Can a nurse start a hospice?

[anashenwrath, ASN, RN]

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?

[turnforthenurse, MSN, NP]

I would think you need a physician or at least a PA or NP with prescribing capabilities, because as a nurse we cannot prescribe medications or treatments to patients. That is not within our scope of practice.

[anashenwrath, ASN, RN]

OK, since this is a long-term goal, I could continue my education and go for an NP. I will put this on the "Things I Would Need to do First" list.

[nurseprnRN, BSN, RN]

Hospice is a very well-regulated industry, since most hospices take patients on the Medicare Hospice benefit or private insurance equivalent. You don't have to be an NP to be in hospice-- many, many RNs have very satisfying hospice careers without it.

If you want to be a free-lancer, you might consider looking into parish nursing.

There is a Specialty forum on AN for hospice nursing, and they would have some good ideas.

And in the meantime, while you are getting some experience under your belt, every hospice is required to have volunteers, and you might consider taking the local hospice's next volunteer class, and putting your name in. One day a week, or every other week, will give you some exposure and networking.

[anashenwrath, ASN, RN]

Thank you GrnTea! Because I'm still so wet behind the ears, it's hard for me to visualize exactly what I'm going for. I just... I think about how a video we watched in class about a midwife (I swear, I'm going somewhere with this!) and she basically was her own boss. She visited patients at home and assessed, delivered babies, provided care and teaching. And I'm like, I want to do that, but for hospice! I want to visit patients (or maybe one day have my own little hospice set-up, but let's take it slow) on my own and provide hospice care to them and their families.

And I know it's a long way off, and who knows what's going to happen to me or to the healthcare industry in that time. But I want to get as close as I can to achieving this!

You're absolutely right about volunteering, now that classes have wound down to just Kaplan, I should look into it.

[NedRN]

Depending on the state, a midwife is advanced practice who can practice independently. That example doesn't help you. As I understand typical hospice care, it is multidisciplinary. So I'm not sure that there is much point to being a sole practitioner except in outlying cases.

[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!

[heron, ASN, RN]

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 ...

[Kijana]

Hi HealthyNurse, I was just wondering if you let your Medicare Job and how much you like your current job in comparison to your medicare job. Blessing to you

Kijana

[time2go, MSN, RN, NP]

As a CHPN, I would go with what heron stated, "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?"

Some exceptions, though: Having an RCFE (this includes board & care homes and assisted living facilities) that markets to hospice agencies, you would have the least restrictions. However, RCFEs are private pay so insurance wouldn't cover your board and care fee. The patient or family would have to pay that (usually anywhere from $2000 to $5000 per month) and the hospice agency would be billing Medicare or whatever other insurance is involved for their hospice care. An alternative would be to open a SNF because only a SNF can provide respite but that's a pretty large undertaking. The stay in a SNF can be paid by medicaid but not in an RCFE. In my state at least, in order to provide hospice respite that is covered by insurance, you need 24 hr RN coverage and to be licensed appropriately. My research indicates you, as an RN, can't just open a senior living home and call yourself a SNF and be able to do respite. I would do it if that were the case! Easy peasy.