hospice in LTC?

  1. 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.
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  2. 35 Comments

  3. by   Lizard101
    I was a hospice worker and I did have pt's in LTC, it was an extra support for the pt, family and staff, we do not take over care, we give added support.
    And on a personal note, my sis-in-law has been in a LTC for 14 years, very young onset of 'alzheimer's'. The family has been through this before w/their mom-organic brain syndrome, it seems it may be inherited, anyhow this is the third time we have been called and told she is dying and on hospice. Since I am a nurse I get called by everyone, first time we fought not to have a feeding tube placed in, meds stopped except antiseizure. This time AGAIN we are fighting the staff not to force feed, even meds no massaging of the face and throat-comfort measures. I spoke w/a nurse there and went over no meds/force feed, she agreed, then spoke about her seizure, can give suppisatory, they can be made by the pharmacy, it goes on & on. Got a call a few days ago from same nurse, death imminent!!!! B/P 100/60- this was the call? I feel that hospice helps the family, they intervene for us, also after death they follow the family for 13 months-for support and that is important as my husband's family is having a tough time coping. The nurse has been at the facility for 20 years, not a new nurse.
    Thanks for letting me vent.
  4. by   RhondaRNConsult
    In my experiences, hospice has not only assisted the resident in long term care facilities financially, but also mentally and spiritually. Hospice takes a great deal of burden off the resident. They have so much to offer. In my eyes, it's an added bonus to have the extra hands around to assist with the love and care that the dying resident needs. It's not that we have to stop caring, it's just another heart & hands to assist us in our endeavours!
  5. by   aimeee
    Originally posted by tinkertoys
    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.
    If you are doing all that currently in your facility, then hats off to you! You are doing a terrific job!

    I previously worked in a long term care facility and now work for hospice. From both experiences, I can tell you that is not often the case. When I worked the floor in LTC there are many instances where I would have welcomed the assistance of the hospice team. The services of the hospice social worker, spiritual counselor and bereavement counselor can be very valuable in assisting family members who are having trouble letting go. Our hospice also sends a home health aide to the facility several times a week so the resident can get extra TLC beyond the basic needs that the CENA's provide.

    I often find that patient's pain is inadequately addressed. Frequently I find that pain assessment by the staff is haphazard and when the patient is actually asked about their pain levels at various times of day they report round the clock pain, but have been receiving only PRN meds WHEN they complained. Many times I have found that certain nurses did a great job of medicating the patient for pain while the nurse on the next shift provided nothing. Hospice involvement insures that symptom management is spotlighted and a priority.

    We have our own special set of standing orders for extended care settings that allows us to immediately implement measures for the common difficulties, i.e. dyspnea, terminal secretions, constipation, pain, anxiety, etc. One quick call to hospice and the order can be implemented versus waiting hours for the MD to call back AFTER he has seen all his office patients!

    As for going to the hospital, it is true that hospitalization is avoided. Hospice costs are reimbursed through the medicare part A benefit. Medicare A will not pay for hospitalization AND hospice care at the same time except under very special circumstances. However, a patient or family always retains the right to revoke their hospice benefit and undergo hospitalization if they wish to. There are times when we will urge patients to do this, such as when a surgical procedure would help to alleviate symptoms which are otherwise impossible to control. In most cases symptom control can be managed just as well on site.
  6. by   km rn
    We have an excellent relationship with hospice and feel it benefits both our staff, hospice staff and our residents. One thing that we are unable to provide our resident's families is support after the resident's death. We do send resident's families memory sheets and families have written back saying they loved the sheets. But as a facility we provide no bereavement support. So hospice fills that gap.

    In addition, the hospice staff provide inservices to our staff usually 1 - 2 times per year on topics of our choice (symptom control, hydration and nutrition in the last stages of death, etc.)
    We also have provided education to hospice staff on dementia care, etc.

    I believe that Hospice has a place in long term care.
  7. by   tex
    I was a Hospice nurse for over 4 years. It was a gift and privelage to be able to provide care not only to the patient, their family but the the nurses/aides. My speciality was pain management, I lived in upstate NY and had fabulous MD's that trusted and provided what the patient needed at the time when I either called the MD or if I would go straight to the MD's office and would offer to wait until I could speak directly to the MD. I use to also go into the surrounding hospitals and see patients and worked as an Liason with the hospital, provided teaching, reassurence to the staff and praise for what they were able to do at the time, and that they made a difference. I had outside pharmacy med's delivered and approved, so that the patient never, I mean never had to have their pain, n/v, hiccups controlled by a needle. The magic of compounding medications, it is wonderful. I now am a MDS cord at a LTC, and you know what, I still am a hospice nurse at heart, and will assist the nurses and call MD's, talk to the families, manage pain, teach and work to make the nurses feel comfortable about what they are doing, give hugs to them and the CNA's....Tex
  8. by   aimeee
    Bless you, Tex! They are lucky to have you. I'm sure you really make a difference there.
  9. by   Fran-RN
    I've had good and bad experiences with Hospice in LTC, seem as in other things it depends a lot on the particular provider. But from a family member of a terminal resident's perspective, they were wonderful! The LTC facility my husband lived and died in was known in the area for their care of teminally ill, but the support the hospice staff gave me and him was such a relief. The social worker helped me arrange for payment of some of my bills so I could stay with my husband at the end, and the nursing staff ensured he had no pain. He had been in quite a bit of underdiagnosed pain prior to their intervention. We can't be all things to all people and their expertise is the dying process, so I say utilize them!!!
  10. by   nursedawn67
    I'm a nurse in a LTC facility and Hospice is a big help...As a nurse in the LTC I can tell you there isn't always time to go through all the meds the res is on to tell the Doctor I think they can do without this and that, the hospice nurses do that for us...and they are a shoulder to lean on for the family..the res....and even the LTC facility staff.
  11. by   Vicki30CNA
    We also have hospice in our LTC facility and the aids that come in to bathe etc are wonderful. The resident usually has flowers picked from gardens on bedside table or snack baskets anything to add color and cheer. They become close to the resident on Hospice and provide undivided, one on one attention at a time it is needed most. Add to that the finacial benifit to the family and the out reach support for the family and it is absolutely worth it. In our facility it isn't that the care is taken out of our nurses hands, rather a hand is taken in partnership!
  12. by   joyflnoyz
    This thread is of big interest to me; the LTC facility where I work is planning on taking a hall and setting it aside for hospice care.
    I don't know if hospice in a facility has the same leeway as hospice at home? With my father-in-law and grandmother, we had a "range" dose of morphine that we could use to keep them comfortable.
    I'd LOVE to work on that wing; this may sound weird, but I've always thought that working with the dying is a special thing. The few times I've had the opportunity I've (well, enjoy seems like the wrong term, but in a way it fits) but I have felt honored.
  13. by   micro
    i have been out of ltc for quite a bit....

    so here is long term memory opinions...

    i think hospice in its idealogy is great and needed and i wish for it myself if ever found it that life predicament......for either myself or someone dear to me....

    but i think in the reality of hospice and today's regulations and also what it has become in ltc......
    that it also leaves families confused even within the ltc system......

    like.......the ltc system is providing the actual care for this patient, the hospice nurse cannot receive or ask for orders from the doc's.........etc.......
    so what exactly are they doing there except for another shoulder.......DON'T GET ME WRONG, FOLKS......NOTHING WRONG WITH ANOTHER SHOULDER........

    so, now.....i go from this standpoint from a nurse and healthcare provider within a ltc facility.......
    come and work an eight to twelve hour shift with me......tell me how i am supposed to give that extra hospice care to this patient............#1.....i do...........without your input........
    #2....if you can't even give a bath or give a med......please???
    #3...what are ltc nurses but THE BEST GENERALIST NURSES THAT THIS SYSTEM WILL EVER SEE!!!!!!!!!!.........cause they have to and they do.......

    sorry......no insult meant towards anyone in hospice or anywhere else............

    micro and out
  14. by   tex
    Micro, I respect your thought r/t Hospice, but I am not sure where your LTC is located but what you experience and have seen with your local hospice is not at all what I have provided in my years w/hospice in two different states I might add. I am now a coordinator at a LTC and I do pitch in to help with the nurses/cna's in regards to understanding hospice. First of all, the hospice nurse not only is a support system for the patient & their families, but the most critical part is asking you the nurse what can I do to help you out and your staff. The hospice nurse if he or she is doing her job right, should be a specialist in pain management and know how to keep the patient comfortable w/o using one needle. The hospice nurse should keep tabs on the pain, constipation, n/v and nutritional and overall well being of that special patient. You should be instructed to call this hospice nurse (and if the hospice nurse isn't available, there is ALWAYS a nurse on call). I would call the doctor and discussed pain management and updated the doctor on the progress of the patient, without stepping on anyones toes. And did obtain orders w/o difficulty for any LTC.........Every nurse I worked with, new to page me or call my office. They would give me an update, and I always offered suggestions, and if that nurse objected (which they never did) I would obtain any order that LTC nurse needed and f/u to see if it was effective. I just didn't go in a LTC 1x aweek, if the patient was getting close, my visits increased to meet the demands of keeping not only the patient and their families but ESPICALLY the LTC nurses and staff. I arranged for our volunteers to go in a sit with the patient so the family could get rest. And most importantly to give the LTC staff a break. Our social worker made multiple visits, and he or she always wanted to know what the patient/family and again most importantly what the STAFF needed. Hey your are right on one account. I couldn't administer the medications, but I cleaned up plenty of soiled patients and gave bed baths my self, including the rest of the hospice staff. I feel bad for the hospice patients you have in your facility, they truley are missing out on what is the most important thing they have left, to die with dignity, a sense of acceptance/well being and in no Pain...........Tex

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