Hospice care

U.S.A. Massachusetts

Published

I have worked in Hospice for 29 years. It has changed over time, some for the better, some no so much. Mostly I worked in small community based organizations, but recently moved and was offered a position with a corporate owned Hospice that also owns most of the facilities where our patients are located. Good pay, NO weekends or on call. How could I not accept.

The facilities were not the best, but the staff seemed friendly. From the first week on the job the aides started complaining about the patients being abused. I started looking into it and discovered the abuse was rampart. Patients in urine soaked beds for long periods of time, no supplies or linens for the hospice aides to do personal care, pressure ulcers left untreated, it was a nightmare. I went to the DON of the facility who was friendly and pretended to be concerned, but I could see it was fake. I went to my boss who basically told me our companies were married, there wasn't much they could do, and to my surprise the aides who had come to me with their concerns were fired.

I spoke to one of the social workers who told me there were lawsuits against the Hospice for wrongful termination, and the staff never lasted long because whenever they spoke or filed a complaint they were fired. I was totally shaken to the core by what I witnessed. I wonder what price I will pay for going to the department of public health. I'm told dozens of complaints have been filed by the staff before me and everything has come back unfounded. Please say a prayer for me.

I have to agree with you there. The whole system is so disillusioning. You have to wonder how it got this way. I suppose if you did not know what is right and what should be you would just accept what is.

Specializes in Hospice.

The HHS Hotline number, don't bother. I not only called several times, I notified state agencies during abuse I was witnessing. Never did any investigator interview me. Never! HHS, they do not respond. It's hard to believe, but they do not respond! It sounds like I'm making it up, and it felt like I was in a nightmere while it was happening. I just discovered in 1 year, the Hospice I was thrown out of after reporting abuse, had 7 nurses who were hired and quit for my position, in 1 year. They all witnessed abuse and instead of risking their jobs, they found other positions and quit. As for the poor aides, there were 9 of them. They called everyone from the department of public health, health and human services, and even the National Hospice and Palliative care nurses org & National Hospice Org. I saw the letters they wrote, begging for help for these patients. It is still hard to believe because it was totally contrary to what I knew for 3 decades in nursing. And I witnessed it first hard. Certainly just as we see in politics on a daily basis, it is happening in healthcare, the compassion is disappearing. It's all about the bottom line. Greedy corporations. It's very sad.

Civilized....and others...... It appears that we get "sucked in" into believing. We go into this field wanting to make a difference and we find out we can only do that once in a bit. Civilized learned that the system is not protective of patients, but protective of their own salaries. It seems to take tons of years of experience to figure this all out, that a lot of people are being duped. And, yes, the bottom line......we all know what that is. I have a friend, a nurse, who had her father go thru 6 weeks torture, late 80's age, dementia, illness after illness, and the person he chose for medical charge had no clue and it kept going, blood transfusions, ICU, PICC lines, this, that, this that, and the docs made tons of $$$ medicare bilking. Finally, finally the person in charge decided "hospice", which of course took interview with social worker, 2 nurses, get the bed, etc. set up. Well, 36 hrs after he was home, he passes. All that $. He ought to have been on comfort care at the hospital and gone peacefully weeks earlier. People are just plain ignorant or most likely believe the health care personal. I have another friend whose loved one went thru lung cancer 15 yrs ago and came out good and got it again. I told her "it does not look good to me". She said, the docs said he had a great chance. Well, surgery Monday, complications, ICU, etc. etc. and Wed she pulled the plug. She felt guilty and I had to reassure her she did the right thing. During the few days of intensive care she said the docs kept telling her he had a good chance. Good chance? They kept at it (the guy also had mets) and as far as I am concerned, medicare-bilking.

I work acute med/surg/ortho/onc and I see this all too frequently. I am tired of tying demented, old, sick, never going to get better, people up so that they do not pull at their feeding tube. Cruel and to think that docs bill and earn $ for this? Not all, but quite the norm.

I was excited to see this post and started reading all of it, but when I got into it most of it was about fraud abuse and whistleblowing. I am a hospice nurse, my husband last year was on hospice for 7 days before passing away now with that company they came in admitted him received one call the next day then nothing until the day I called them to say he had passed. I as a nurse chose to work hospice and feel that I help my patients and theior families. No its not a typical 8-5 job there are many days that I may not get home till hours later due to admitting a patient or getting a call saying Mr Smith is doing bad and the family members wanting a nurse to come see them.you noticed I said them because not only to we treat the patient we are there for the families as well and at times they need a shoulder or a caring ear to have someone listen to them. I am on call and there are times my phone doesnt ring but there are many times it rings off the hook, some of it I can handle over the phone, like the ltc settings sometime they just need an increase in there meds and they know that hospice can get it to them faster but all my patients have my number and the direc line and they know they can call at anytime and talk to either me or another on our staff . I have gone to admit someone and find out that the doctor has not explained to them that there is nothing else they can do medically and sends them into shell shock I can see it in there eyes omg I'm dying when that happens I carefully explain what hospice is for, what we can do for them and their families, explain that yes while there is no more medical intervention for them this doesnt mean they cant get out and enjoy what time they do have. I will leave before admitting them and come back at a later time after they have had a chance to absorb it and talk with their familes. Hospice isnt something that you can force on someone, they have the right to say no even when the doctors have said they need this, it has to be their choice and the families. I am sorry for thise who have lost their jobs for reporting the abuse it's going to be the same for any job you hold, if your really wanting to work hospice then go to the smaller companies and see the difference, we do help with the end of life making it easier for them and the families and yes we deliver hospital beds but at the end we deliver so much more.

Showmegirl, to repeat, I am not against hospice. I am just being truthful to quite a bit of what hospice does in addition to being of help. In all honesty, if a family member is having difficulty with their loved one's pending death, etc., other than adding more meds, which is what is 99% done "to get the job done", the family member does not need a nurse. The family needs someone to talk to. The patient needs the nurse for the increase or change in meds. Perhaps a social worker/type or spiritual care person is more of what the person/family needs at that point.

Hospice has its place, yes. But, I believe that it is used when the physician has no more time to give to the patient and family and turns them over. Then the interviews, etc. start. There is a lot of $$$ going into this program and yes it is good for some, and great that it is there, but many people do not understand it may not be needed as it is not discussed that way by physician.

Whoa. To get the job done? I really hope you don't mean that as it sounds. No, no, no. Pain medication is added to get the patient to a comfortable level. You do realize that tolerance builds very quickly with chronic pain and massive amounts can be needed just to keep the patient comfortable, right? I am a member of the Pennsylvania Cancer Pain Initiative and I have spent a lot of time learning about pain and pain relief. That is the BEST part of hospice. Pain relief is job #1. You have to meet the physical needs before you can meet the spiritual needs - remember Maslow.

Spiritual care and care of the family is job #2. Hospice recognizes that the spiritual aspects are extremely important and the family needs support too.

Years ago when I started out I worked on a neuro unit. People generally died in the hospital then. I remember people with brain tumors screaming in agony. There was little to offer them. The docs were afraid of suppressing their breathing so they used demerol and PRN dosing which we now know is completely wrong for chronic pain. I am so grateful that we now have hospice care available. No one should die in agony that way. No one should die in a hospital if they can be at home.

Agree. No one ought to die in pain. And agree that people ought to be able to die at home but some families just cannot let that happen, whatever the reason. Then, comfort care (hopefully) is done, thus no hospice is needed.

Specializes in Hospice.

I don't think anyone is against pain management, but if you believe Hospice is for everyone your head is in the sand. Hospice has strayed very far from what the original intent of Cicely Saunders was. Hospice has become a BIG business. At this moment 50% of all Hospices in this country are owned by large corporations, they are not the ones that are taking on cancer patients, they are admitting patients with "disability unspecified" which means more profits. I'm not saying all Hospice's are bad, or even the staff of these Hospice's are not all caring and compassionate people, however they are run by corporations earning lots and lots of money. I just read a story from another Hospice nurse who didn't understand why her company would not pay for her dementia patient who had a UTI, the patient was not in pain, just aggiatated. Instead the DON ignored the RN/case manager who knew the patient and she put that patient on a morphine drip and the patient lasted 4 days. The idea that Hospice pushes of having a "peaceful death" is wonderful, if your ready. And if your working nites in a NH and you call the oncall Hospice nurse for your patient, let's have a count of hands on how many times that Hospice nurse came out........

Well I agree with that, the profit potential is why these for-profits crop up. Capitalism is the American way.

I also see that many new changes are coming in to make it much less profitable, much more accountable- more like home health which has a hard time even staying viable. I think hospice went unchecked for a long time but is coming under the microscope just as home health, LTC and hospitals have been.

It is a rare employee that agrees with everything their employer does these days. It is a dog-eat-dog world. You should see the West Penn/Allegheny Health System -Highmark vs. UPMC war that is going on. Ugly! As nurses our priority is the patient. Employers are looking at the dollar signs either to stay alive or to make money. If patients are placed in hospice inappropriately they are signing for it or their family members are. And they can revoke the hospice benefit at any time if they do not agree with something. That is the bottom line. They CHOOSE hospice.

Agitation from a UTI is most likely from pain. Did you ever have a UTI? Dementia patients are often under medicated because like children they cannot speak for themselves. I think if I was old and suffering with no way to speak for myself I would be very grateful to float out on morphine rather than to aspirate to death like many of them do. Unfortunately I have seen too many people die over the years.

Interesting thread because I thought for sure I was going to get blasted for my opinions on Hospice, and again, let's remember I am NOT against it. It is needed in certain circumstances, yes. But it is a corporation and the "nicey nicey talk" that they give? Yes, they are needed, again said, in certain times. I remember being for the "interview" with several hospice people, and one of the brouchures given out was how to donate to hospice. That one really got to me because it was not necessary. I am sure they get a lot of people who donate from the estate to hospice and really take $ away from themselves. Every hospice person at the interview spoke slower than most, and it was as if they were little robots, nice yes, but fake and actually felt to me like they were pushing their product. As said earlier, I took mom off hospice as they almost killed her with meds and that was 18 mo ago and here she is alert, oriented, cooking, continent, at almost 91. If Hospice was so great, they would have seen that my mom was not a person for it.

Hey even our local hospital has a web page on how to donate. Everyone solicits donations now. It helps compensate for losses from those who cannot pay.

Specializes in Hospice.

It's interesting to hear about donating to Hospice. I guess people don't understand 50% are profit making corporations. The largest Hospice in Florida made 3 BILLION in profits last year while medicare has been trying to get them to pay back 13,000 in medicare fraud for almost 15 years now. The little community Hospice certainly need money, but not these massive corporations.

+ Add a Comment