Dear Hospice Nurses, I beg you for a moment of your time, please. - page 2
Good morning. As some of you may know, my dad has not been doing well for the last six months to a year and has been the topic of two of my articles. I am here to humbly ask you for information... Read More
Mar 23, '13My thoughts are with you and your family... I have been in your position and it is one of the hardest things I had to do. depending on what state you live in you may not have a choice as to which hospice you choose. Here in Upstate NY there is only one hospice per county. Be that squeaky wheel, if you are not comfortable with the nurse or the plan of care say so. there is always a supervisor to speak to. Comfort should be the main objective from the beginning, no matter what the prognosis. there should be a plan in place from the first day to say "if dad is having problems breathing I can give him these medications that will make him more comfortable" . And there should be an effort made to make the day to day comfort better. Ask them to use their medical director as a resource for advice to take to your Dad's PCP for med changes to for instance help prevent the mucous plugs. A lot of PCP's are hesitant to use those comfort meds such as morphine on a day to day basis. I can tell you from experience that for someone with pulmonary disease that a little whiff of roxanol a couple of times a day will do wonders for their quality of life. The earlier someone goes to hospice the better in my opinion. I preferred to get my patients more than the one week average stay. There is much more time to get the relationship built and the teaching that is critical for the family to prepare them for what to expect. Dad is in charge, that is what is important, make sure you know what his wishes are and impress upon the hospice these are Dads' wishes.
It was my experience with my Dad at home on hospice that got me started on that track in my career. It was the kindness and continued long friendship with his nurse that showed me that I can make a difference and share my experience with others to teach them how to cope with the toughest times in their lives and that of their loved one. I have had the privilege of knowing many many families over the last 10 yrs. You have the privilege of going with Dad on this journey until the time comes that he has to make the next leg of it on his own ( though I do believe that he will not be alone on that leg of his journey) .
Mar 28, '13CP - Just for clarification, it is correct that you do not need a physicians order for an information visit; however, admission to hospice care DOES require an order. So it is very important to be sure that your Dad's doctor is on board to give a hospice referral. If not, you may need to find another physician to evaluate your dad's condition and give the referral.
(((((((Hugs for you and yours))))))
Mar 28, '13"My dad is end stage COPD with spine compression fractures. He is DNR. He wishes to die at home if possible and, even when "healthy" suffers from mucus plugs that cause rapid desaturation and deterioration to such a point that it has resulted in his last several hospitalization/intubations."
Just a little bit of information that has not yet been mentioned...
Your dad would not be eligible for hospice services if he is still seeking treatment at the hospital. Your dad would qualify for hospice services based on the severity of his COPD, but continuing treatment is contrary to hospice guidelines. Make sure your dad is ready for this next step before he signs up. I had a similar problem recently with a patient whose daughter took her to the emergency room for a dizzy spell. The patient was immediately discharged from services and it is still not clear whether we will be able to accept her back or not.
Also as far as choosing a hospice company, I would make sure they are JACHO certified and that the nurses have CHPN (certified hospice & Palliative Nurse) designation. If your dad were my patient, I would be sure to educate your mother on exactly what needs to be done should your dad go into respiratory distress suddenly. (Sit patient up, administer morphine and lorazepam, increase oxygen or point a fan in patient's direction, etc.) Also educate on what to expect in the dying process as far as common signs/symptoms. I have found that family members are more comfortable when they fully understand the process. If it seems that your mother is simply not going to be able to deal with the situation, select a hospice with an inpatient unit. This way, he can be admitted during the final stage for continuous nursing care. Just knowing that this is an option might give your mother some peace of mind.
I wish you and your family well. This is a difficult time for you. There are many services that hospice offers that can be helpful such as chaplain, social worker, therapist, bereavement services for 12 months after death, and more depending on your state. Do take advantage of all that is available to you.
Mar 28, '13Just a reminder that not all patients have access to more than one hospice agency. In our community there is one choice only.