[Rahilly]

would like to get some discussion going about the place of hospice in nursing facilities, what is experience of other hospice nurses in terms of dealing with nursing home staff, state regulators, etc.
Always a challenge for me!

[Terra]

I am an RN in a skilled nursing facility. Along with rehab pts and post-op pts that require long-term recovery assistance, we do often care for patients who are terminal and receiving comfort measures and supportive care only. I have been in nursing for only 1 year, and would appreciate any advice you could give me that would help me to better care for my patients and their families.

[Rahilly]

Terra, I don't know what the population is like in your nursing facility, but we provide extra attention and support for patients and families of those who are terminally ill. Many of the residents for whom we provide hospice care, have no relatives or visitors. Our staff may be the only extra people residents see other than their regular staff. Also our nurses are very knowledgeble about pain control and sypmtom management at the end of life. We can advocate for the resident not to go back and forth to the hospital for unnecessary, futile care when they are terminal. I think hospice has a very useful place in long term care.

[Gail]

Rahilly, I am a hospice nurse and we had many patients in Nursing Homes. It really depended on the physicility....and we had to do quiet a bit of education at first...but then we found it worked great for some of our patients. Once the staff relized exactally what we did and were about they welcomed us with open arms. At first we had some difficulity with DME's and some of the medicine because of the way things were ordered. They were not used to getting some meds on a stat basis....ex...morphine. Once all of this was ironed out and a lot of education and inservices.....things went smooth at most of the nursing homes we were in in Houston. This also gives the families that are not able to care for the pt. in their homes, or the pts that had no caregiver a great option!

[earle58]

Hi Rahilly,

I am an RN in a ltc facility and have always advocated for our elderly. Working there full time has enabled extremely intimate and therapeutic relationships between the residents and myself. As a result, when hospice services are summoned, I feel myself becoming upset for I would think that no one could give these people better care than myself and my collegues, who are also extremely committed to these people. I am even thinking about becoming a hospice nurse, but in a ltc facility, there are very solid relationships between nsg. and the residents (and their families) and we're very sensitized to any sort of pain they might be feeling. So, I don't know if this is the norm in all ltc but I don't see the need for hospice where I work....

[teamrn]

I've been a hospice nurse for @9 years, most of it in the home setting. I do have nursing home patients regularly, so I feel that I can comment on hospice in long term care facilities. Some hospices in my area seem to have the majority of their patients in NH, others like mine have fewer numbers. In our hospice, we have long term care case managers whose job is usually ONLY nursing home patients, inservicing, etc. They may case manage home care patients, and I may fill in for them in LTC. I see NH patients as really benefitting from hospice services, as the addition of CNA, counseling, spiritual and volunteer suport to their care team greatly enhances their quality of life. For many of these residents, there is little, if any family involvement.

[EmptytheBoat]

I ran across this old thread; recently I had hijacked a thread trying to divert
to this topic (sorry about that), and did receive a few replies. Interesting to read this discussion from back in '99 and '00. My brief experience with Hospice
in the Nursing Homes mimics similar to these replies. I do feel some resentment from LTC staff and actually I find taking care of an LTC resident
like walking in quicksand, usually takes me twice as much time than a home patient. Just thought I would get this old thread restarted because
most of my patients are nursing home residents and can use some advice and
support. Thanks!

[BeExcellent]

I apologize in advance to anyone that has already read my views on hospice and nursing home pts. Hospice in a Nursing Facilitiy can be a great challenge but also the most fun you can have and get paid for it. There is no place that YOU, yes, YOU can make a difference. Have no expectations. Families are stressed and staff are trying to bail out a sinking Titanic of work. Buy staff candy, tell families that whatever they did or didn't do was "perfect". Get Judy Garland, Dean Martin and Frank Sinatra CD's from the library. Your pt's will SING! Buy rose oil and mix with baby oil gently rub frail hands and feet. Speak to your pt's always. Buy greeting cards at garage sales and leave a card every vist. Soon those bare rooms are over flowing with cards. Everyone will know that your pt is someone to love. It will be the best 30 minutes you spend all week. Wait until that pt that has never talked to you says after months, " I always feel better when you are here." It makes me think I am stealing by getting paid!

[EmptytheBoat]

Thank you BeExcellent, what a great post, and just when I needed it
most! God bless you!

[river1951]

"I am an RN in a ltc facility and have always advocated for our elderly. Working there full time has enabled extremely intimate and therapeutic relationships between the residents and myself. As a result, when hospice services are summoned, I feel myself becoming upset for I would think that no one could give these people better care than myself and my collegues, who are also extremely committed to these people. I am even thinking about becoming a hospice nurse, but in a ltc facility, there are very solid relationships between nsg. and the residents (and their families) and we're very sensitized to any sort of pain they might be feeling. So, I don't know if this is the norm in all ltc but I don't see the need for hospice where I work.... "
Too bad your facility is not the norm, but if I were you, I would never turn down help to make good work better. Working together we can make a GREAT difference; I so feel for my staff when they tell me the resistance they sometimes get in communicating with the LTC staff. We know the staff is overworked, but we are an asset not a detriment, and not at all like the government when we state we are only here to help... .