Hospice and LTC... Who provides the care?

  1. Recently we had a resident slowly expiring. All families were there, had been there for 3 or 4 days. Hospice nurse and hospice aide were also present, but they sat with the families as if they were just there to comfort. I gave all the meds and our LTC aides did all the ADL. I was a little bit confused...
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  2. 5 Comments

  3. by   Nikki69
    I am a nurse aide at a LTC facility, and what I'd just like to point out, is that, the LTC aides are there 24/7, but the hospice help is only there periodically. In my experience, the LTC aides do the same thing for the dying ones as they do the rest of them, and the nurse does what she normally does. The hospice aides come and do it all over again "better", and the hospice nurse comes and tells the LTC nurse to give more morphine. What I am trying to say is that hospice is just an extra helping hand to give to the patient and families of patients because we are so pressed for time.
    At least that's what I have seen.
  4. by   GLORIAmunchkin72
    I have had different experiences with hospice so I really don't know what's the norm, or if there is one. A while back we had a hospice resident who got all her care from hospice. The hospice aide INSISTED on giving the total ADL and much more and our aide did little for the resident.
    Quote from Nikki69
    I am a nurse aide at a LTC facility, and what I'd just like to point out, is that, the LTC aides are there 24/7, but the hospice help is only there periodically. In my experience, the LTC aides do the same thing <a style='text-decoration: none; border-bottom: 3px double;' href="http://www.qklinkserver.com/lm/rtl3.asp?si=92&k=for%20the%20dying&st=1" onmouseover="window.status='Search for: for the dying'; self.ql_skeyphrase='for%20the%20dying'; if(window.event) self.ql_sevent=window.event.srcElement; self.ql_timeout = setTimeout('ql_doMouseOver(1)', 1000); self.ql_isOverLink=true; return true;" onclick="if(self.ql_timeout) clearTimeout(self.ql_timeout); self.ql_isOverTip = false; ql_closeiframe(); self.ql_skeyphrase='for%20the%20dying'; window.status='Search for: for the dying';return true;" onmouseout="window.status=''; if(self.ql_timeout) clearTimeout(self.ql_timeout); self.ql_isOverTip = false; setTimeout('ql_closeiframe()', 1500); ">for the dying</a> ones as they do the rest of them, and the nurse does what she normally does. The hospice aides come and do it all over again "better", and the hospice nurse comes and tells the LTC nurse to give more morphine. What I am trying to say is that hospice is just an extra helping hand to give to the patient and families of patients because we are so pressed for time.
    At least that's what I have seen.
  5. by   PBAJS

    we have hospice at my ltc facility. here is my two cents.

    [color=#993300]"hospice nurse and hospice aide were also present, but they sat with the families as if they were just there to comfort."
    the hospice team provides care/assistance to the resident and the family.

    [color=#993300]"i gave all the meds"
    our nurse gives the meds

    [color=#993300]"and our ltc aides did all the adl. i was a little bit confused ..."
    our hospice aide does all the personal care and adl for the hospice patient.

    [color=#993300]"i am a nurse aide at a ltc facility, and what i'd just like to point out, is that, the ltc aides are there 24/7, but the hospice help is only there periodically."
    hospice help may be there for what appears to be a short time, however, hospice is available and may be called at any time = 24/7.

    [color=#993300]"in my experience, the ltc aides do the same thing for the dying ones as they do the rest of them,"
    except the hour or two that the hospice aide is there.

    [color=#993300]"and the nurse does what she normally does,"
    for meds, treatments, charting, it's the same. one thing i noticed that is different, for a hospice patient the facility nurse calls the hospice nurse who will contact the doctor.

    [color=#993300]"the hospice aides come and do it all over again "better",
    if our cnas had one or two hours per patient they could do it 'better' too.

    [color=#993300]"and the hospice nurse comes and tells the ltc nurse to give more morphine."
    right, the doctor will give the orders to the hospice nurse who will give the orders to the facility nurse.

    [color=#993300]"what i am trying to say is that hospice is just an extra helping hand to give to the patient and families of patients because we are so pressed for time."

    hospice is not just an extra helping hand; hospice provides many services. thankfully, too, as we do not have the time (or knowledge) for the emotional, spiritual, financial, bereavement, comfort, counsel and support that the patient's family may need.


    our hospice company representatives did an in-service for us. a different company, but i found a page online that appears to be the information we received at our in-service. hospice services overview http://www.tlcathome.com/wv/whatishospice.htm


  6. by   aimeee
    Legally, hospice services in a nursing home are supposed to be over and above the services the resident would normally be receiving from nursing home staff. Although our nurse will administer medications if she is there, most facilities will only allow their own employees to sign the MAR so the nurses prefer to give it if they have to sign for it. If we are having difficulty controlling symptoms, we will sometimes initiate continuous care to help get things under control. Its tough to provide the extra TLC that a dying person deserves when you have 25 other patients to attend to...that's when even just being present is a huge thing. As a LTC nurse, it was always a relief to me to know that hospice staff were attending to my dying patients so I didn't have to feel guilty about being pulled away to attend to other emergent matters.
  7. by   Mazzi
    As a hospice nurse going into the LTC facility, I try very hard not to "take over" the care from the staff. My duty is to be the second pair of hands, if needed, give my expert advise or recommendation to the staff, support them and help them any way I can to make the pt and the family comfortable. Alot of the time I assist with the emotional/spiritural aspect. I call in our chaplin and/or MSW to assist also. I am the go between the LTC and the Doctor. How many times have I called the Doctor's office for the staff and got right to the Dr.'s nurse, where the LTC will fax the office and hours later may get the response. We work hand in hand and do not feel like one is better or more needed than the other. I have put on gloves to assist an aide in cleaning up a BM. I have changed dressings when I see the RN/LPN is running from room to room trying to take care of 10/20 residents. I hope that they do not feel threatened by me being there. I am a support person that just happens to work for Hospice.

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