340:100-5-26.2. End-of-life issues

Issued 4-10-03

  1. Purpose. The rules in this Section are established to support the decisions of persons receiving services from the Developmental Disabilities Services Division (DDSD) regarding end-of-life issues. DDSD affirms life and regards dying as a normal process that should neither be hastened nor prolonged. DDSD encourages individuals to fully exercise their rights and make decisions about end-of-life issues that allow them to live with dignity and comfort.
  2. Applicability. Rules in this Section apply to DDSD staff and to service providers who are contracted, licensed, or funded through a DDSD Home and Community-Based Waiver or DDSD state funds and serve a person(s) who has been certified by a physician to be terminally ill. A person is considered terminally ill if he or she has a medical prognosis of life expectancy of six months or less if the illness runs its natural course.
  3. End-of-life services. When a person is diagnosed by a physician with terminal illness or is referred for hospice services, the case manager holds a personal support team meeting within five working days to review all care options with the person, guardian, or next of kin including consideration of hospice services. 1

    Instructions to Staff 340:100-5-26.2
  4. Case manager responsibilities. If the person, guardian, or next of kin elects hospice care, the case manager:

    1. identifies resources, including available funding, prior to selection of a hospice provider;
    2. notifies the DDSD state office Medical Services Unit that hospice services have been elected;
    3. arranges to meet with the service recipient, guardian or next of kin, DDSD nurse, health care coordinator, residential agency representative(s), other personal support team members as needed, and the hospice team to develop a treatment plan;
    4. integrates the hospice treatment plan into the Individual Plan (IP) and amends the plan of care to terminate services no longer needed and add any needed services;
    5. assists to coordinate the implementation of the treatment plan between the hospice team and the personal support team; and
    6. ensures that DDSD does not duplicate services provided by hospice but supplements hospice services to the extent needed in each situation.
  5. DDSD nurse responsibilities. If the service recipient, guardian, or next of kin elects hospice care, the DDSD nurse is responsible to:
    1. assist, in conjunction with the case manager, the service recipient, guardian, or next of kin with the selection of a hospice agency;
    2. develop a nursing support plan to identify hospice needs; and
    3. coordinate medication issues between the hospice provider and the residential provider to ensure compliance with OAC 340:100-5-32 regarding administration, documentation, and disposal of medications.

Instructions to Staff 340:100-5-26.2

  1. General Information regarding hospice services. The purpose of hospice care is to provide for the palliation (comfort care) or management of the terminal illness and related conditions.
    1. Hospice is a concept of care available to persons with a terminal illness. Hospice recognizes death as the final stage of life, and helps the service recipient live his or her final days to the fullest, surrounded by family and friends.
    2. Hospice care does not deliberately prolong the process of dying. The focus is on the person, not the terminal illness. Consequently, support focuses on pain management and symptom control, rather than disease treatment.
    3. Hospice provides state-of-the-art comfort through quality medical and emotional care.
    4. Hospice care is person-centered, taking into account and honoring the needs, wishes, beliefs, and situation of the person and family.
    5. Desired outcomes of hospice care include:
      1. living with dignity and comfort;
      2. controlling and managing pain;
      3. focusing on the whole person, including his or her physical, social, emotional, and spiritual well-being;
      4. providing support to the person to maintain control over his or her own life as much as possible for as long as possible;
      5. providing care in a familiar environment, usually the person's home;
      6. providing support to the person, family members, and caregivers with their emotional, interpersonal, and spiritual needs;
      7. acknowledging advance directives and do not resuscitate (DNR) orders, as defined by Section 3131 of Title 63 of the Oklahoma Statutes, in accordance with OAC 340:100-5-26; and
      8. assisting individuals to secure information regarding advance directives and DNR. Hospice services are not contingent on the execution of an Advance Directive or DNR.