Is a hospice program needed in LTC?

aimeee, BSN, RN · Sep 3, 2007

I began my nursing career in LTC so I have experienced hospice from both sides. Some facility nurses do an excellent job of caring for their end-of-life patients...but often there is inconsistency in the knowledge base of the various nurses caring for the patients. For instance, I have encountered quite a few who are fearful of giving morphine to the dying because they don't want to depress their respirations and be the one who "kills" them. They are also extremely busy. I remember so many times when I couldn't even touch a chart until the shift was all done...every moment was spent getting the meds out, answering the phone, hunting down missing meal trays, dealing with a constant stream of needs.

What hospice brings is expertise in symptom management and in dealing with death and dying. You might think that since the LTC population is generally very late in life that staff would be experts in this. As mentioned above, some are. When hospice becomes involved however, the hospice RN becomes the case manager. She/He can work with the staff to improve consistency of care and to educate where necessary. The Social Worker and Spiritual Counselor can also provide extra help to patient/family who have unresolved issues. The Home Health Aides can also provide extra TLC, really lavishing time and focusing on them. Volunteers may also play a role, reading to patients, playing music or singing for them, helping them prepare a scrapbook to leave to family, or just being an extra companion. And if symptom management is particularly difficult to get under control, hospice can institute continuous care and provide one on one direct care for a day or two until the symptoms are resolved.

Much of what LTC's do is geared toward rehabilitation and stabilization. State regulations often require them to do things that are counterproductive for the dying person because the regulations are written with the view of maintaining the health of residents. Once the person has been declared terminal and hospice comes in, it helps the LTC because they can change the focus of their care from stabilization and rehab to comfort. It also helps the LTC show that they are doing everything possible for their residents to maximize their quality of life.

leslie :-D · Sep 6, 2007

it depends on the ltc facility.

some are staffed with such devoted nurses/cna's, that only periodic consults are needed.

but there are such advantages to using hospice.

the extra hands are very convenient when ltc nurses don't have the time to always be there.

hospice volunteers are an invaluable resource.

and unfortunately, there are facilities that are run so poorly, that quality of care is always a concern to the residents who live there.

i think that hospice brings more overall.

i would rather be safe than sorry.

leslie

Nascar nurse, ASN, RN · Sep 6, 2007

As a long time LTC nurse, I whole heartedly agree with all of the above posted. We have several hospice patients in our long term care. We have been extremely fortunate to have a "dedicated" team assigned to our facility (meaning we get the same group of hospice nurses/aides on a routine basis). This has brought fantastic continuitiy of care to our residentsand brings real peace to families.

As said before, our regulations are so "extreme" (for lack of better term) that we become very hesitant with what we preceive as larger doses of medications - hospice comes in and suddenly we, as a group, are REALLY allowed to do what is best for the resident without the intense scrutiny.

As LTC staff, we simply do not, and never will, have the time to "foo-foo" over a resident on a continued basis. I'm not saying it should be this way, but it is a reality! The hospice staff gives so much of the extras that that resident deserves.

I absolutely love our hospice group and couldn't imagine not having them as a part of our team.

andre · Sep 6, 2007

As a long time LTC nurse, I whole heartedly agree with all of the above posted. We have several hospice patients in our long term care. We have been extremely fortunate to have a "dedicated" team assigned to our facility (meaning we get the same group of hospice nurses/aides on a routine basis). This has brought fantastic continuitiy of care to our residentsand brings real peace to families.
As said before, our regulations are so "extreme" (for lack of better term) that we become very hesitant with what we preceive as larger doses of medications - hospice comes in and suddenly we, as a group, are REALLY allowed to do what is best for the resident without the intense scrutiny.
As LTC staff, we simply do not, and never will, have the time to "foo-foo" over a resident on a continued basis. I'm not saying it should be this way, but it is a reality! The hospice staff gives so much of the extras that that resident deserves.
I absolutely love our hospice group and couldn't imagine not having them as a part of our team.

I could not agree more with this post!

It isn't that LTC nursing staff don't want to provide excellent end of life care...and obviously in many cases, they do.

But given the LTC nurses' patient loads, and that the focus of hospice is really very different than your SNF patients....well, for all of those reasons having a hospice program in LTC facilities is a necessary adjunct to the care those residents are already receiving.

bklynborn · Sep 6, 2007

I totally agree..........I work LTC and we use Hospice when needed the extra hands and hearts are a terrific thing for residents and family members alike. The bath aides are wonderful. The one to one unrushed care is what the resident deserves and I can not do it with my patient load.

Hospice Nurse LPN, BSN, RN · Sep 7, 2007

As an LPN I began in LTC, moved in hospice, and I'm back in LTC and in school. Even though I TRY to give the best possible care to ALL my pts, the reality is I can't. There is only so much you can do for 62 residents in one night. (This has NOTHING to do with the 100 other things required of us at night!) Hospice nurses (and CNA's) have more time to "foo foo" with the patients (as stated above). A good hospice team is worth their weight in gold. :lol2:

The other morning, while counting narcs @ the end of my shift) I noticed that I give more PRN pain narcs in one night than some nurses give in a week. I'm sure it's due to my background in hospice. I just make a point of asking when I'm passing meds, "do you need anything for pain this evening". I also check for s/sx of discomfort when making my rounds.

bklynborn · Sep 7, 2007

What is it with nurses and pain meds? I don't understand. It's such a simple thing to do for someone..........the offer of pain medication. Most elders are so stoic they just suffer mostly because they don't want to "bother" the nurse. I always make a point of asking at HS.

I has a gentleman last night who was complaing of pain 9/10 I looked back at the MAR and found that all he had had all day were 2 tylenol, geez.

aimeee, BSN, RN · Sep 7, 2007

What is it with nurses and pain meds? I don't understand. It's such a simple thing to do for someone..........the offer of pain medication.

When I started in LTC I think one of the reasons nurses didn't medicate more for pain was that it was so darned inconvenient. Since the narcotics were all kept in the locked cupboard in the nurses station, it was very time consuming to have to keep running back and forth to the nurses station constantly all night long. There were two consequences.

1) Nurses avoided giving any more narcotics than they had to.

2) Nurses signed out narcotics at the beginning of their shift for the people they knew were going to need them so they would have to keep running back there (risky if a surveyor should walk in)

It took some time, but eventually I convinced the DON to let us each have a supply of narcotics in the lock box in the med cart. Wow! What a time and step saver that turned out to be. And it led to better compliance too because then the nurses didn't sign them out ahead of time.