patient in nursing home

tewdles, RN · Sep 3, 2009

I'm not up on hospice nursing. What kind of care do you do with a nursing home patient? Do you give all their meds? Does someone stay the day with them? or do you just come in once a day and conference with the LTC nurse and assess them? bathe or do their care? Can someone tell me? Thanks

You ask a good question. It is important to understand that hospice nursing is essentially the same regardless of where the patient lives. Hospice staff visit intermittently and facilitate delivery of care that is consistent with the hospice philosophy and with the patients wishes and goals for his/her death. In the family home we collaborate with the family and provide supplies, medications, education, support, and 24/7 backup to allow the patient to live out his last days in his place of love and comfort. These patients and families are empowered to have a great deal of control over what is and isn't done. The hospice staff make many recommendations and suggestions for symptom management but, ultimately, the plan of care is decided by the patient. In other words, if the hospice team makes recommendations for pain control but the patient has a spiritual belief that involves suffering, they are allowed the path they desire. In the nursing home setting the hospice team interacts with the facility staff to insure that the hospice philosophy of care is reflected in all aspects of the patient's life. We collaborate with the staff from dietary to medical to impact the patient's quality of life and of death. The hospice team will often make recommendations for significantly streamlining the medication plan of care for the elderly patient. This is accomplished for several purposes...1) When a certification of terminal illness is completed many preventative medications become superfluous and unnecessary...2) Medication profiles are often streamlined (with patient/family consent) to minimize incidence of side effects as death nears...3) patients are often sick of taking a grocery list of pills. It is interesting to note that there are many documented cases of patient health improving noticeably following this proactive change in the medication plan. Also, if hospice recommends discontinuing a medication but the patient desires to continue it, they may. So...yes, we give them their meds.

Hospice does not "spend the day" with them routinely. All hospices have volunteer programs and therefore can provide hours of companionship for hospice patients. The nurses, social workers, clergy, etc visit according to the plan with each visit averaging approximately one hour. The home health aids visit more frequently than most of the disciplines and they provide the bathing/dressing ADL care. Hospices must have the ability to provide "continuous care" if needed to insure the peaceful, comfortable death desired by the patient. This is generally not necessary in nursing homes as those staff are often emotionally attached to the clients and deliver a high level of care during the hospice experience. The hospice staff equip the facility staff with medications, education, some supplies, and support to empower them to care for their hospice patients. Many nursing home staff appreciate working with hospice because hospice is very much about being rapidly responsive to the needs of the patient. This means that hospice is easy to get in touch with and provides answers/recommendations/orders very quickly. Hospice anticipates symptoms and therefore often has medications available in the nursing home in advance of the actual need, this is very helpful to the staff. Do we bathe patients? YES, I have even worked with MSWs who have helped to bathe people.

I hope this helps you to understand a bit more about hospice.

retiredlady · Sep 3, 2009

Thanks a lot. That answers my questions and i know that you all perform a very valuable service.