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Hospice and Palliative Care for Therapists

Learn evidence-based hospice and palliative care principles to support your patient and their family in the advanced stages of living and end-of-life care.

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About this Certificate Program

Rehabilitation therapies are by their very nature palliative care, not curative. The goals are to maximize function, mobility, ADL independence, communication, and quality of life. As a result of aging, disease, and medical interventions, many patients, families, and their therapists face ever-greater challenges in the more advanced stages of living with and treating such conditions. This MedBridge Certification in Hospice and Palliative Care provides the highest quality and most current education available in the field, developed from American Physical Therapy Association and National Hospice and Palliative Care Organization courses provided by national experts in this area of practice.

Target Audience

This certification will benefit therapists in a wide variety of settings. The most applicable would be a therapist working for a hospice agency where advanced practice is essential for both client quality of life and organizational success. Acute care settings often have a palliative care program that needs the therapy component to provide a full spectrum of services. Skilled nursing facilities and long term care programs have many clients who would benefit from a palliative approach to therapy. Private practice and outpatient settings also see clients with progressive, non-curable conditions. Using the therapeutic approaches offered in the MedBridge Hospice and Palliative Care certification, a therapist in any of these practice areas can enhance function, safety, quality of living, and the transitional experiences through the full spectrum of a client’s life.

Goals & Objectives

  • Understand the role of rehabilitation therapies under the Medicare Hospice Benefit and successful strategies for team integration and program success.
  • Recognize patient situations where a palliative care model is appropriate and utilize clinical practices to support function, independence, and quality of life.
  • Identify hospice appropriate fall risk assessments and implement risk minimization with physical, psychosocial, and spiritual strategies.
  • Recognize opportunities to provide patient and family education about disease process and end of life trajectory and closure issues.
  • Integrate psychosocial and spiritual awareness into therapy practice to support patient/family end of life processes and therapist self care.
  • Describe clinical features, functional measures, and palliative outcomes relevant to late and end stage neurodegenerative diseases.
  • Identify strategies utilizing mindfulness techniques to decrease stress, increase self-awareness, and improve communication in a palliative care or hospice practice.
  • Discuss parameter of dying including the physiologic process, trajectories, clinical prognostic measures, and signs and symptoms of approaching death.
  • Identify the differences between palliative care and hospice practice in different settings and the components of patient directives.

What's Included in the Certificate Program

Courses
Accredited Online Courses*

18 hours of online video lectures and patient demonstrations.

Courses
Case Study Interviews

Recorded Q&A sessions between instructors and practice managers.

Courses
Interactive Learning Assessments

Case-based quizzes to evaluate and improve clinical reasoning.

Section 1: Hospice Care

2 Chapters

Hospice and Palliative Care: A Primerkeyboard_arrow_down

Course
  • History and DevelopmentChapter 1

    In the first chapter of this course, Rich Briggs introduces participants to the origin and definition of end of life care. He identifies the palliative aspects of rehabilitation therapies and discusses modern approaches to hospice and palliative care.

  • Medicare Hospice BenefitChapter 2

    Chapter 2 begins by reviewing hospice philosophy and goals. Rich Briggs identifies populations and diagnoses receiving end of life care. Participants will learn the hospice care reimbursement structure and be able to differentiate covered services and equipment. Interdisciplinary team roles and interactions are discussed.

  • Roles of Physical, Occupational, and Speech TherapyChapter 3

    In Chapter 3, Rich Briggs identifies the evaluative role of therapy and consultative opportunities in care. Participants will learn the appropriate treatment orientation and use of practice patterns.

  • Cost Neutral StrategiesChapter 4

    Participants will learn to utilize complementary visit integration for efficient practice and how to implement reduced aide visitation with family training. Rich Briggs discusses how to identify fall and injury prevention measures.

  • Program Development for Organizational SuccessChapter 5

    In the final chapter of this course, Rich Briggs identifies the barriers to utilization of therapy services. Participants will learn to discern internal and external marketing opportunities, and recognize the top ten reasons for hospice therapy. They will learn to provide improved patient/family quality of life, safety, and satisfaction.

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Palliative Care & Hospice Spectrum: Opportunities to Transform Carekeyboard_arrow_down

Course
  • An Overview of Palliative CareChapter 1

    Using a case study of a patient newly diagnosed with ALS, this chapter will explore the concept of palliative care as an extra layer of support to assist with the coordination of care, the promotion of quality of life and the management of symptoms which limit this. This chapter will also explore past and current models of palliative care as well as services provided, payment models and practice settings. Finally, barriers to palliative care access will be explored.

  • An Overview of Hospice CareChapter 2

    The origins of compassionate end of life care began with the vision of Dr. Cicely Saunders, who is known as the founder of the contemporary hospice movement. This chapter will explore the hospice care from several perspectives including the services provided, eligibility requirements and the primary diagnoses served. Finally, eligibility requirements for admission to hospice will be discussed.

  • Advanced Directives and POLSTChapter 3

    If you were in a serious accident today, with no hope for recovery, would your family or loved ones know what to do? Surprisinlg, only 30% of Americans can answer positively to this question. Advanced directives may well be the single most important step towards individualized and compassionate end of life care. This chapter will discuss the two components of an advanced directive; the durable medical power of attorney and the living will. Videos of actual end of life discussions will be shown to highlight approaches to end of life planning. Finally, the emerging use of physician orders for life sustaining treatment (POLST) will be discussed, including indications for completion of this document.

  • Physical Therapists and End of Life CareChapter 4

    "My father is dying, why would he need a physical therapist?" This question, commonly asked by patients, and even by other physical therapists, belies the reality of the benefits of physical therapist intervention. This chapter will explore the role of the physical therapist in the provision of non- pharmacologic pain management, patient education and exercise. Briggs’ 2007 model of physical therapist practice patterns will be briefly discussed to provide a contextual framework for the delivery of interventions. A brief overview of end of life outcome measures will be presented and the chapter will end with a patient case study and video.

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Section 2: Clinical Practice

4 Chapters

Hospice and Palliative Care: Transitions from Rehab to End of Lifekeyboard_arrow_down

Course
  • Paradigm ShiftChapter 1

    In the first chapter of this course, Rich Briggs defines palliative care and identifies heuristic errors in physical therapy practice. He demonstrates how to apply physical therapy as a palliative intervention.

  • Clinical IndicatorsChapter 2

    Chapter 2 reviews select diagnoses that have a terminal trajectory. Participants will learn to utilize clinical findings to identify palliative care needs. Rich Briggs also reviews words and expressions that indicate end of life awareness.

  • Palliative Therapy Practice PatternsChapter 3

    Rich Briggs identifies rehab-light therapy practice characteristics and defines Rehabilitation in Reverse for the declining patient. Participants will learn to recognize Case Management as an ongoing care tool.

  • Skilled Maintenance and Supportive CareChapter 4

    In Chapter 4, Rich Briggs justifies skilled vs. unskilled maintenance care situations. Participants will review both physical and psychosocial Supportive Care practices.

  • Clinical PearlsChapter 5

    In Chapter 5, participants will learn to utilize optimal equipment height for function. They will learn to recognize the significance of pulse monitoring and predicted maximal heart rate and apply appropriate edema mobilization and management strategies. Rich Briggs identifies the use of visualization with passive range of motion.

  • Conclusion and ConversationChapter 6

    In the final chapter of this course, participants will learn to recognize signs and symptoms of clinician stress. Rich Briggs identifies therapist self care activities and describes the use of presence with non-attachment. The chapter ends with an explanation of the practice of Living Our Dying.

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What's Up With Falling Down?keyboard_arrow_down

Course
  • Managing Falls with a Person in DeclineChapter 1

    Rich Briggs begins this course by discussing the frequency of falls in older adults and identifying standards of practice in fall management. Participants will learn patient/family concerns about autonomy and when falls are acceptable as a natural process at end of life.

  • Risk ManagementChapter 2

    In Chapter 2, participants will learn about the spectrum from maximum safety to high risk. They will learn how to apply the components of Triangle of Safety.

  • Physical Assessment Issues and ToolsChapter 3

    Participants will learn to identify and advise about environmental hazards and utilize targeted physical and functional assessments. Rich Briggs demonstrates how to apply appropriate fall and balance assessment measures.

  • The Role of Therapy in Fall ManagementChapter 4

    Rich Briggs identifies medical interventions affecting mobility and risks. He provides risk management tools and information to patient/family and demonstrates equipment options.

  • Psychosocial and Spiritual Issues of FallingChapter 5

    The final chapter in this course begins by identifying normal practice rituals of functional mobility. Participants will learn to recognize near death awareness communication and appreciate potential body/spirit transitional experiences.

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Palliative & Hospice Care: Late to End Stage Neurodegenerative Diseasekeyboard_arrow_down

Course
  • The Scope of Palliative CareChapter 1

    What is palliative care? When might a patient benefit from a palliative care program? This chapter will provide an overview of the scope, purpose and indications for palliative care. Payment systems and models of delivery will also be discussed as well as evidence for the effectiveness of palliative care programs.

  • Exploring the Palliative Care Needs of Patients with Neurodegenerative DiseaseChapter 2

    Although patients with MS, ALS, Parkinson’s disease and Dementia may have different symptoms in the early stages of their disease, the end stage clinical picture is characterized by common symptoms such as pain, fatigue and respiratory distress. Furthermore, the severity of these symptoms have been compared to those of end stage cancer. This chapter will provide an overview of the pathogenesis of ALS, MS, Parkinson’s disease and dementia, including the transition to end stage and the need for palliative care.

  • Living and Dying with Neurodegenerative Disease: Disease Specifics and Case IllustrationsChapter 3

    What is it like to live and die with Parkinson’s disease, ALS, dementia and MS? This chapter will include interviews with Dee, a 62 year old nurse who is living with ALS; Cindy, a 57 year old female living with late stage MS; and Nancy and Joanne, two elderly women living with Parkinson’s disease. The case of Helen, an 89 year old with dementia, will also be presented as an illustration of what can happen when patients are not provided with timely access to palliative care programs.

  • Assessing Our Patients for Hospice and Palliative CareChapter 4

    During a patient's functional decline, what indications point to referral to hospice and palliative care? What outcome measures can assist the decision making process? This chapter will explore specific indications for hospice referral for MS, ALS, Parkinson’s disease and dementia. In addition, specific palliative outcome measures will also be explored. Finally, functional measures that are commonly used by physical therapists will be explored for their use in hospice and palliative care.

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Hospice and Palliative Care: Conversations at the Bedsidekeyboard_arrow_down

Course
  • Introduction: Cognitive ReframingChapter 1

    The first chapter of this course introduces participants to the concept of cognitive reframing, as well as the limits of patient and family understanding and acceptance. Participants who complete this chapter will be able to identify overall observation and listening skills, and utilize primary observation and listening skills.

  • Issue of Physical and Functional Mobility; Medical ConditionsChapter 2

    This chapter addresses the difficult topic of addressing changes in physical status and functional mobility during hospice care, including family education about disease processes, affirmation of maximal patient aerobic and anaerobic effort, and discerning variable life course trajectories.

  • Issue of Physical and Functional Mobility; Beyond DiseaseChapter 3

    This chapter pays particular attention to orthopedic considerations during the trajectory of the disease process, including decision-making around functional activities and activities of daily living.

  • Pyschosocial and Spiritual ConcernsChapter 4

    The final chapter of this course addresses the non-physical aspects of palliative care, unpacking the complex relationship between body, mind, and spirit as patients and their families approach end of life situations.

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Section 3: Therapist Awareness and Self-Care

5 Chapters

Death and Dying: Attitudes, Causes, Process, & Measureskeyboard_arrow_down

Course
  • Societal Attitudes Towards Suffering and DeathChapter 1

    Death and suffering are universal and pervasive human experiences, yet most of us avoid these topics. How can we effectively and compassionately interact with patients facing the end of life if we are not aware of our own attitudes? This chapter will invite learners to explore their own experiences and attitudes towards death and pain. Suggestions for preparing ourselves to meet the needs of dying patients from both personally and professional perspectives will also be discussed.

  • How We Die: Causes and TrajectoriesChapter 2

    250,000 persons die each day in the world, and these deaths have commonalities in terms of the causes and trajectories. This chapter will explore the leading causes of expected and unexpected death. The concept of death trajectories--the length of time over which the process of physiologic decline occurs--will be explored, categorized and linked to the resulting implications for patient education and support.

  • The Physiologic Process of DyingChapter 3

    For many persons the process of death evolves over months, weeks and days. This chapter will describe the physiologic, behavioral and psychological processes associated with the gradual shutting down of physiologic processes associated with imminent death. Finally the unquantifiable but prevalent concept of deathbed phenomena will be discussed along with suggestions for supporting patients and their families when these occur.

  • Assessments for Prognosis, Symptoms and FunctionChapter 4

    While none of us can predict the exact moment of death, the presence of several observable indicators allows for general prognostication, which can help patients and families to experience optimal quality of life in the face of decline. The measurement of symptom type and severity can be used to guide optimal interventions for comfort and the assessment of function can help us support patient quality of life.

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Mindfulness to Cultivate Empathy, Resilience, & Therapeutic Presencekeyboard_arrow_down

Course
  • The Problem of StressChapter 1

    This chapter will describe the impact of stress on emotional and physiological responses which impact health care providers by contributing to burnout, disengagement and medical error. The root of stress can be traced to the triune brain theory which suggests that our lowest brain centers are primed for fight or flight. This chapter will also discuss the concept of “amygdala hijack” and its contribution to increasing our impact of chronic stress.

  • Harnessing Positive NeuroplasticityChapter 2

    Mindfulness practices have been shown to change the structural composition of the brain. Similar to building muscle bulk through consistent practice, the consistent use of mindfulness practices is needed to promote these beneficial brain changes. This chapter will describe the relationship between practice dependent neuroplasticity and the intentional use of mindfulness strategies to increase our capacity for empathy, resilience and presence.

  • An Overview of MindfulnessChapter 3

    Mindfulness is described as the purposeful direction of moment to moment, focused and non-judging attention to the internal and external experiences of our lives. While the concept of mindfulness was founded in the Buddhist spiritual tradition, these concepts have been adapted and expanded as an approach to stress reduction. This chapter will explore several concepts related to mindful attention, including self-talk, emotional responses to failure and self-monitoring. Each of these concepts provides rich opportunities for embracing the “what is” of our daily lives without resistance or judgement.

  • Mindfulness PracticesChapter 4

    The cultivation of mindfulness can be accomplished through formal practices such as sitting meditation, and can also be incorporated into our daily lives through several practices that increase our awareness of emotional responses and the thoughts that arise. This chapter will explore each of these approaches, providing learners with opportunities for direct experience. Because practice is needed to reap the benefits of mindfulness, practical suggestions will be included for the development of both formal and informal practice.

  • The Neurophysiology of MindfulnessChapter 5

    The mechanisms by which mindfulness practices change the structure of the brain are becoming increasingly well understood. More importantly, every aspect of the mindfulness meditation process (focusing, losing focus, recognizing the loss of focus and redirecting focus) each produce beneficial outcomes which improve cognitive functioning. This chapter will explore the neurophysiologic structures impacted by each aspect of mindfulness meditation practice and provide evidence from recent studies which relates these changes to observable benefits.

  • Strategies for Empathic CommunicationChapter 6

    By incorporating mindfulness into our daily interactions, we can actually deepen our practice in the midst of our workday. More importantly, we can increase our empathy and engagement with others through deeper and more meaningful relationships. This chapter will explore four strategies: Active Constructive Responding, Appreciative Inquiry, Placebo/Nocebo and Mindful Speaking. Opportunities for practice will enable learners to experience the benefits of these strategies and promote their use in daily interactions.

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Hospice and Palliative Care: Being With Losskeyboard_arrow_down

Course
  • Being with Loss, Suffering and Dying; a Contemplative Care PracticeChapter 1

    The first chapter of this course defines the concept of a contemplative care practice, and will help the participant to recognize clinically relevant live situations that elicit personal reflection. This chapter also introduces the concept of recognizing mind, body and spirit when contemplating loss and suffering.

  • Suffering and Non-AttachmentChapter 2

    This chapter takes a closer look at the concepts of suffering and non-attachment. Participants will learn to differentiate between pain and suffering, and recognize mental and emotional responses in order to better identify clinical opportunities to better utilize presence and non-attachment approaches.

  • Being Present: A Mindfulness PracticeChapter 3

    Engaging in the practice of mindfulness can help therapists to experience personal awareness of mindfulness for use in client interactions. This chapter will help the participant to recognize the varying cultural manifestations of ‘presence’ and 'beingness,’ and provide strategies to promote mindful awareness in patients.

  • Mindfulness PracticeChapter 4

    This chapter delves into the emotional responses of patients and clinicians, and provides tools for identifying opportunities to support patient emotional expression, and to recognize personal responses to challenging clinical situation and the consequences of those responses.

  • Therapists Self-CareChapter 5

    The final chapter of this course addresses an often-overlooked aspect of hospice and end of life care: self care for therapists. This chapter emphasizes the importance of recognizing one’s own issues of unfinished business, and identifying opportunities for growth with reflective self-examination.

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Suggested Readings

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Hospice and Palliative Care References

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Instructors
Rich Briggs

PT, MA

Karen Mueller

PhD, DPT, PT

CEU Approved

18 total hours* of accredited coursework.
MedBridge accredits each course individually so you can earn CEUs as you progress.

      Our clinic could not be happier with MedBridge.

Amy Lee, MPT, OCS
Physical Therapy Central

       MedBridge has allowed us to create a culture of learning that we were previously unable to attain with traditional coursework.

Zach Steele, PT, DPT, OCS
Outpatient Physical Therapy & Rehabilitation Services

    MedBridge has created a cost-effective and quality platform that is the future of online education.

Grant R. Koster, PT, ATC, FACHE
Vice President of Clinical Operations, Athletico Physical Therapy

Frequently Asked Questions

Do I get CEU credit?
Each course is individually accredited. Please check each course for your state and discipline. You can receive CEU credit after each course is completed.

When do I get my certificate?
You will receive accredited certificates of completion for each course as you complete them. Once you have completed the entire Certificate Program you will receive your certificate for the program.

*Accreditation Hours
Each course is individually accredited and exact hours will vary by state and discipline. Check each course for specific accreditation for your license.

Do I have to complete the courses in order?
It is not required that you complete the courses in order. Each Certificate Program's content is built to be completed sequentially but it is not forced to be completed this way.

How long do I have access to the Certificate Program?
You will have access to this Certificate Program for as long as you are a subscriber. Your initial subscription will last for one year from the date you purchase.

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