[jerseyRN]

Looking for some advice... or maybe just a pep talk.
After four years in hospice home care, which I love, I recently accepted a new assignment with a caseload that's mostly LTC, with a only a few homecare cases. Right now I have 4 homecare and about 16 LTC in three facilities (I work 4 days a week).
I really miss the family involvement that I had with a strictly homecare caseload. And often in the nursing home, I feel extraneous... like I'm not sure what we're really bringing the patient... and the staff sees us as PIAs...
Meanwhile, I bring just as much work home as I did before. Same amount of work, less personal satisfaction.
Opinions please..... (!!)

[mcdonaldgirl]

JerseyRN, I work LTC, and personally, I appreciate all the help you Hospice nurses give us at our facility. Thank you!

"Mac"

[aimeee]

Facility nursing is challenging because sometimes you do run into that kind of attitude by staff, especially in the nursing homes. Hang in there! Their tune will change when they are having trouble controlling the patient's symptoms or the families are needing lots of intervention. Assisted living facilities are usually very grateful for the extra skills that we bring.

[doodlemom]

I've always seen our job as trying to make life easier for the LTC facilities. We try to treat the facility as the family and give them as much support as possible. After getting to know the facility staff, you might find that you actually enjoy them and will feel like part of their team. Also, you might want to call family members every time you visit and they may get more involved. Sometimes when I've had several patients at one facility and the family knows that I'm there, they will show up. It's definitely not the same kind of care but it can be rewarding in different ways.

[jerseyRN]

what's a reasonable caseload for a LTC hospice case manager? how many is everyone carrying?

[jerseyRN]

p.s. thank you all for your input!

[indigo girl]

Originally Posted by mcdonaldgirl

JerseyRN, I work LTC, and personally, I appreciate all the help you Hospice nurses give us at our facility. Thank you!

"Mac"

I couldn't agree more. I loved having hospice for my LTC patients. We had a respectful and helpful collaboration. There was a real need for their help in managing symptoms, intervening in family problems, and just supporting the LTC staff in caring for our terminal patients. What a wonderful resource you all are!

[BeExcellent]

My hospice tries for a caseload of 12. Sometimes, I have less, usually I have more. I also have a mixed case load. I have come to enjoy my LTC pts. I do special things for these pts. I have started to use music to connect with pt's that are demented. I have a CD player with a variety of CD's, usually I play Frank Sinatra or Dean Martin, sometimes a relaxation CD. I put small headphones on with the cord in back so the cords aren't distracting or scarey and I watch for a reaction. Most seem to enjoy the music. They will relax or even start humming along. I also use mild scented oils to massage their hands and feet. I have some pts that are non verbal that rub their hands when I come as if anticipating their massage. I also bring little treats to the staff. Usually candy Hugs and Kisses for caring for our pts. It takes time but the staff will warm up to you. LTC staff have a huge work load and you do make a difference in end of life care for your pts. As was suggested, calling family, even if it is leaving a message is a must. It takes time but it all comes together.

[doodlemom]

Originally Posted by BeExcellent

My hospice tries for a caseload of 12. Sometimes, I have less, usually I have more. I also have a mixed case load. I have come to enjoy my LTC pts. I do special things for these pts. I have started to use music to connect with pt's that are demented. I have a CD player with a variety of CD's, usually I play Frank Sinatra or Dean Martin, sometimes a relaxation CD. I put small headphones on with the cord in back so the cords aren't distracting or scarey and I watch for a reaction. Most seem to enjoy the music. They will relax or even start humming along. I also use mild scented oils to massage their hands and feet. I have some pts that are non verbal that rub their hands when I come as if anticipating their massage. I also bring little treats to the staff. Usually candy Hugs and Kisses for caring for our pts. It takes time but the staff will warm up to you. LTC staff have a huge work load and you do make a difference in end of life care for your pts. As was suggested, calling family, even if it is leaving a message is a must. It takes time but it all comes together.

BeExcellent, what a WONDERFUL gift you are to those patients! You really make a difference in their lives and the lives of the staff. No patients need us more than the ones in nursing homes, don't you think?

We have a dedicated nursing home team and our nurses usually don't have more than 14-16 patients. Some of us have had up to 10 patients in one building so this makes it alot easier. I complete all of my work before I leave the building because we are required to leave a note in the chart. I usually sit at or near the nursing station to do my charting and end up getting to know the people that work there pretty well. When I go home, I am done with my work. Our home nurses have around 10-12 patients.

[ca43]

If you go into the long term care facilities with the idea of helping rather than increasing the workload for them most facility nurses are very grateful for the assistance. By this I mean, make the doctor contacts for them instead of requesting they make calls for you. Do dressing changes while you are there or assist your patient with their meal consumption. Also just a thought. 30% of new admissions in LTC will die in the first year. There is a need for these folks for hospice care. The families of these patients are often dealing with the loss of independance for their loved ones and now they are facing losing the family member theirselves. Sometimes hospice care will actually improve quality of life so much that these patients then have to non-recert because they have a reason to keep living. Avg case load at our hospice is 12-14.