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.