When considering what medications are hospice-covered, we all know to look for drugs that “are used primarily for relief of pain and symptom control related to the individual’s terminal illness.” However, there is more to consider than just covered or not covered. There are appropriate and inappropriate medications based on the symptom management goals of the patient.
When assessing for appropriateness, ask yourself questions such as:
- Does this patient need strict control of blood pressure/blood sugar?
- What are the effects of this medication is discontinues?
- Is this medication treating symptoms or slowing the disease progress?
Below is a chart from a Delphi consensus panel that will help you decide what to keep and what to discontinue.
By discontinuing inappropriate medications, the patient will benefit from a decreased pill burden and fewer side effects from unnecessary drugs. The hospice agency will also benefit from the decreased drug costs.
- Social Security Act in section 1861(dd) and Federal regulations in Part 418
- Colloca, Giuseppe, et al. “Inappropriate drugs in elderly patients with severe cognitive impairment: results from the shelter study.” PloS one 7.10 (2012): e46669.
- Holmes, Holly M., et al. “Integrating palliative medicine into the care of persons with advanced dementia: identifying appropriate medication use.”Journal of the American Geriatrics Society 56.7 (2008): 1306-1311.