[FONT=arial black]unfortunately sometimes people are not ready to actually hear that their loved one ie dying. Something that helps is to be able to fully explain hospice. Every hospice has their own policies, but the family needs to shop for the one that will meet theit goals and needs. You do not have to be a DNR to be on hospice, but we will try to acheive that status. You always have the right to fire a hospice that is not meeting your needs. You should be alowed to continue previous medications as long as they are indicated, not harming you, and in some way helping even if sometimes the help they are giving you is merely the belief that they help. (I say again, reiterating as long as they are not harming you) palliative care is emotional, spiritual, and physical. Our company doesnt require a patient to stop feedings as long as the patient can tolerate it. We teach the family what that means... is the patient aspirating? What are his residuals. How much edema. Lung congestion. It is a process. Can we merely adjust the rate down to a more tolerable lefel. Then teaching further about the outcomes of the intervention. Poss wt loss, decreased nutrition, protein malnouishment, etc.
Patients often live longer with hospice that initially expected because the constant availability of staff to intervein and the interdiciplinary process. The POC/interventions are patient and family driven. What do they wajt at this time. We do not have an expectation really of how long the patient will live other than at the moment of admission the patient has an "expected" limited life expectancy of 6 months or less if the disease process continues on its normal path, which is very vague because human will is not a factor.
We do not tell a patient that they are "not allowed to go to the hospital," but we will explain that if there is not a contract at that hospital, it will be necessary for them to revoke their benefit sovthe howpital can bill medicare, not the patient. We will explain doing this several times will eventually lead to our decision not to readmit.
We have alternate levels of care where we can provide nursing care in the home for block times from several hours daily to 24 hrs daily for symptom, crisis interventions.
Pateints/families need the reassurance that hospice in not just giving up and taking someone home to die. Its about providing the best care possible for someone that is likely dying. If you have a particularly difficult family, tell them honestly that every hospice differs somewhat and ask them to interview several that service youtlr area to determine if one will meet their needs. Have more than one person present at the education visit, write important questions down ahead of time so they dont forget them. They need to find the company that makes them feel good about the decision, one that makes them feel supported.
When somebody dies, the people left behind have to be able to go on with their lives without constant regret that they didnt do enough. Shopping for the right hospice will help them have control and starts them in the mindset that they are still looking out for their lovedone's best interest.