Escorted out of the patients home.........

Specialties Hospice

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Specializes in Med Surg, Hospice, Home Health.

So i have a scheduled admission today. I was a few minutes early. Met family member, who lives out of state-he is poa and he is well organized. He provides a copy of his power of attorney, a list of medications, a list of daily duties he expects the nurse, hospice aide, and volunteer to provide DAILY, and a 6 page set of instructions of physical therapy exercises he expects nurse to complete every day with patient..............................family member reiterates and requests writer to agree to implementing each page duties to be incorporated into patients care plan.

I educate that we expect our patients to decline, that hospice is for patients that have a 6 month or less life expectancy, should the disease process take a normal course. He stated "i expect her to make a full recovery." Writer educates that if a patient is improving, that legally we have to run the course to discharge the patient. He states "i've heard of patients being on hospice for years..." Yes, back in the day, you could have a patient take a decline, then improve, decline and improve-but with changing healthcare regulations-the company may be fined 3 times what we received in payment should we keep a patient on service that is not declining, or is not going to pass in 6 months.

wait for it.....it gets better.......

Patient with stage IV lung cancer, family member states she currently walks with a walker, but "i expect her to make a full recovery...." Writer attempts to educate what hospice is.....comfort measures until nature takes its course. ((i'm a weekend on call nurse-my job is to put out fires, control patient symptoms, and generally help to keep the patient out of the emergency room)).....Family member tell me that he expects "daily nursing visits," writer educates-when a patient is receiving daily nursing visits-they are experiencing uncontrollable symptoms or a rapid decline (pt pps is still 50%), Family member then states that he expects a home health aide or volunteer for 6-7 hours a day as this is what he was "promised" by marketing..."

This is where we hit an impasse.....

I called my clinical manager (who just happened to have spent an hour with this family member yesterday, attempting to educate about what hospice IS and what it ISN't..........clinical manager said yesterday, on his list was "daily watering of plants"..........My clinical manager spoke with him on the phone and reiterated that hospice does not provide a sitter for 6-7 hours a day.......Family member reiterated"my mother is expected to be alone every day!" ((family member has a sister that resides with patient and we don't replace the family.....family members response is "yes, but she leaves to go shopping and such....)).

SO, family member was pleasant about it but said to me "i don't have time for your apologies....I have to call home health so they can visit today." He walked me to the door......

Sometimes i just feel like I am spinning my wheels.....This family member is needing senior sitters or similar. No healthcare plan is going to cover sitters.........we do range of motion, but we don't do 6 pages of physical therapy exercises with a patient. At the greatest, a nursing visit may take 45minutes to an hour.

Thank you for listening. I was so frustrated, I took another blood pressure pill. My face is still red and I can feel the heat coming off of it...I know that marketing has to "sell" a service, but I can't provide what this man is wanting for his mother--hospice works in partnership with the family-not as a replacement for the family...

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Specializes in Hospice.

Let it go ... this person will get a reality check soon enough. I realize that you are probably under some pressure to bring in any possible admits, but this one would be biiiiiiiig trouble if the hospice tried to meet his demands.

As you know, sometimes clients hear what they want to hear, sometimes marketing people promise the moon to make their numbers, sometimes clients play the good nurse/bad nurse game to manipulate. Impossible to know which one is going on here.

You might consider writing an occurrence report detailing the incident as a way of documenting your perception of events. If your agency uses them as "punishment" or a way to place blame, then a memo to yourself with the facts of the visit might be in order in case someone wants to find somebody to throw under the bus.

Meanwhile, give thanks that you and your colleagues dodged this particular bullet. Sounds like a nightmare!

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Specializes in Med Surg, Hospice, Home Health.

thank you, heron. This is what my clinical manager said....better to refuse services now and stay with home health, than sign on and have him revoke or complain in a day or two--because then that is a "service failure" and a major "ding" for my branch location.

My clinical manager spent an hour with him yesterday and she went through what hospice is and what it isn't. Clearly he wants aggressive physical therapy and truly wants private duty nursing-what hospice isnt.

Thank you for listening. My companys' marketing unit keeps a running"tally" of admits that don't happen and what nurse went to do the admission....I have a two page report documenting what transpired and sons' expectations that clearly do not connect with a hospice philosophy.

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Specializes in Hospice.

Good for you, and your manager!

This client wouldn't be the first who tried to sign on to hospice in the mistaken belief that hospice would provide everything they want.

ETA: glad you wrote that report. It would be good to get an idea of how many admits got "lost" due to unrealistic promises from marketing.

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Sometimes we feel it is too bad that marketing can't be the persons dealing with the abominable situation that they create.

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Specializes in Med Surg, Hospice, Home Health.

Thank you Calliotter3! My hubby says "marketing is writing checks that nursing can't cash."

I remember one night, I got a call at 8pm from a pending admission that I was to admit the following day. Lung ca patient, having an anxiety crisis. Initially the family called home health, said they didn't want to go back to the er, they had already been there that morning....could hospice nurse come tonight. I called and spoke with the patients son, educated that i could get an ekit out there with roxanol and ativan, and i'd call for oxygen, and I was on my way to admit. I got there, patient in no serious distress, I could hear audible expiratory crackles.....home health had been giving 1l ivf/day....wife asked when i'd be out in the morning to hang the fluids. I educated that i could hear his crackles without a stethescope, plus pt had 3+ edema lower extremities---wife said "well, then we're not ready for hospice....." i cancelled ekit, 02 (sat was 98%), called doc, and my clinical manager......

Marketing was ******---said i should have called branch director and we could have "brainstormed...." Really? I told them it was not appropriate on an already fluid overloaded patient to give a liter of fluid daily.....I asked should I give 80iv lasix prior to daily ivf???? I told them i wasn't going to make a patient uncomfortable just to increase census and appease a family member.....

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Specializes in Med Surg, Hospice, Home Health.

****** = Irritated lol

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Specializes in Hospice.

Sounds like your marketing folks need an intensive inservice on just what it is that hospice is supposed to do ... not to mention basic ethics! Good luck!

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Specializes in LTC, Psych, Hospice.

Oh my goodness, Atlanta! I truly feel for you. I used to work for a large "chain" hospice company and our marketers would pull some of the same stuff. One pt I had told the marketer that they were at work all day and the pt had a sitter. They wanted the nurse to make visits after supper. She told them that was no problem. What? When the DON told her (the marketer) our hours were 8-5 and evening visits were PRN only she had the DON written up for not being a team player. We actually did admit the pt and it was explained to them that the nurses make visits between 8-5 and they were o.k. with it. I made sure I left them a note or called w/ every visit.

The company I've been with for the past several years is a small, privately owned place. Our census is about 20-25. One of our owners actually does the marketing, but never meets with the families. One of us nurses, MSW, or chaplain does the info visit and gets the legals signed. Our DON does all the admits.

Sounds like what this family of yours needs is 24 hours sitters or LTC placement. Water the plants? Are you kidding me? Thank your lucky stars they were a "no admit". Hope you have a peaceful w/e!

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

Those admission visits are flipping annoying as all get out...especially when being done on OT...which is how I do them.

I completely understand the pressure out marketing people have...and thank god for the work they do or I might not have a caseload. But seriously, there ought to be some deal breakers, even for them.

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Specializes in Hospice, ONC, Tele, Med Surg, Endo/Output.

I'm amazed this patient was even accepted after speaking to the poa. The poa is absolutely crazy!!!

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Specializes in Med/Surg, Tele, Dialysis, Hospice.

I am an on-call hospice nurse and I, too, get fed up with what is promised vs. what we can deliver!

I recently received a call from our triage nurse stating that a patient's family was demanding a visit at 9 PM because the patient needed someone to put her pajamas on her and brush her hair. The family member had apparently complained loudly because the HHA "only stayed long enough to give her a bath and back rub" and therefore "shirked her duties" and was going to be written up if the family had anything to say about it. This patient was not active or even pre-active at the time, still eating and drinking, getting up with a walker, alert and oriented x 3, etc.

Anyway, since the triage nurse said that the family was demanding a visit, and since our policy is to provide a visit when one is requested, regardless of the reason, I called the patient's family, asked if there were any other family members present, and confirmed that there were at least four family members of various ages in the home, so it's not like she was alone, any one of them could have helped her to get ready for bed. I asked if the patient was having any medical problems and was told "No, she is just ready for bed now and needs you to come and get her ready for bed". I also happened to have just been notified by the triage nurse that another patient had just died and that the bereavement level of the immediate family members was very high, so I politely told "pajama lady"'s family that they would have to wait until I completed the other visit, as it took precedence at the moment. The response I got to that was, "Well, that's bull____! We were told by your admissions department that we could have a visit anytime, for anything, and that you would stay as long as we wanted you to. We will go ahead and get her ready for bed but we are _____ off about it and are going to find a 'better' hospice company than yours, ______ it!" Meanwhile, the admissions people who told them that they could have a visit, on their terms, anytime that they demand it, sit behind their desks and promise these patients and their families the moon.

It's a good thing that I love my job....(sigh)...

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