It shouldn't have happened this way.... - page 7

by nerdtonurse?

14,814 Views | 67 Comments

Okay, so I work part time with hospice. I like it. It's a nice break from feeling like I'm torturing souls their last days on earth up in ICU because their family of freeloaders are all living off their granddad's check.... ... Read More


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    Quote from needshaldol
    Don't get me going on hospice. I find that hospice is useful in few cases. Most people at end of life do not need hospice unless they need a free use of a bed that is easy for the family to control. Hospice takes over the primary doctors duties and the doctor is probably very happy. But hospice is a paid position. There are a lot of staff at hospice, a lot of $ that goes out to staff. Sorry folks, I have seen it with my own two eyes with both parents. I fired hospice twice.
    I'm sorry that you have obviously had bad experiences with hospice in the past. I have been a mental health nurse for 8 1/2 years and just recently changed to hospice RN case manager 3 weeks ago. I have to disagree with you about hospice only being useful in few cases. The problem is that most people are not educated to what hospice really is or what it means. Most of the time, hospice is called in when the patient is already imminent instead of weeks ago when the problems started.

    I recently had a case where a gentleman had been in the hospital for over one month reviving chemo treatments. The last dose of medicine nearly killed him then. The family called us to do a consult at the hospital. While there, I witnessed a level of suffering that was ridiculous for an in-pt with a hospitalist as attending. The chemo had shredded his throat, he was able to talk very little due to the throat pain. He asked for pain medications but told the nurse he would like a shot instead due to his throat pain. The doctor refused to give him one. Also ignored the suggestion of B&O Supp for bladder spasms every 30 seconds. The only order the dr would write was to d/c all meds. Hospice stepped in, got him moved to nursing home, got comfort meds onboard, educated and calmed the family. I am proud to say that we were able to bring him the comfort and peace he and his family needed for the three days he was on services.

    SmalltownLVN/RN
    catlvr and tewdles like this.
  2. 1
    I agree you did the right thing. I also have seen hospitalists hold pain meds for the wrong reasons. We all have seen awful care which can be heart breaking.
    tewdles likes this.
  3. 0
    I am sorry that you had to endure that. (((Hugs)))
  4. 0
    Was this doc reported? At least to the chief of staff? if not the medical board?
    Quote from smalltownLVN
    I'm sorry that you have obviously had bad experiences with hospice in the past. I have been a mental health nurse for 8 1/2 years and just recently changed to hospice RN case manager 3 weeks ago. I have to disagree with you about hospice only being useful in few cases. The problem is that most people are not educated to what hospice really is or what it means. Most of the time, hospice is called in when the patient is already imminent instead of weeks ago when the problems started.

    I recently had a case where a gentleman had been in the hospital for over one month reviving chemo treatments. The last dose of medicine nearly killed him then. The family called us to do a consult at the hospital. While there, I witnessed a level of suffering that was ridiculous for an in-pt with a hospitalist as attending. The chemo had shredded his throat, he was able to talk very little due to the throat pain. He asked for pain medications but told the nurse he would like a shot instead due to his throat pain. The doctor refused to give him one. Also ignored the suggestion of B&O Supp for bladder spasms every 30 seconds. The only order the dr would write was to d/c all meds. Hospice stepped in, got him moved to nursing home, got comfort meds onboard, educated and calmed the family. I am proud to say that we were able to bring him the comfort and peace he and his family needed for the three days he was on services.

    SmalltownLVN/RN
  5. 0
    I beg to differ. I have yet another story about hospice. My dear mom passed away end of April. When I could no longer care for her I had her in a wonderful very expensive assisted living which I paid extra for for all the extra care. She started to do very poorly and I got hospice involved per their suggestion.
    At the first meeting I was told that hospice would come in every day as needed and bathe her. I said that that was not needed as it was paid for in the assisted living plan that I had for my mom. They said they wanted to do it so of course I said fine.
    I just received the statement from medicare which hospice billed and was astonished. Ten days of service was billed at $1900.00. I am shocked. I have the itemized bill. 15 min of a CNA $180. 15 min of RN $290. Yes they were good to my dear mom but.......it is a huge business. Why were they not upfront with me?
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    I have to admit I am thankful I know nothing about the billing aspect of hospice except that our patients do not pay for our services out of pocket. However, our hospice has our aides provide care because they have been trained to be our eyes and ears. They have more experience with issues that arise with hospice pts than most CNAs. They report daily if ANY issue comes up that needs to be checked out. They have smaller caseloads than LTC facility CNAs and are able to spend more time with the pts. Of course anyone can refuse the aide as their right. I'm sure the assis living employees took great care of your mom but not all decisions are based on profit. At least I hope not.
    tewdles likes this.
  7. 0
    10 days of service at $1900 = $190/day

    That $190/day pays for nursing, social work, volunteer coordinator, chaplain, HHA, medical director, medications related to hospice diagnosis, comfort and incontinence supplies, durable medical equipment, any lab tests or procedures, and all supplies needed by staff to safely complete their jobs.

    You may say that you did not require all of those services, however, those services are required by law to be available at the drop of a hat and to be informed and participative in the ongoing care of the patient and family. The hospice must employ and pay them regardless of whether or not you take advantage of them.

    Sounds like a bargain to me compared to what non-hospice patients frequently cost their insurers at end of life.

    Hospices typically lose money on patients who are on service for fewer than 90 days.
  8. 0
    By the way...a hospice may bill what they want, the hospice per diem payment is not determined by what they bill.


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