Match each clinical scenario with the most appropriate level of palliative or hospice care.
- A 62-year-old woman with metastatic breast cancer who wishes to remain at home; her pain is stable on an oral opioid regimen, and she needs intermittent nursing visits for monitoring.Routine home hospice care
- A 78-year-old man with end-stage chronic obstructive pulmonary disease receiving home hospice whose primary caregiver is severely fatigued and needs a brief period of relief.Inpatient respite hospice care
- A 59-year-old man with terminal pancreatic cancer who develops acute, intractable agitated delirium at home that is unresponsive to aggressive adjustments of subcutaneous medications.General inpatient hospice care
- A 71-year-old woman with severe heart failure who desires to continue life-prolonging intravenous inotropic therapy but requires expert symptom management and goals-of-care coordination.Palliative care consultation without hospice enrollment
Answer
The patient with stable symptoms at home matches Routine home hospice care. The patient whose caregiver needs a break matches Inpatient respite hospice care. The patient with an acute, intractable symptom crisis matches General inpatient hospice care. The patient continuing life-prolonging milrinone matches Palliative care consultation without hospice enrollment.
Each level of palliative and hospice care is designed for specific patient and family needs. Palliative care can be provided concurrently with active treatment. Routine home hospice is for stable patients at home. Respite care is strictly for temporary caregiver relief. General inpatient hospice is for acute symptom crises unmanageable at home.
Step-by-Step Solution
Key Concept
Differentiating the Medicare hospice care levels (routine home, general inpatient, and respite) and distinguishing them from concurrent palliative care.