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NURSING HOME PALLIATIVE CARE TOOLKITRevised February 2019This material was prepared by Heliocentric Advisors and adapted by Allianz Health Solutions, for Allianz Quality, the Medicare Quality Innovation

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How to fill out nursing home palliative care

01

To fill out nursing home palliative care, follow these steps:

02

Begin by contacting the nursing home facility and setting up an appointment. They will provide you with the necessary paperwork and guide you through the process.

03

Review the forms and gather all the required documents. This may include personal identification, medical records, and information about the patient's current health condition.

04

Fill out the forms carefully and accurately. Pay attention to any specific instructions or requirements mentioned in the paperwork.

05

Ensure that all necessary signatures are obtained. This may include the patient's signature (if they are capable of signing), the family representative's signature, and the healthcare provider's signature.

06

Submit the completed forms and documents to the nursing home facility. Keep copies for your records, if necessary.

07

Follow up with the facility to ensure that your application for nursing home palliative care has been processed successfully.

08

Remember to ask for assistance or clarification from the nursing home facility staff if you have any questions or concerns during the process.

Who needs nursing home palliative care?

01

Nursing home palliative care is designed for individuals who require specialized medical and emotional support due to a life-limiting illness.

02

The following individuals may benefit from nursing home palliative care:

03

- Elderly individuals with advanced chronic diseases such as heart failure, cancer, or chronic obstructive pulmonary disease (COPD).

04

- Those who have received a terminal diagnosis with a limited life expectancy.

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- Patients who require pain management, symptom relief, and emotional support.

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- Individuals who prefer to receive care in the comfort and familiar environment of a nursing home rather than a hospital.

07

It is important to consult with a healthcare professional or palliative care specialist to determine if nursing home palliative care is suitable for a particular individual's needs.

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What is nursing home palliative care?

Nursing home palliative care is specialized medical care for people with serious illnesses.

Who is required to file nursing home palliative care?

Healthcare providers in nursing homes are required to file nursing home palliative care.

How to fill out nursing home palliative care?

Nursing home palliative care can be filled out by documenting the patient's symptoms, treatment goals, and advance care planning.

What is the purpose of nursing home palliative care?

The purpose of nursing home palliative care is to improve the quality of life for patients with serious illnesses.

What information must be reported on nursing home palliative care?

Information such as pain management, emotional support, and communication about end-of-life care must be reported on nursing home palliative care.

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