A patient’s hospice care team is a highly-trained, multidisciplinary group of care professionals, with each member playing a role in the planning, provision, and management of the patient’s holistic end-of-life care.
Playing a crucial role in the care team is the hospice medical director, an expert physician that is responsible for ensuring that every patient’s care wishes are honored, that the hospice team is supported, and that the care goals set for each patient are being achieved."A hospice medical director is devoted to helping provide patients the highest level of quality end-of-life care."
By better understanding the specific function and purpose of the hospice medical director, and the effect this role has on patients, families, and caregivers, we can more fully understand how such a pivotal member of the hospice team plays its part in providing quality care.
What is a Hospice Medical Director?
The official role of hospice medical director was established in 1982 alongside the Hospice Medicare Conditions of Participation (COP). Under this federal mandate, all United States hospices participating in the federal Medicare program were required to have a dedicated medical director on staff.
At its core, the COP states that the hospice medical director is responsible for patient palliation and management of the terminal illness and conditions related to the patient’s terminal illness.
How Hospice Medical Directors Help Hospice Patients
First and foremost, hospice medical directors are committed to ensuring that every patient is provided with the highest level of care and that the care provided meets every patient’s unique needs.
They create and maintain the medical component of every patient’s plan of care.
The hospice medical director is responsible for developing a comprehensive medical care plan for each patient and ensuring that every member of the hospice team, caregivers, and the patient’s family, are knowledgeable of the care plan.
While every care plan is unique, each plan normally includes:
Detailed interventions to manage pain and symptoms
Measurable patient outcomes and goals from executing the plan of care
The specific drugs and treatments necessary to carry out the plan and provide quality care to meet the needs of the patient
They provide patients with certification of terminal illness.
Prior to being admitted to a hospice care program, and during each period of re-certification, a hospice medical director must verify that a patient is terminally ill — with an estimated 6 or fewer months left to live — and is qualified to receive hospice care.
They ensure that patient’s care wishes are honored with dignity.
Above all else, the patient’s desire for her or his care is honored. No medication is administered nor treatment pursued that is not desired by the patient, or in the case of a patient’s inability to communicate, the family.
How Hospice Medical Directors Support the Hospice Care Team
In addition to ensuring that patients are provided with quality end-of-life care, the hospice medical director also plays a crucial role in supporting the hospice care team and ensuring that every facet of the hospice’s patient care program is operating at the highest of standards.
They provide the hospice care team with medical advice.
During the interdisciplinary group (IDG) meetings, held at least once every 15 days to analyze and review patient care needs, the medical director advises the care team as to how to best go about providing each patient with the specific care that they need.
They ensure that infection control standards are being met.
Hospice medical directors also play a role in maintaining a clear, concise plan concerning the hospice’s infection control program. Medical directors may also perform regular quality assessments to help improve existing infection control programs.
They ensure every aspect of the hospice team and facility are operating at the highest standards of care.
As per federal mandate, hospice medical directors are required to develop and exercise meaningful, internal, data-driven quality assessments that analyze the constant improvement of palliative outcomes and the effectiveness and safety of patient and family service.
How Hospice Medical Directors Help Families and Caregivers
While the medical director role is heavily based in the provision of patient care and supporting the hospice care team, their duties also extend toward helping the families and caregivers of the patients.
They ensure that the family understands the patient’s plan of care.
While there can be many moving pieces that comprise a patient’s care plan, the hospice medical director ensures that families understand exactly what medications and treatments will be used in the pursuit of providing a terminally-ill loved one’s end-of-life care.
They uphold the family’s wishes for patient care.
Though the patient’s personal wishes for their own care are upheld above all, should it be the case that a patient cannot communicate for themselves, the hospice medical director ensures that the family’s wishes for their loved one’s end-of-life care are honored.
They determine the ability of the patient and/or family to administer care.
As a part of the interdisciplinary group meeting, the hospice medical director determines whether or not the patient or the patient’s family member is able to safely administer drugs and biologicals while the patient is at home.
Dedication to Quality End-of-Life Care
Though a hospice medical director’s responsibilities are numerous and varied, they all align around a primary focus: to provide patients with the highest level of quality end-of-life care that is in alignment with a patient’s personal care wishes.
Have you had the experience of working with a stellar hospice medical director? Are you a medical director yourself and want to share what you’ve learned during your years of professional experience? Share your thoughts with us in the comments below!
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- Gazelle, Gail, M.D. "Understanding Hospice — An Underutilized Option for Life's Final Chapter." New England Journal of Medicine. Division of General Medicine and Primary Care at Brigham and Women's Hospital, 26 July 2007. Web. 1 Nov. 2016.
- NCHPP Physician Steering Committee Members. "Medicare Hospice Conditions of Participation." National Hospice and Palliative Care Association. N.p., n.d. Web. 1 Nov. 2016.
- Oliver, Debra Parker, Elaine Wittenberg-Lyles, George Demiris, Paul Tatum, Kelly Regehr, and Stephanie Burt. "The Role of the Hospice Medical Director as Observed in Interdisciplinary Team Case Reviews." Journal of Palliative Medicine. Mary Ann Liebert, Inc., 2010. Web. 1st Nov. 2016.
- "State Operations Manual Appendix M - Guidance to Surveyors: Hospice." Centers for Medicare and Medicaid Services. N.p., 10 Sept. 2015. Web. 1 Nov. 2016.