Working in SNF or LTC

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    I'm new to Hospice and most of my patients will be in a SNF or Nusing Home. Is anyone else working as a case manager in these type of facilities? What are your responspibilities? My understanding is that there will be a nurse and aide at the facility who are responsible for meds, adls, and most patient care. I've been told that I will be there to assist in care but haven't been given any specifics yet, so I'm curious what role other Hospice RN's play at these facilities.
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    Whenever I have worked LTC, we had several hospice patients.
    The hospice nurse was not responsible for any of the daily pt needs like assessment, medication administration, wound care etc. Those are all the responsibility of the ltc nurse and the hospice pt is treated exactly like the regular pt including calling their MD for orders and change in condition.
    Except:::::
    The hospice nurse did bi-weekly visits to each pt but if they had a bunch of patients in the same ltc, you would pretty much see them daily even though they were not necessarily there to see your pt. They did their own assessment, spoke with the pt about concerns, were very involved in decisions about pain management and would usually write pain med/anxiety med orders on the charts.
    If the pt's pain isn't managed, we (the facility nurses) would call the hospice nurse and she would either come in and reassess, or just change med orders over the phone.
    One of the most important functions of the hospice nurse in ltc is just sitting and visiting with the pt. The pt's were more likely to share their complaints with the hospice nurse than the floor nurse who was always busy. And finally, being a go between with the pt's family. I can say I really appreciated the information and education offered to the family by hospice nurses. If I had a family member I felt needed intervention, the hospice nurse was always able to talk things over with them and clear the air.
    If the hospice pt was turning bad, we always called the hospice nurse and she would (depending on how dire the situation was) send a sitter to be with the pt and family in the final moments, and if she wasn't busy attending to another terminal pt, she would also come sit with the family and if needed change roxanol/ativan orders prn. The hospice nurse would also come to the facilty to pronounce and do the final paperwork with the family and funeral home reps.

    To summarize, HOSPICE NURSES ROCK!!


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