[AtlantaRN]

On friday, one patient went into respite so wife could go on a cruise. (now we had an arrangement with a local nursing home, and I had encouraged wife to go check out the nursing home a month before her cruise...she didn't go to see the nursing home)...so I get a call stating "we don't like this nursing home...you said you had an inpatient unit (that I never said, we don't have an inpatient unit, we have "contracts" with 2 different facilities, one a nursing home, and one a freestanding inpatient hospice facility--one of our competitors, in fact)...

anywhoo, they ended up at inpatient hospice facility.

Question...when I had a patient at the nursing home previously, I was to do a visit every day for those five days...

The administrator at the free standing facility said that a daily visit wasn't necessary because they are a free standing facility, and they do assessments every 8 hours.......This is a patient I usually see twice a week, he is stable and has alzheimers...

Should I still go every day and do a nursing visit, even when he is in an inpatient hospice facility?

thanks!

[aimeee]

I'm getting the idea there may be some confusion between levels of care here. If your patient is under a Respite level of care, there should be no need to visit every day, just the usual number needed for case management. However, Medicare regulations specify that the facility that is providing the respite care MUST have an RN available at all times. But if you are providing GENERAL INPATIENT care at a facility, there would be a need for a daily assessment by the case manager because everyday you must justify the need for this high level of care.

Since your patient is stable and in the inpatient hospice unit for respite, it would seem there is only a need for the usual number of visits for care management....maybe one to make sure he is settled in and the team taking care of him understands his needs and then another phone visit a few days later just to be sure everything is still going okay?

[chris_at_lucas_RN]

Sorry--I misread this and understood pt entered a hospital without approval of the hospice.

My apologies.... I defer to the other posters here.

[AtlantaRN]

thank you! I remember seeing the patient at the nursing home setting everyday, but the administrator at this hospice said because this is a freestanding hospice, and their nurses do nursing assessments q8h that it wasn't necessary.

edited to add: It really chaps my hide that they were given the information about the nursing home a month ago, address and all...then they have the nerve to say "oh no, can't leave him here..."

i've found too that when families see on the forms that an RN will visit 1-3 times a week, they all want "3", even if the patient is stable.....

[AtlantaRN]

yes, it is "respite", but frankly I always thought respite was for "caregiver breakdown", not for a cruise....I'm new to this so I'm learning. My boss said it was fine for the 8 days when it was the nursing home, and she said she would just change level of care for one day (is that even legal), but now that it's high $$ out of companies pocket for an inpatient hospice unit (it looks like a dayspa compared with the nursing home frankly), even the inpatient hospice told the patients daughter "only 5 days"...

Thank you for your input.

[AtlantaRN]

Originally Posted by aimeee

I'm getting the idea there may be some confusion between levels of care here. If your patient is under a Respite level of care, there should be no need to visit every day, just the usual number needed for case management. However, Medicare regulations specify that the facility that is providing the respite care MUST have an RN available at all times. But if you are providing GENERAL INPATIENT care at a facility, there would be a need for a daily assessment by the case manager because everyday you must justify the need for this high level of care.

Since your patient is stable and in the inpatient hospice unit for respite, it would seem there is only a need for the usual number of visits for care management....maybe one to make sure he is settled in and the team taking care of him understands his needs and then another phone visit a few days later just to be sure everything is still going okay?

yes, I went to see him Friday, he had been there for about 2 hours, as I stated this is a market competitor and the manager I had worked for at a hospital about 5 years ago. This patient has alzheimers, they had a locator band on his arm; and he was sitting in a gerichair with the table attached...when he is at home the wife has a sitter come in 8h/day, but at the inpatient hospice, they have 2 nurses aides and 2 nurses (the good thing is one wing is closed, so they have that high staff ratio for only 6 beds right now). The administrator stated to the daughter that he was only there for 5 days, not 8...and the administrator stated the daughter was highly irritated and said "he needs to be here 8 days, my mom will pick him up after her cruise". Administrator was firm on 5 days. The social worker is dealing with the daughter. Daughter said "we'll be there everyday to sit with him" (at the inpatient hospice), and the family said he does better at home in familiar surroundings, frankly I don't see why they didn't arrange to have the sitter stay with him. Anywhoo, it's been a major hassle. I don't know why they didn't check out the nursing home as suggested--I wouldn't just blindly take a family member to a facility...but maybe it's just me.

He was settled in fine. Thank you for your input. I've done 54.5 hours this week and I have 1 visit today, i'd rather not have to drive all the way out there if it isn't necessary (my 1 visit is 36 miles one way, and if I had to drive out to the freestanding hospice, it's another 35 miles one way).

linda

[aimeee]

Originally Posted by AtlantaRN

yes, it is "respite", but frankly I always thought respite was for "caregiver breakdown", not for a cruise....I'm new to this so I'm learning. My boss said it was fine for the 8 days when it was the nursing home, and she said she would just change level of care for one day (is that even legal), but now that it's high $$ out of companies pocket for an inpatient hospice unit (it looks like a dayspa compared with the nursing home frankly), even the inpatient hospice told the patients daughter "only 5 days"...

Thank you for your input.

I think a cruise would be fabulous respite!! Seriously though, you are correct. Respite is supposed to be for people who are physically and/or emotionally exhausted and just really need a break. It might also be utilized in the event of something like a scheduled caregiver hospitalization. The reimbursement for respite care is not that much more from Medicare than the regular per diem though so maybe your boss was thinking they would just eat the extra charges for the three extra days originally planned.

[hospicenurse]

Respite by Medicare regs can only be up to 5 days - no more. However, they could, if they chose, switch him back to the regular homecare rate for the remaining three days. It's not much difference in reimbursement, but the inpt unit would probably rather use that bed for a GIC patient.

AtlantaRN - I'm really curious about your agency contracting with a competitor for inpatient care. I don't mean to highjack your thread, but could you tell me more about how that came about and how well it works? Do you feel it works well for the patients & famililes? Is there a distinction between their patients and yours? Any worry that they will try to "steal" your patients? I manage a care center and will be seeing competition come into the area very soon. Would like to explore this possibility.

hn

[AtlantaRN]

Because we don't have an inpatient unit, we have a contract with a facility that is 40 miles east of our office. We prefer our patients go to a local Nursing Home...but family of this patient was distressed that it wasn't a free standing "hospice", but a nursing home.

Frankly it was a hassle, and no i wasn't personally worried that they would try to steal my patient. My patient was with a competitor prior to his transferring to our service. (the former hospice had the wife revoke the patient each time he got hurt and required inpatient admission....last time, he had a 4cm laceration to head...also they only sent a nurse 1/week, and an aide 2/week, and this patient is a high maintenance patient.

linda