Forms and information for Physicians. (resources and articles at bottom of page)
Regional Hospice admission agreement (includes NS Hospice)
Equipment rental agreement for NS (must accompany order form for equipment)
To refer a patient to North Shore Hospice:
1 Refer patient to N.S. Palliative program with a note requesting Hospice waitlisting.
2 A Palliative Care Physician will assess the request and if appropriate the patient will be added to the waitlist.
3 Patient or POA must sign the admission agreement prior to being placed on waitlist
4 GP will be notified of patient’s status on the wait list.
Criteria for acceptance to NS Hospice
Prognosis must be 12 weeks or less and the patient is unable to remain at home.
The patient must be registered on the N.S. Palliative Care Program and have a no CPR in place.
Patient and family must accept and understand the purpose of hospice care.
Patient must not be receiving IV medications or PEG feed or require regular tests.
Patient must not be a wandering risk or have any history of unprovoked violent or aggressive incidents.
If a patient’s condition stabilises, a family meeting will be held after 8 weeks at the Hospice and plans will be made for patient to transfer either home or to a residential facility.
Resources and articles or videos of interest
Talk to me – Seriously ill patients views on physician behaviours that influence quality of end of life communications (video)
DNACPR information (video)
Ten steps for what to say and do (video – Diane E Meier)
The Serious Illness conversation (Bernacki)
Messaging Palliative care (article)