What is Different with Using OASIS in Hospice?

For hospice nurses, the goal of care is not curative but palliative, focusing on comfort and quality of life for patients nearing the end of life. While the Outcome and Assessment Information Set (OASIS) is a vital tool in home health care, its role differs in hospice care. Hospice nurses must understand what makes their assessment approach unique and how OASIS aligns with the specific goals of hospice care. Here’s what’s different when hospice nurses complete OASIS assessments.

The Role of OASIS in Hospice Care

OASIS is designed to collect data that reflects a patient’s clinical condition and care needs, helping to shape care plans and influence Medicare reimbursement in home health settings. However, the overarching goal of hospice care—providing comfort rather than pursuing curative treatment—shifts how hospice nurses approach the OASIS assessment.

In hospice, the focus is on symptom management, quality of life, and supporting the patient and their family through the end-of-life process. While OASIS is still an important tool for gathering patient data, it must be adapted to align with these goals. The following sections outline the key differences in how hospice nurses use OASIS compared to home health nurses.

Differences in Care Goals

In home health care, OASIS assessments are often geared towards tracking a patient’s improvement or decline over time, assessing their ability to perform daily activities, and determining the best interventions to restore or maintain their health. For hospice nurses, the goal is not to track functional improvements but rather to ensure that symptoms like pain, nausea, anxiety, and respiratory distress are well-managed.

Focus on Symptom Management, Not Recovery

For hospice nurses, the OASIS assessment will emphasize the patient’s comfort and symptom relief rather than improvement in mobility, strength, or independence. Questions about functional status in OASIS will still be important but mainly to determine how to support the patient in remaining as comfortable as possible. 

Example: When assessing ambulation or mobility, a hospice nurse might focus on how to make movement as comfortable and safe as possible, rather than on setting goals for walking more independently.

Adjusting OASIS for End-of-Life Care

Since hospice patients are generally in the final stages of life, some sections of OASIS require a modified approach. Nurses need to adapt their thinking to reflect the goals of hospice care.

Section on Pain and Symptom Management

The section of OASIS that addresses pain is one of the most important you will want to focus on. For patients in their final days or weeks, effective pain management is often the highest priority. Hospice nurses must assess how pain affects the patient’s quality of life and determine the best course of action to alleviate discomfort.

Key Considerations:

• Pain management should be the central focus in OASIS, with detailed notes on where the pain occurs, its intensity, and how it responds to medication or other treatments.
• Nurses should consider not only physical pain but also emotional or spiritual distress, as these can significantly impact the patient's comfort at the end of life.

Mental Health and Emotional Support

OASIS assessments often evaluate a patient’s cognitive function and mental health. In hospice care, nurses may notice that mental and emotional health issues take on a different significance. Patients nearing the end of life may experience anxiety, depression, or fear, which require specific interventions beyond traditional mental health care.

Hospice Approach:

• Hospice nurses use OASIS to assess not only cognitive decline but also emotional and spiritual well-being, recognizing that patients may need more support in dealing with feelings of loss or coming to terms with their situation.
• Interventions could include counseling, support groups, or involving chaplain services, all with the goal of providing holistic care for both the patient and their family.

Activities of Daily Living (ADLs) in Hospice Care

In home health care, improving or maintaining a patient’s ability to perform activities of daily living (ADLs) is a key objective. Hospice nurses, however, focus on making ADLs as comfortable and manageable as possible, without the expectation of improvement. While this is gauged with the OASIS, it should also be written down in the hospice software as far as how to handle ADLs and make it patient specific to ensure the best quality of care for each individual.

Key Adaptations:

• Rather than encouraging independence in activities like bathing, dressing, or eating, hospice nurses assess how to assist patients in completing these tasks with minimal discomfort.
• Hospice nurses may look for ways to modify ADLs to reduce strain on the patient, whether that means introducing adaptive equipment, changing the patient’s environment, or relying more on caregivers.

Functional Decline and Its Place in Hospice

Unlike home health, where a decline in function may signal the need for more intensive interventions or a change in the care plan, in hospice, functional decline is expected. Therefore, hospice nurses use OASIS to monitor these changes but with a different perspective.

Acceptance of Decline

Hospice care embraces the natural decline that comes with terminal illness. Rather than being a negative outcome, the decline may be seen as part of the natural process of dying. Hospice nurses must still document these changes using OASIS within the hospice software but do so with the understanding that the focus is on comfort and dignity, rather than reversing or delaying the decline.

Example: When filling out the functional status section of OASIS, hospice nurses focus on making the patient’s remaining time as comfortable as possible. For instance, they may suggest the use of a hospital bed, mobility aids, or increased assistance from family or caregivers.

Caregiver and Family Involvement

In hospice, the patient’s caregivers and family members play an important role in the care process. OASIS assessments in hospice settings place more emphasis on the involvement of caregivers and the support they need. The nurse’s role often extends beyond caring for the patient to providing education, emotional support, and guidance to family members.

Family Education and Support

Since caregivers are often responsible for the majority of the patient’s daily care, hospice nurses use the OASIS assessment to identify any gaps in the caregivers’ ability to provide adequate support. They may need to teach caregivers how to administer medications, manage symptoms, or provide physical assistance with daily activities.

Key Adjustments in OASIS:

• Hospice nurses assess the family’s readiness to provide care, offering training where necessary.
• The emotional and psychological state of the caregivers is also considered, ensuring they receive the support they need to cope with their loved one’s condition.

Anticipating Future Needs

Another difference in OASIS for hospice care is the forward-thinking nature of the assessment. Hospice nurses often use OASIS to predict the patient's needs as their condition worsens. Anticipating needs such as increased pain management, changes in mobility, or additional caregiving help allows the nurse to adjust the care plan proactively.

Hospice Approach:

• The OASIS assessment helps identify when a patient may need more intense symptom management, like stronger pain medications, or when more advanced medical equipment, such as oxygen or suction machines, may be needed.
• It also helps nurses determine when additional support for the family might be necessary, such as counseling services or respite care.

Documentation and Regulatory Differences

In hospice, documentation is especially important not only for ensuring quality care but also for meeting regulatory requirements. Hospice care is closely monitored by CMS to ensure that agencies are providing appropriate care for patients who are nearing the end of life. OASIS data can influence hospice reimbursement rates and is used to demonstrate that hospice patients are receiving the care they need.

Key Documentation Tips:

• Accurate OASIS documentation ensures that hospice agencies receive proper Medicare reimbursement and meet compliance standards.
• Incomplete or inaccurate data could result in financial penalties or a reduction in services for patients.

Conclusion

While OASIS is a familiar tool for both home health and hospice nurses, its application in hospice care requires a unique approach. Hospice nurses use OASIS to ensure that their patients receive care focused on comfort, dignity, and quality of life during their final days. In hospice care, accurate and thoughtful OASIS assessments are not just a matter of compliance—they are essential for providing compassionate end-of-life care.