hospice in LTC?

Specialties Geriatric

Published

I have just been told that LTC centers are being strongly advised to offer hospice for their terminal patients. This confuses me. First, I feel that we do a good job of supporting our end-stage patients and their families. We have MD's that work with us to provide adequate pain control. we try to keep in good communication with families, to keep them informed, and we do our best to see that our patients don't die alone. I understand that hospice has a more organized support structure, but I truly don't understand what purpose would be served by involving hospice with our patient's care. It seems to me that that would take the pt's care out of our hands, and make us little more that a housing provider. I have also heard of hospice patients that were told that if they signed with the hospice, they were not to go to the hospital for any reason. Please understand-- I have the utmost respect for hospice. I believe it provides a much-needed service to our terminally ill and their families. I just don't see where it applies in this case.

At my facility we do not advocate for Hospice. That's not to say we don't have an occasional hospice patient, but we don't solicit hospice care. I am a DON and I, as well as our administrator feel that in LTC hospice is a waste. Think about it--what can they provide that we can't? WE know the residents and are with them 24/7. They pop in for about 10 minutes 2-3 times a week. Come on here, give me a break! I also feel that having hospice ties our hands and keeps us from doing our jobs. It has been our experience that hospice is not there for the families either--we have provided 10x more support for our families than hospice ever has! I do believe however, that there IS a place for hospice--in the home. I think Hospice is great for patients who remain at home and advocate such. I just feel that in a LTC facility they are just basically in the way.

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Specializes in MS Home Health.

LTC does not really do a good job with one on one long term, could be daily social workers, volunteers, daily aide care or they can even do what is called continuous care where they can place a one on one nurse or aide with the patient for 4 to 8 hours straight. That is something that a home cannot do. Hospice also pays for all the meds that relate to a terminal diagnosis which a patient in the home would have to possibly pay for. Does that help make sense of it?

renerian

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My opinion as a LTC nurse is that when someone is in their final days, the more support that can be given to both family and resident the better. What one doesn't think of, the other one will and all needs will be met. I have lost many residents in my years of nursing and have been blessed to work with Hospice frequently. I find them to be very helpful and good team players to provide all needs for all family members and residents.

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Specializes in Mostly LTC, some acute and some ER,.

There is no hospice in my town, so my LTC would have to care for hospice patients, and I'll be damned if I let a patient die alone. If I know that it is likley that they will die, I won't let them be alone. If I need a break, I will not go and get some one, I will ring the call light until some one comes and stays with them until I am back. We usualy find a way to work things like that out. we do it in shifts so that we could get the rest of our stuff done.

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Hospice has been coming in to our facility more and more since I have been there (Jan). I particularly like the fact that I can sometimes suggest to the MD that concept of hospice be introduced to a family that is having a hard time letting go. I was also impressed with our local catholic parish conselor- she was a great help to a family recently that was struggling with hydration/ gt feeding on their mother who repeatedly needed the feeding turned off d/t GI bleed.

BTW- what do others have for facility policy if a resident's po food intake declines. Our facility states they must have 1) IV hydration or 2) GT or 3) hospice.

I feel this is unethical manipulation of outcome for financial reasons. I believe Hospice is private pay in some circumstances, so that would require GT or IV hydration, not giving the family the choice to let go without hospice.

Anyone?

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Specializes in LTC,Hospice/palliative care,acute care.

We don't have such a policy in our facility-each resident's situation is unique-and we still have not brought hospice in and our current administration won't (thankfully the DON retires in 2 yrs) I just transferred a 98 yr old resident to the ED-no advance directives.I am sure that she was dying-and I wish it could have been in her home among people that cared for her-without painful invasive procedures that were sure to only prolong her suffering...I was unable to get her first contact on the phone-the second said that whatever the doc wanted was OK....He did not really want to be bothered.He tried to call the 1st contact himself but hung up after 3 rings-her voice mail at work picks up after 4....Everyone is presented the info upon admission-the doc told my supervisor that "Your nurses have to start getting these people to write advance directives" This is the same doc that several months ago when I broached the subject with another family and also strongly encouraged them to get in touch with the doc-he told the family" It's too soon for this conversation' IMHO-it's NEVER too soon to have that conversation...I hope my old friend is not suffering-I was off the weekend and fought the urge to call to find out what is going on-don't want to cross that line but the situation really bothered me.....

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ktwlpn,

They didn't teach us anything about this kind of family interraction in nursing school. As a fairly new nurse, I have always struggled with this gray area, legally. Now I DO approach the families- I feel that we, as nurses, have an ethical responsibiliy to educate the families on alternatives to lying in bed with IV Hydration for two weeks while prolonging the dying process or for 3 years with a g-tube. But I have to be careful- what does the facility policy dictate? I stll feel an ethical responsibility - as what if the family member has not been educated by the doctor or an ineffectual social worker . I am just very careful not to impose my judgement on the family member and must support them with their decision- and that can be very hard. I am also at odds with the facility, if you have read my other posts.

I have read about manipulation of outcome and have thought about how MD's might approach a family with "Without a g-tube he will starve to death." Do a google search on Tube Feeding in the Elderly. Opened my eyes!

Also- see http://www.agingwithdignity.org . I ordered 25 copies at $25 and they have been invaluable.

Blessings,

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:kiss huggs and kisses to my hospice friends, when in LTC they came night or day, good weather or bad, i have nothing but respect for hospice, only wish i had the credentials to do hospice care my self, i would love to help the dying go with dignity and respect, but most of all, with out being alone. My biggest compliments came from the families of my residents that i had the pleasure of being able to "hook" up with hospice. my favorite compliment was, when are you going to become a hospice nurse. love to all hospice nurses, you do a wonderful job, one that is not always most pleasurable, but most rewarding.

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Well, I understand your viewpoint. However hospice does give the "families," much extra support after their loved one's passing. Phone calls to the family, info on funeral matters and legal matters. I don't always have the answers for that nor the time. In regards to the medical aspect, our physician still sign their orders or should I say recommendations. I don't look at it as giving up control I look at them as consultants. I'm usually the one that is present for the passing, not hospice. So it's nice to know I can call them if I or the family need the support. Even if it is to just answer questions I already know the answer to or orders that are already on the chart. Look at it this way, we are already taxed as "staff" to have an extra nurse to talk to is supportive to the family as well as the nursing staff. Sometime too, they talk to families that need help deciding on hospice care...giving our nurses back-up on info we have already tried to educate the family on. Anyway, it's an extra set of arms around at times and anyone in long term care knows we need all the help we can get! :wink2:

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I am thinking of going into hospice because of what I have seen them do fro LTC residents. I think all the help we can get is great.

I have been working in LTC for over 13yrs in two states and ALL my exp have been good. They are a God send and if you ever come upon a parnoid dr they can help with the fight on drugs fear. NO ONE SHOULD DIE IN PAIN NOW! Just my opinion and I stand or fall by um all the time......

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Originally posted by Steve Malenurse

I am thinking of going into hospice because of what I have seen them do fro LTC residents. I think all the help we can get is great.

I have been working in LTC for over 13yrs in two states and ALL my exp have been good. They are a God send and if you ever come upon a parnoid dr they can help with the fight on drugs fear. NO ONE SHOULD DIE IN PAIN NOW! Just my opinion and I stand or fall by um all the time......

I just got hired in Hospice and I am orienting. I will go out with an RN tomorrow. So far, everyone I have met there is great!

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I am so gratefull for the Hospice workers that care for pts. in the LTC facility where I work. I am almost always on the rehab unit so I don't work with them too often only when I float to other floors, but their help is wonderfull, I have been told also that if the pt. takes the hospice they also then can have large doses of the pain meds they need without any question from the state, and their condition can be monitored here at the facility instead of sending them to the hospital, I find it wonderfull when a person comes to terms somewhat with the dying process and chooses to die with dignity, respect and comfort.

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