speedy identification of patient and family needs through the use of comprehensive assessment at admission and continuously throughout the hospice service period. This chapter will examine the interdisciplinary team assessment process and targeted content in the assessment that identifies the needs of the patient and their family.

4. Team Development of the Hospice Plan of Care

The interdisciplinary hospice team works together with the patient, their family, and the patient’s primary physician to develop a patient centered plan of care. The plan of care serves as the roadmap for the hospice team to provide holistic palliative care to the patient and their family. This chapter will describe the hospice team process for the development of the plan of care and define how the hospice team completes a continuous assessment and plan of care update cycle until the patient’s death or discharge from hospice.