I know I want to be a hospice nurse. It's why I went into nursing and my hours on the hospice unit have confirmed that it is what I want to do.
And I'm not tryingto get ahead of myself, bcs I know I'm hitting the market as a new grad, and will probably take any job offered to me.
But, down the line, I dream of working as an independent hospice nurse. Maybe doing private homecare services. And then, as the dream does that thing dreams do where they get all mighty and out of hand, I'm like, "You know what would be great? If I could actually run a small hospice. Like, just a few beds."
I definitely know nurses who run nursing homes and LTC facilities. My classmate's mother actually has a ten-bed home. But is that possible with hospice? Do I need to have a physician?
This is all quite far down the line, but I guess I'm just looking for an idea of if this is feasible, and if so, what would be the ideal steps toward it?
Quote from HealthyNurse
Hello! I work for the government and hospice agencies are one of the provider types that I'm responsible for surveying (regulating). Hospice is highly regulated and as stated above, you would not be able to work independently, even as an NP. There is no such thing as an independent hospice provider. You would need an entire team of individuals (the interdisciplinary team). One of those must be a physician- a mid-level provider cannot be substituted. The IDT has to include a registered nurse, physician, social worker, spiritual counselor, and bereavement counselor. There is sometimes some overlap (often a social worker can act as the spiritual/bereavement counselor, if qualified). With hospice, you also have to have volunteers and provide hospice aide/homemaker services, in addition to the core services listed above. There are many, many rules regulating hospice care, so I would suggest that you get quite a bit of experience before deciding to start a hospice agency. Good luck in your future career!
Thank you! Although I disagree with part of your post, you do give a really good reality check on the nitty-gritty of financing hospice work through government or private insurance payment. (All the private insurers' hospice benefits pretty much follow the CMS model, I think.)
As I understand it, NPs and RNs are perfectly able to practice independently ... they just can't bill Medicare or insurance unless they meet certain guidelines. The trick would be to find the right business model. Consultant/case manager/disease manager for families who want to get support for a loved one, but who are turned off by the the way hospice agencies operate? Start an agency providing skilled caregivers with special training in hospice and palliative care? Start an inpatient care home that can contract
with hospice agencies to provide respite care without having to provide all the services required by CMS, because the contracting hospice already does that?
Not everyone who is dying is doing so in the context of a certified hospice agency's inpatient unit.
And hospice, as the above quote from HealthyNurse shows, is way more than just prescribing drugs. In fact, it's mostly about very basic quality of life: dignity, autonomy, comfort ...
Last edit by heron on Mar 10, '13
: Reason: additional thoughts