Information For Health Professionals

Franklin Hospice provides specialist palliative care for people with progressive life-limiting illnesses whose needs exceed the resources available through primary palliative care services.

Care is needs-based and may be provided alongside active treatment aimed at prolonging life or improving quality of life.

Referral should be considered when complex needs emerge, rather than being based solely on prognosis.

A patient is appropriate for referral to Franklin Hospice if they meet all of the following criteria.

1. Progressive Life-Limiting or Life-Threatening Illness

The patient has a diagnosed or clinically recognised progressive condition associated with significant health deterioration, increasing care needs or risk of death.

This may include:

• Advanced cancer
• Advanced organ failure — heart, respiratory, liver or renal disease
• Neurodegenerative conditions
• Advanced dementia
• Frailty with progressive decline
• Multiple serious co-existing conditions

Clinical judgement, SPICT™, Phase of Illness, AKPS and other recognised assessment tools may assist in identifying patients who would benefit from specialist palliative care.

2. Specialist Palliative Care Need

The patient’s physical, psychological, social, cultural and/or spiritual needs are complex enough that they cannot be adequately met by the GP, hospital team or aged care facility.

Specialist palliative care involvement is based on complexity of need rather than diagnosis or prognosis alone.

3. Patient or Representative Agreement

• The patient has consented to referral where they have capacity to do so.
• Where a patient lacks capacity, referral may proceed in consultation with their enduring power of attorney, legal representative, next of kin or other appropriate decision-maker.

4. Residence and Catchment Requirements

• The patient resides within the Franklin Hospice catchment area.

Patients do not need to meet all of these indicators. They are examples of situations where specialist palliative care involvement may be beneficial.

Complex or Uncontrolled Symptoms

• Difficult-to-manage pain
• Persistent nausea or vomiting
• Breathlessness despite optimal treatment
• Delirium, agitation or confusion
• Fatigue causing significant functional decline
• Recurrent hospital admissions related to progressive illness
• Complex wound care, lymphoedema or secretion management

Functional Decline

• Rapid functional decline
• Increasing dependence in activities of daily living
• Frequent falls or admissions

Psychological, Existential or Spiritual Distress

This may include severe anxiety or depression, or loss of meaning related to illness.

Complex Whānau or Social Needs

Complex family/whānau dynamics, safeguarding concerns or a lack of informal support may indicate a need for specialist involvement.

Care Planning and Coordination

Referral may be appropriate where there is a need for Advance Care Planning, difficult goals-of-care conversations or coordination across multiple services.

Deteriorating or Terminal Phase

Specialist support may also be appropriate where the patient is in the deteriorating or terminal phase and wishes to remain at home or in a residential facility.

The following situations do not meet the need for specialist palliative care support:

• Stable chronic disease without evidence of progressive decline
• Symptoms that can be effectively managed within primary care services
• Chronic pain or other symptoms not associated with a progressive life-limiting condition
• Psychological or social needs occurring in the absence of a progressive life-limiting illness
• Competent patients who decline hospice involvement
• Patients who are not yet aware of their terminal diagnosis and are not ready to engage with palliative care, unless the referrer is seeking advice only

Advanced Cancer

• Progressive metastatic or locally advanced disease where further curative treatment is not planned or tolerated.
• Functional status declining; treatment now primarily for symptom control.

Advanced Heart Failure

• NYHA class IV symptoms including breathlessness at rest or minimal exertion, recurrent hospitalisations and symptoms refractory to optimal therapy.
• Not a candidate for transplant or advanced mechanical support, or has declined these.

Advanced Respiratory Disease

Examples include COPD and interstitial lung disease.

• Severe breathlessness at rest or minimal effort; frequent exacerbations and hospital admissions.
• Long-term oxygen dependence; hypercapnia; patient no longer wishes intubation or ICU treatment for exacerbations.

Advanced Renal Disease

• Stage 4–5 chronic kidney disease with eGFR below 30 mL/min, significant comorbidities and/or a decision to stop or not start dialysis.
• Progressive decline despite optimal treatment.

Advanced Liver Disease

• Decompensated cirrhosis with complications such as refractory ascites, encephalopathy, variceal bleeding or hepatorenal syndrome where the patient is not a transplant candidate.
• Progressive decompensation and declining function despite optimal treatment.

Neurodegenerative Conditions

Examples include MND/ALS, advanced Parkinson’s disease and advanced dementia.

• Progressive loss of function, increasing symptom burden such as dyspnoea, aspiration, pain or anxiety, and complex care needs.
• For dementia: severe cognitive and functional impairment with complications such as recurrent infections, weight loss or pressure injuries.

Frailty and Multimorbidity

Multiple progressive conditions with overall decline despite optimal treatment, repeated hospitalisations and limited reserve, where the focus is comfort and quality of life.

Healthlink E-Referral

Healthcare professionals can send an electronic referral via Healthlink.

Medtech users: use our Healthlink address frankhos.

Email

Complete the referral template and email it to:

nurses@franklinhospice.org.nz

Urgent Referrals

For patient discharges or time-critical referrals, please call 09 238 9376 to confirm receipt and discuss urgency.

Referrals are accepted from registered healthcare professionals involved in the patient’s clinical care, or the patient themselves through self-referral.

Referrals from friends or family without the patient’s consent are not accepted.

If the patient lacks capacity, consent must be provided by their enduring power of attorney, legally appointed advocate or next of kin.

If a referral does not meet eligibility criteria or is not appropriate at that time, a Franklin Hospice clinician will contact the referrer directly to inform them of the decision.

Where relevant, alternative supports or appropriate timing for re-referral may also be suggested.

All referrals are reviewed by a Franklin Hospice clinician.

The urgency of response and type of service involvement are determined according to:

• Complexity of need — physical, psychological, social, cultural and spiritual
• Level of risk to the patient, whānau/family or caregivers
• Current phase of illness — stable, unstable, deteriorating or terminal
• Existing supports and resources including primary care, community services and whānau/family capacity

How Care May Be Provided

• Directly — face-to-face or telehealth contact
• Indirectly — advice and support to the primary care team
• Episodically — time-limited input during periods of increased need
• Continuously — ongoing specialist involvement while needs remain complex

Specialist hospice involvement may be reduced or transferred to other services when the patient’s palliative needs stabilise and can be effectively managed by their primary care providers.

Patients can be re-referred if needs increase or circumstances change.