Hospice in LTC

doodlemom · Feb 10, 2006

What's funny about the for-profit vs not-for-profit hospice debate is that all hospices, regardles of their profit status, are paid the same reimbursement rate by medicare; therefore, it stands to reason that ALL hospices potentially make a profit. I have worked for both types of agencies and I have to say in all honesty that my patients at the for profit hospice receive better care because we can provide more for them. We also accept indigent patients because it is the morally correct thing to do. I'm not saying all for-profit agencies do so, I'm simply stating that the one I'm currently employeed by does.

From a marketing standpoint, for-profits generally market only to the funded markets - ie:nursing homes, assisted livings. This guarantees that they will get a very low percentage of non funded patients. Our agency averages about 15-18% charity care at all times. I would find it hard to believe that any for profit would carry this many unfunded patients. We are NOT turning a profit. I do not question whether for profits provide good care. I realize that they do. Just out of curiosity, what is the census that your SW's and chaplains carry? Also, what does your bereavement program look like?

My personal feelings about for-profit agencies is very similar to the way I feel about Walmart ( I do not shop at Walmart.) They are putting local agencies out of business. I detest the corporate mentality in my personal and professional life. I know that there are many of you out there that work for the for profits and I know you are doing good work. Please don't take this as a cut.

Marty1 · Feb 14, 2006

Hi

We have many LTC patients in out Hospice almost 4o% sometimes

WE just hired a consultant who agreed that the service we give to them is not only needed but very needed in this area.

We have 4 LTC facilities and 2 assisted living ..

It works quite well so far and we are growing everyday

I believe this populatio and the familes benefit greatly from this service

Marty

suebird3 · Feb 16, 2006

Thanks for all the input so far! I appreciate it. I also just fielded a potential Hospice patient for the facility tonight. Refered the daughter to my Administrator and Admissions in the morning.

Halfacre · Mar 17, 2006

I am a certified hospice and palliative nurse. Hospice is my first love in nursing. The way to get your patients served who need it...The hospice needs to build the relationship with "the Brass". Many facilities wait for family approval before they consult hospice. If you can get hooked up with a hospice that consistantly puts the patient and family before their census...that helps. "the brass" will see the need to let hospice explain the benefits to family. For instance; would you ask a family to commit to surgery before they consulted with the surgeon..DUH...NO! The same is true for hospice. Someone who knows what they are talking about needs to talk with the family.

FYI-some of the resistance is $ driven. Some hospices only pay 95% of the daily R&B charges (because that's all medicare sys they must pay).

Good luck at resolution

BethyC123 · Mar 26, 2006

I work in a facility that houses both an Assisted Living building and a LTC Alzheimer's unit. I am not a nurse, just a CNA. But as someone who watched her mother die in Hospice, I really feel strongly about it. I couldn't agree more with the fact that families are reluctant. And I have been there, I was extremely reluctant to "give up hope" when my mother was ill. It felt almost like we would be saying we didn't love her or care if she died if we just "let her go" without trying everything possible. The bad thing is that it is such an emotional time for the family that they often can't see beyond that, to the fact that their loved one is in such pain that palliative treatment would be a much better option.

It is a struggle where I work. Often patients are not put on Hospice care until they litterally have only days left to live. And it is very hard to see that, because as a caregiver you know that the patient is suffering so much, but that the family isn't willing to see Hospice as a kindness. Even when the patient is not in pain or suffering physically, I think Hospice can be the right way to go. I have a very old gentleman patient who sighs and looks sad every day, and even tells me that he wishes he could just "pass on peacefully in the night," but his family has him up for physical therapy, all kinds of medications and treatments. And at some point I suppose it comes down to an ethics decision, but I wonder if it wouldn't be better if a lot more patients like him were utilizing Hospice care.

Sorry such a long post!