The hospice interdisciplinary group (IDG) creates a patient’s plan of care and provides holistic care to the patient, caregiver, and family. Hospice Conditions of Participation require the IDG to “review, revise, and document the individualized plan as frequent as the patient’s condition requires, but no less frequently than every 15 calendar days.”
As such, the IDG meet at a minimum every 15 days. In many hospice organizations, the interdisciplinary group meets weekly to review patient status and to determine if changes are required to a patient’s plan of care. It is important that during the IDG meeting patients’ care plans are reviewed and updated based upon patients’ assessments. Timely and accurate documentation is critical; this documentation may be reviewed by surveyors and by CMS to ensure compliance with regulations.
Who is required to attend an IDG Meeting
Required members of the IDG meeting include:
A doctor who is an employee or under contract with the hospice agency
Registered nurse
Social worker
Pastoral or other counselor
These four individuals are minimum participants in the IDG meeting. If one of these members i missing from the IDG meeting, the meeting does not meet Medicare regulations and it is considered as if the meeting did not take place. . Care must be taken to ensure that the minimum requirement – IDG meeting with the participation of at least these four individuals at a minimum of once every 15 days – is met.
Additionally, a staff member is typically identified to serve as the scribe for the IDG meeting. The scribe captures any changes to a patient’s plan of care that are agreed upon during the meeting.
What activities occur during the IDG meeting?
When the meeting begins, all participants sign the meeting sign-in sheet. These sheets serve as documented proof that the hospice has met the Medicare Conditions of Participation – that the required members of IDG participated in the meeting. Sign in sheets are stored in a place that is accessible for review upon the request of auditors or surveyors.
Prior to the IDG meeting, a list is drawn up of the patients who will be reviewed during the meeting. For each of these patient’s members of the care team provide an update on the patient’s current condition, highlighting any concerns. The team then discusses the plan for the upcoming two weeks.
Patients may be ordered for discussion as follows:
Deaths
Admissions
Recertifications
Evaluation
Let’s review each of these in detail.
Deaths
Each death since the prior IDG meeting is reviewed. The team discusses whether bereavement has been requested or declined. In the case where bereavement has been requested, the individuals who will be receiving bereavement services are identified. Any further details or concerns on the services that will be provided are discussed.
Admissions
The RN Case manager discusses any new admissions since the prior IDG meeting, including patient diagnosis and hospice eligibility criteria. Visit frequency is discussed, hospice aide services, and patient psychosocial needs. Typically, all team members partake in this discussion including a discussion about patient medications and prognostic indicators.
Recertifications
At this stage in the IDG the team discusses all patients who are the end of their benefit period and need to be recertified. Any face-to-face visits that were conducted will be discussed and any that are still pending will need to be scheduled. For patients who were evaluated and are found not to meet criteria, the team discusses how to notify the family and details on how to transition the patient off of hospice care.
Evaluations
All remaining patients on the list are reviewed by the members of the IDG. The team discusses whether any changes to the plan of care are needed, whether any medications need to be changed or if any additional support is required (e.g., chaplain, volunteer). The plan of care may be updated if the team agrees that a change in visit frequency is required.
Updating patients’ plan of care
While each patient is discussed, any changes to the patient’s plan of care are entered into the patient’s chart, which is signed by the medical director.
Hospice care is patient- and family-centered, where the patient’s and family’s preferences and needs drive the care plan.
The hospice interdisciplinary group (also referred to as Hospice IDG or IDG), also referred to as the interdisciplinary team (IDT) is a team of healthcare professionals who work together to create a plan tailored to the needs of hospice patients. The IDG is crucial because it reflects the fundamental principle of hospice care: a multidisciplinary and holistic approach to treating a patient. Hospice care is not just about managing medical symptoms; it involves addressing the physical, emotional, social, and spiritual needs of the patient and their family. This comprehensive care model requires combined expertise of different healthcare professionals working together as a cohesive team.
Multidisciplinary and 360-degree approach
The idea of a multidisciplinary approach is central to hospice care because a single healthcare professional cannot fully address the complex needs of a patient at the end of life. Hospice patients often experience pain, emotional distress, social isolation, and spiritual concerns, all of which need to be treated so that the patient has a peaceful and dignified end of life experience. Each of the members of the IDG can address different aspects of hospice patient needs.
Physical needs: Managed by the physician and nurse. The physician provides medical direction and oversees patient care while the nurse manages the patient’s medical needs such as pain control and symptom management.
Emotional and social needs: The social worker provides emotional and social support, caring for emotional health, caregiver stress, and family dynamics. Consideration is also given to connecting the family with community resources
Spiritual needs: These are managed by the chaplain, who offers spiritual care and counseling, based on the patient’s and family’s beliefs. The chaplain helps patients and families explore spiritual concerns, questions of meaning, or religious beliefs in the context of their journey.
Daily living needs: Hospice aides assist with personal care like bathing, dressing, and grooming. They ensure dignity and comfort in activities of daily living like bathing, dressing, and grooming.
Companionship and support: The hospice volunteer offers companionship and practical help, like errands or respite for family caregivers.
By involving individuals from different disciplines, hospice care can take a 360-degress approach to a patient’s needs. It means that every aspect of care – physical, emotional, social, and spiritual – is addressed by someone with the expertise to manage that particular dimension. This all encompassing approach is what makes hospice care unique and effective.
Are all member of the IDG required per CMS regulations?
Per CMS regulations, only core members must always be part of the IDG to ensure that hospice care addresses every critical aspect of the patient’s experience. Four disciplines are considered core required members of the team. These include:
Physician
Registered nurse
Social worker
Chaplain
Some professional members may be included in the IDG as needed, depending upon patient’s individual circumstances. These include:
Hospice Aide
Volunteer
Therapists
Bereavement Counselor
How is the IDG aligned with regulatory standards?
CMS requires that hospice care involve an interdisciplinary approach because it reflects the need to treat the “whole” patient, not just their medical condition. The IDG ensures that the care plan is tailored to the patient’s evolving needs and that it incorporates feedback from multiple disciplines to achieve the best outcomes. The interdisciplinary model is also a regulatory requirement under the hospice Conditions of Participation (CoPs). As such, surveyors will review the functioning of the IDG during inspections to ensure compliance. A well coordinated interdisciplinary team ensures regulatory compliance and quality patient care.
Why is the interdisciplinary hospice team essential?
Hospice care is patient and family centered, meaning that the patient’s and family’s preferences and needs drive the care plan. The IDG works collaboratively to ensure that the care plan remains flexible and responsive to changes in the patient’s condition. As hospice patients often experience rapid changes in health, having professionals from different disciplines ensures that all aspects of care can be addressed promptly and effectively.
In summary, the IDG reflects hospice’s holistic, multidisciplinary approach to care by ensuring that all dimensions of the patient’s well-being are addressed. Required team members focus on medical, emotional, and spiritual care, while optional members can be added to meet unique or additional needs. This alignment ensures that hospice remains flexible and patient-centered.
Documentation is an essential part of patient care, especially when you are working as a member of a hospice team. Hospice documentation involves writing down everything you did, observed, and discussed with the patient and their family during your visit. This includes the care you provided, any changes in the patient’s health, and specific events that could impact the patient’s future health. Documentation is like a diary that keeps track of the patient’s journey, making sure everyone involved in the patient’s care is on the same page.
Why is documentation important?
Documentation is a way for the team members to share information about the patient’s health condition and any changes in the patient’s condition. It also serves as legal proof of the care that was provided to the patient. More specifically, there are a number of reasons why documentation is important:
Communication with the care team: Since hospice care involves multiple healthcare professionals, documentation helps everyone stay informed. Not all members of the care team are present during each patient visit. Notes in the medical record provide vital updates on the patient’s condition and ensure that all members of the care team know how the patient is doing and can make informed decisions about patient care based upon the most up-to-date information about the patient’s health status.
Legal requirements: Documentation is also a legal requirement. Documentation serves as proof that a patient visit occurred and that specific care was provided. If something goes wrong or if there is a legal question about the patient’s care, the notes in the patient’s medical record can be used to show what happened and when.
Continuity of care: Proper documentation ensures that the care plan is followed consistently. It helps the team track the patient’s progress and make any changes to the patient’s care, as needed. Without accurate records, important details may be missed which can lead to gaps in the patient’s care.
Guidelines for good documentation
As we have discussed, documentation plays a critical role in helping with communication between the members of the care team, helping meet legal requirements, and in ensuring continuity of patient care. So how can you make sure that the documentation that you write is good documentation — that it is clear, accurate, and useful? The following are some guidelines to follow:
Document right after the visit: Document your visit immediately after you complete your visit. This helps you remember exactly what happened and ensures that your notes are fresh and accurate.
Be clear: Think about what you want to write before you start. Make sure your notes are easy for other members of the care team to understand. Write your notes in a way that it is easy to follow, so that others can quickly find the information that they need.
Stick to the facts: Only write down what actually happened. Avoid including your opinions or assumptions.
Use quotation marks: If a patient or family member says something important, include their exact words in quotation marks. This helps convey the exact message they intended.
List your tasks: Write down any tasks you did, helped with, or observed.
Be specific: Include specific information to help other members of the care team better understand the patient’s current condition. Examples of specific details are (depending on role):
Patient’s mood
Any pain or changes in pain
How well patient moved around
Changes in appetite
Weight changes
Changes in need for oxygen
Increased or decreased difficulty breathing
Conclusion
Good documentation is more than just writing things down. It is a vital part of providing high quality care. By keeping accurate, detailed, and timely records you help ensure that the patient receives the best possible care and you fulfill your legal responsibilities as a healthcare provider. When in doubt, always ask for help to make sure that your documentation is accurate and useful. Your supervisor, clinical director, or members of your QAPI team are all great resources in case you have questions.
As a member of the hospice healthcare team, you play an important role in caring for your patients. Because of this, you will often learn private information about them – not just about their health, but also about their personal relationships, their financial situations, and other sensitive and personal information. It is important to understand that you have a legal and ethical responsibility to keep this information confidential and only share it – when necessary – with other healthcare professionals who are part of the patient’s care team. It is your responsibility to protect patient privacy.
Why is it important to keep healthcare information private?
In 1996, the Health Insurance Portability and Accountability Act (HIPAA) was passed to protect people’s health information. The main goal of HIPAA is to ensure that health information is kept private and secure, and only shared with those who need to know in order to provide care or process medical records. This law applies to everyone working in healthcare.
What does HIPAA protect?
HIPAA protects what is called “personal health information” (PHI). This includes any details that could identify a patient, such as:
Name
Medical record number
Date of birth
Address
Email address
Social security number
Only those directly involved in a patient’s care or those who handle billing or administrative tasks should have access to this information.
Your role as a member of the patient’s healthcare team
As a member of the patient’s healthcare team, it is important to follow HIPAA rules to protect your patient’s privacy. If you share a patient’s health information without permission, it can harm the patient and break the trust they have in you. Here are some important things to keep in mind:
Do not share information unnecessarily: Never discuss a patient’s health with friends, family, or on social media. Only discuss patient care with other healthcare workers who are directly involved in that patient’s care.
Keep conversations private: If you need to talk about a patient’s care with another healthcare worker, make sure you do so in a private place where others cannot overhear.
Secure patient records: Whether you are handling paper records or using electronic systems, always ensure that patient information is stored securely.
Why following HIPAA is important
By following HIPAA regulations, you help protect your patient’s privacy, ensure their information is handled with respect, and build trust. Patients and their families rely on you to keep their personal information safe, and HIPAA provides the guidelines you need to do so.
What are the guidelines of not following HIPAA?
Hospices and their employees must protect patient information at all times. If HIPAA rules are not followed, it can lead to serious consequences including fines, penalties, and even imprisonment. This applies not just to the hospice itself but also to any vendors or contractors who work with patient information.
Final thoughts
Understanding and following HIPAA is an essential part of your job as a member of a patient’s healthcare team. By keeping patient information private, you help ensure their safety, comfort, and trust in the care they receive. Remember, protecting privacy is not just a legal requirement – it is a crucial part of providing compassionate and respectful care.
Advanced directives give patients the ability to direct their medical care in advance. Advanced directives are legal documents that tell doctors and caregivers what a patient wants for their healthcare if the patient becomes too sick to speak or make decisions. Advanced directives explain what kind of medical care the patient would like to receive, or not receive, in different situations.
Advance directives can also name the person who should make medical decisions for the patient in the case that the patient is unable to make those decisions.
Who writes an advanced directive?
The patient, while they are still able to make decisions, will write the advanced directive. Sometimes a family member or a close friend will help the patient, but it is important that the patient’s wishes are clearly written down.
When are advanced directives used?
Advanced directives are used if the patient is too sick or injured to talk or to make decisions about their own care. For example, if a patient is unconscious or has a severe illness that makes it difficult for them to speak, doctors or caregivers will check the advanced directive to understand the patient’s preferences and to know what to do.
How should advanced directives be treated?
An advanced directive is a legal document and must be followed carefully. The following is some guidance for members of the patient’s care team, relating to the patient’s advanced directive:
Know where it is: It is important for members of the patient care team to know if the patient has an advanced directive and to know where it is kept. This will help ensure that the patient’s wishes are followed, if the need arises.
Respect the patient’s wishes: The advanced directive represents the patient’s voice when the patient cannot speak for himself or herself. It is important to follow what it says in the advanced directive.
Communicate: If a member of the care team is not sure that they understand what is written in the advanced directive, they should speak with other members of the care team. Together, they can work to understand the advanced directives and ensure that the patient’s wishes are honored.
Stay calm and supportive: This situation is often stressful. It is important that members of the care team remain calm and provide support to the patient and members of the family.
Knowing how to provide support during times of hardship or crisis can make a significant difference in someone’s life. The Ring Theory, developed by clinical psychologist Susan Silk, offers a framework for offering support. Specifically, Ring Theory provides a framework for offering support that centers around the needs of the person experiencing the crisis. In this blog we will explore the key principles of this theory and its practical implications for providing effective support.
The Concept of the Ring Theory
At its core, the Ring Theory outlines a model for providing support during times of crisis. It is based on the idea of concentric circles. The person who is directly affected by the crisis is at the center of these concentric circles. Surrounding circles represent their closest relationships, with each circle representing a different level of connection to the individual in need.
Understanding the Circles
Center Circle: The innermost circle contains the person experiencing the crisis. This individual is at the heart of the support network and should be the primary focus of empathy and assistance.
Immediate Family and Closest Friends: The next circle consists of the individual’s immediate family members and closest friends. These individuals have the strongest emotional connection to the person in need. They play a crucial role in providing support.
Extended Family and Close Friends: The third circle includes extended family members, colleagues, and friends. They are also close to the individual but may not be directly involved in the individual’s day-to-day life.
Acquaintances and Casual Friends: The outer circles comprise acquaintances, colleagues, and distant friends who may have a connection to the person in need but are less emotionally involved.
According to the Ring Theory, each concentric circle is advised to “comfort in” and “dump out.” This means that individuals in the outer circles may talk about their stress to anyone in the larger circles but must provide comfort and support to those in smaller circles.
Practical Application of the Ring Theory
When applying the Ring Theory, it is important to prioritize the needs of the person at the center of the crisis. Instead of burdening that person with our own emotions or seeking validation for our feelings, we should focus on offering comfort, practical assistance, and a listening ear.
Offer Comfort, Not Complaints: Prioritize the needs and emotions of the person in crisis over your own. Offer words of comfort, empathy, and practical support.
Listen Without Judgment: Provide a safe space for the person to express their feelings without fear of judgment or criticism.
Respect Boundaries: Understand that everyone copes with crisis differently. Respect the person’s boundaries and preferences for receiving support.
Provide Practical Assistance: Offer tangible help such as running errands, preparing meals, or providing childcare to alleviate some of the person’s burdens.
Avoid Sharing Your Own Struggles: Refrain from sharing your own struggles unless explicitly invited to do so. Focus on validating the person’s feelings and experiences instead.
Additional Considerations
Beyond understanding the core principles of the Ring Theory, it’s important to recognize that providing support during a crisis can be complex and multifaceted. There are many considerations that one needs to keep in mind. Here we list some:
Cultural Sensitivity: Different cultures may have unique approaches to coping with crisis and seeking support. Be sensitive to cultural norms and preferences when offering assistance.
Self-Care for Caregivers: Supporting someone in crisis can take a toll on your own emotional well-being. Remember to prioritize self-care and seek support from your own network when needed.
Professional Resources: In some cases, the support needed may go beyond what friends and family can provide. Seek professional help or refer the individual to appropriate resources if necessary.
Where can you get more information
Ring Theory Helps Us Bring Comfort In – Psychology Today article discussing the principles of the Ring Theory and its application in supporting individuals in crisis.
The Comfort in, Dump Out Theory Explained – Psychology Today article providing an overview of the Comfort in, Dump Out Theory and its relevance in offering support during difficult times.
By understanding and applying the principles of the Ring Theory, we can provide meaningful support to those who need it most, fostering a culture of empathy, compassion, and understanding.
