Help with Medications
Hospice can help manage the difficult to manage symptoms that occur with liver failure including pain, recurrent fluid build up, confusion and weakness.
Help with Equipment
Hospice can make sure correct equipment is ordered for your loved one to ensure proper care and safety.
One of the most difficult issues with liver cirrhosis is the young age of most patients. This leads to a lot of psychological, social and family dynamics. Hospice spiritual care teams and social work teams can help patients and caregivers manage stress and connect them to community resources.
Patients with advanced liver failure or cirrhosis will be eligible for hospice if they start meeting the following criteria. Meeting 1-2 of the following list can make a patient eligible for hospice (as determined by a physician). Hospice eligibility will allow the patient to receive additional services which will help alleviate patient symptoms and help with caregiver burdens. These interventions if received early enough may help prolong life given the additional healthcare services received by the patient (Physician, nurses, CNA, Chaplain, Social Worker, etc.). This focus on improving quality of life and reducing patient suffering but does allow for frequent patient check-ins by healthcare staff which help catch issues early and correct them before they spiral out of control.
- Blood clotting time starts to increase with increased bruising noted. This can be detected in labwork with an INR of greater than 1.5.
- Albumin levels of less than 2.5 indicating liver failure. This abnormality shows up as increasing edema in the hands/face/feet of the patient with eventual swelling of the belly due to increasing fluid (ascites).
- Presence of ascites. If the patient’s abdomen starts filling up with fluid this is a sign of advancing liver failure. If the fluid needs to be drained due to ineffectiveness of medications and needs to be done more than every 3 months, the patient is demonstrating advancing liver failure. This finding can be further complicated by infection of the fluid in the belly (SBP), development of kidney failure in addition to liver failure (Hepato-Renal Syndrome), progressive confusion due to toxin build up (hepatic encephalopathy).
- Increasing muscle wasting evidenced by loose clothes, muscle atrophy noted on exam, increasing weakness, and increasing dependence on caregivers for activities of daily living. If the patient needs help with more than 1 activity of daily living (transferring from bed to chair or chair to walking, incontinence, bathing/showering, dressing oneself, walking, and feeding oneself) in the setting of liver cirrhosis, it may signal that the patient may be hospice eligible.
Patients who are ACTIVELY awaiting a liver transplant and fulfill the above criteria may be certified for hospice . However, if a suitable donor organ becomes available, the patient must be discharged from hospice care to proceed with the transplant.
How Can Hospice Help?
Hospice focuses on addressing the patient’s symptoms and addressing any underlying comorbidities that may be affecting quality of life. One of the biggest focuses for hospice care is quality of life including pain and other symptom management.
At Lenity Light Hospice, we accomplish this by scheduling regular nursing visits to assess the patient for any uncontrolled symptoms. Anything that needs to be addressed is done so under the guidance of physicians. Medications are adjusted until pain and other symptoms are controlled.
Hospice is available to the patient and caregivers 24/7 and will provide various specialties to help take care of a patient. These include physicians, nurse practitioners, nurses, CNAs (nurse aides), volunteers, therapists, chaplains, social workers and other staff. Hospice also covers most medications, supplies (gloves, briefs, bandages, etc.), medical equipment (hospital bed, commode, shower chair, wheelchairs, walkers, bed side tables, oxygen, etc.).