Working with patients and their families in the end stages of advanced disease(s) that are not physically, emotionally, or spiritually ready for Hospice care.

Admission Criteria

  • Meet conditions for Home Health
  • Patients must be HOMEBOUND
  • Services provided by and under care of physician
  • Has intermittent skilled need
  • Must agree to scheduled LMSW within 72 hours of admission to AIM
  • Patient still desires to seek treatment for advancing illness
  • Patient likely to pass away in 6-12 months

Goals of AIM

  • To capture patients in the beginning of end stage of life
  • Advanced care planning to provide a transition from curative to comfort care
  • To effectively manage symptoms and pain
  • Work closely with members of a collaborative team, including the patient's physician, to create a plan that tailors to patient-specific goals
  • To encourage earlier and appropriate use of Hospice
  • To address Advance Directive within 1 week, no later than 30 days
  • To address Out of Hospital DNR within 30 days
  • To meet spiritual, cultural and emotional needs to patient with advanced illness

AIM patients can be referred to Doctor’s Choice from the community, a facility, a physician, or be an existing Agency patient. AIM patients will be serviced under our skilled home health service line with an emphasis on advanced care planning.

The AIM program brings Home Health and Hospice together to utilize the strength of each discipline in achieving a common goal; a focused, multidisciplinary approach to symptom and pain management.

Qualifying diagnosis for palliative care include:

  • Heart Failure
  • Chronic Obstructive Pulmonary Disease
  • Cancer
  • Dementia
  • Parkinson's Disease
  • Renal/ESRD
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