hospice diagnosis help

  1. hi, I am a home healthcare nurse whose agency is 'creeping' into hospice. there are no hospice services in my area.........kinda rural and such.............anyways, I approached the hospice director where I work and asked about two patients on my caseload who I feel would be better served under hospice...............both are in their nineties, frail and kind of 'failure to thrive'.............recurrent pneumonias, poor p.o. intake, little mobility, etc..........I was told that if the Doctors could give a 'terminal diagnosis' they would qualify..................however is hard to be specific..........both are kind of terminally elderly, versus any other diagnosed problem............(have a lot of 90 + y/o's on my caseload, most aren't so frail)..........any ideas or help would be appreciated...........thanks!
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  2. 20 Comments

  3. by   adrienurse
    I would speak to the physician. What does he/she think? Has anyone looked into why these people are failing to thrive. Does their failure to thrive have more to do with their inability to care for themselves properly, and if so, could these people more appropriately be placed in long-term care? What do the families of these people think.
  4. by   kids
    Originally posted by adrienurse
    I would speak to the physician. What does he/she think? Has anyone looked into why these people are failing to thrive. Does their failure to thrive have more to do with their inability to care for themselves properly, and if so, could these people more appropriately be placed in long-term care? What do the families of these people think.
    What adrien said...and, what are the patients cognitive status, what do they think?

    In the area I live in FTT is an acceptable terminal dx, all the Docs here have to do is write an order that says "on going FTT, prognosis <6 months, refer to Hospice".

    That gets Hospice involved and lets them present the concept and services provided.

    Also, in my state (WA) Medicaid will not pay for both HH and Hospice (gets sticky when you have terminal children who need skilled PDN since Hospice doesn't provide PDN).
    Last edit by kids on Mar 6, '03
  5. by   hoolahan
    I am also doing HH, but I have no words of wisdom. Do you believe I had a 100 ye old woman and the doc refused to put her on hospice? I mean exactly how much longer did he think she would live? She just wanted to be able to die at home, "like in the old country."
  6. by   renerian
    I agree have a conversation with the doc and ask him what his thoughts are on an admission diagnosis.

    renerian
  7. by   aimeee
    Are you using the Hospice guidelines worksheets? They don't have to meet every criteria for a particular diagnosis sheet when there are multiple difficulties present. What kind of weight loss over the last six months have they had? You can use failure to thrive as a terminal diagnosis if nothing else works. What about muscle wasting? Albumin levels? Dementia? Underlying PVD, CHF or COPD? All these things buttress the failure to thrive diagnosis.
  8. by   karbyr
    thank you all, very helpful
    what is a hospice worksheet?
  9. by   Mary Dover
  10. by   aimeee
    Excellent cite posted by Mary! Thank you! I bookmarked that one.

    The guidelines I am speaking of are Prognosis worksheets that are basically the info in the medicare guidelines converted to a check-off worksheet. I can't remember who supplies them, but I have some in my car so when I go out later I will see if it says on them.
  11. by   aimeee
    I believe they are published by the NHPCO and they come in a booklet form. Check out this site....about halfway down the page there is a link to pdf files you can download for specifics on failure to thrive and debility. I'm going to have to take a look at those myself.

    http://endoflifecare.tripod.com/Caregiving/id18.html
  12. by   lizzzzy
    We use diagnosis i hate to deal with, debility unspecificed. Look at diet, recent changes or decline in health, cognitive state, etc.
  13. by   kids
    Thank you Mary and Amy, have book marked both sites.
  14. by   mchospicern
    Depending on the fiscal intermediary who pays your hospice on behlaf of medicare, "Decline in Health Status" may be the preferred dx, rather than "adult failure to thrive." Last time I checked, CAHABA liked AFTT, and Palmetto likes Decline in Health. Whenever possible, however, it is preferable to have a disease specific diagosis. Even if the patient doesn't meet all the criterea on the LMRP, you, the medical director, or the MD can justify in the are provided for supporting doccumentation, why the patient has a limited life expectancy.

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