[abcwood]

I am new to Hospice and our Palliative doctor will be giving an inservice on "Hanging the crepe" to assist us RN's in charting for the hard recertification. I was wondering if there were any other suggestions out there?
Thanks in advance!

[Allow Mystery]

Hi ABC,
"Hanging the crepe", eh. Is this the same as "stretching the tape"?
A hard recertification doesn't need to be, you may always do an easy discharge if patient doesn't meet Hospice criteria. Please let us know
about your inservice.
Best wishes!

[uahrn915]

Sounds more like "stretching the truth".

I agree with Mystery. A hard recert is a discharge. If the powers that be are pushing to recert and you feel the pt is inappropriate, ask that the patient be reassigned to another case manager. If that line of thinking continues, start fixing up your resume'. Medicare and Medicaid don't play.

Jeff

[dosamigos76]

I would agree with everyone else. If your hospice is wanting you to be creative with your recertifications, I'd be looking for another job. If they're wanting you to create a total picture regarding patients that are eligible d/t their dx and co-morbities, then that is a bit different.

Sometimes we forget to note that patients have extras that have prevented declines in areas, such as a low air loss mattress and why the bedbound patient doesn't have breakdown. Or the COPD pt that also has an irregular heart rate, htn that has been hard to control that is declining overall.....

Cheryl

[shrinky]

If you are charting the little declines that you see in your visits thus should be easier. If no decline the discharge is the only option. we have had to discharge several patients recently. However the patient with COPD I have had for a long time has not been denied yet. She recently started seeing and talking with dead people even though she is still ambulatory and eating fair. She also has increased need for Morphine due to dyspnea so I document the little changes she makes each visit. This makes it easier when it is time for recert because it is all there in my notes.

[abcwood]

Thanks everyone for your input. I guess I should have been more clear. I was interested in help with the patients that we are aware of a decline but not an obvious decline. I appreciate all your help!

[Sabby_NC]

If there is no obvious or steady decline and that patient does not meet the medicare guidelines or LCD's then they need to be discharged and readmitted when there is a steady 6 month or less diagnosis.
It is better to discharge and readmit than get caught and have money tied up in ADR's trust me LOL
From the time we admit we always inform families that if there is an improvement and the pt is no longer appropriate we will need to discharge and readmit.
I prefer to discharge than to 'fudge' the recert because it is hard to come up with documented proof of decline if there is none!!