House Dr. doesn't allow hospice in facility

I would first go to the hospital administration, this is a patient advocacy issue and should be addressed by them along with encouraging the family to ask for hospice consult and notifying the ombudsman. http://www.ltcombudsman.org/static_pages/help.cfm

I would contact your local hospice directly.

I work for a hospice as a home health aide. We see patient's in SNFs all the time. Anyone can refer a patient to the hospice I work for. Anyone, nurse, family member, friend. Call them. If the patient is appropriate for hospice care and wants to be on hospice, the medical director of the hospice will become one of the patient's doctors. As I understand it, the hospice care is paid for by medicare and the SNF care is still payed for by medicaid. There is much misinformation about hospice. Please call your local hospice to find out what they can do in general and for this patient, directly.

Good luck. Let us know how it goes.

It is always appropriate to bring up Hospice with family members anytime there is end stage disease. You may contact the patient's responsible party and, without laying accusations, explain to them the increasing difficulty of managing their family member's pain and ask them if they have considered end of life care. Refer them to your facility's Social Worker, or let them know that they may call around to local Hospice providers themselves if they choose.

Then I would speak with my DON and my administrator, and explain the situation to them. It's up to your facility's administrative people to interact with the physician and determine why he's doing things as he is. It's up to the facility, which approves his continued practice there, to lay down the law.

Remember, it is NEVER appropriate to mention to the family that you don't think the present doc is doing the right thing for the patient or any other observation of that kind. The facts they need to deal with are 1) the increasing pain control problem and 2) the possibility of Hospice services.