"Time to Talk About Death"

Dear Zen123, please do not feel like you have to bring hospice to people...you simply need to make sure they are educated about their choices. Most of the time, as a floor nurse, that means that you advocate that education for your patient to the physician. Hopefully, the physician will agree that it is prudent to consult hospice and you can facilitate that through the case nurse or the MSW or similar. The nice thing about hospice is that most agencies have staff that are specifically trained to speak with patients and families about this topic. You are correct that it is a sensitive subject discussed during a very sensitive time in a family's life. While you do not have to personally provide the information that this family needs, it is often very appropriate for you to be present during the meeting...and I would encourage you to join them when you can, especially if you have worked hard to develop a trusting relationship with the pt/family.

by tewdles;3897801

Dear Zen123, please do not feel like you have to bring hospice to people...you simply need to make sure they are educated about their choices. Most of the time, as a floor nurse, that means that you advocate that education for your patient to the physician. Hopefully, the physician will agree that it is prudent to consult hospice and you can facilitate that through the case nurse or the MSW or similar. The nice thing about hospice is that most agencies have staff that are specifically trained to speak with patients and families about this topic. You are correct that it is a sensitive subject discussed during a very sensitive time in a family's life. While you do not have to personally provide the information that this family needs, it is often very appropriate for you to be present during the meeting...and I would encourage you to join them when you can, especially if you have worked hard to develop a trusting relationship with the pt/family.

Yes I am very well aware of the above. I wish we all could operate so smoothly at times how you describe it above, but not all of us have that kind of support when we need it- fast. Those who work in a LTC as a Charge Nurse knows this all too well. I spoke with the MD. on the phone and ordered - The resident was either going to be sent out to the ER or Hospice. The family was at bedside. The Social Worker was off. I care not to elaborate more..

In short, the family declined/ was not ready for Hospice, and was sent out to the hospital.

Thanks for your input.

Zen...yah, that happens, frustrating not to have support from SW ...and, the families get to make the choice...sometimes the patient needs to be in the hospital in order for the family to seriously consider hospice. I hope that those in LTC get good response from hospice agencies when they need an "informational visit". The hospices that I am aware of often work hard to have good, professional relationships with the LTCs and ACFs in their service area. That, in my understanding, usually means having the capacity to respond quickly to a request for hospice information or services. Most of us "case nurses" nurture good trusting relationships with the facility staff where we have patients. If they need an "informal" hospice evaluation I will help them out. If they have a family with questions about hospice I will answer them for the staff...the family still gets to chose from a list of hospices...I just provide that support for the facility if I am on the campus.

i can tell you now, that it is never a good time to discuss hospice in an emergent situation.
the ltc facility should be setting up meeting with the family, to discuss current med'l status and prognosis...
and careplan accordingly.

years ago, i was on a hospice committee, and we went to a ltc facility in 'hopes' of transitioning resident(s) to hospice.
long story short, it.was.a.meat.market.
the ltc nm, had all the charts and would go 1 by 1, determining who should be hospice or not.
meanwhile, the cn was going nuts, adamantly stating that so and so did not belong on hospice.
(this cn clearly loved her pts and was being protective).
that was my last meeting ever.
selecting appropriate pts was all revolved around $$ in their eyes.

stuff like this happens too, too often.
i quit as a committee member that very day.

i understand your frustrations.

leslie

leslie...not surprised that you quit that committee...sounds creepy if you ask me. In an ideal world these people would be referred for hospice evaluation because of change in their condition (either acute or gradual) which is impacting their daily life and ability to be comfortable. All of us in hospice see things that are not "kosher" and that sort of practice in LTCs is one of those things. Sometimes hospices view those facilities as their bread basket...providing a steady supply of terminal dementia patients with slow decline. Many hospice agencies covet those patients as they are low cost and provide a more stable patient population over time than the typical oncologic referral who has a life expectancy of 14 days or less. Because of that phenomenon it is important for hospices to have good relationships with facilities...we want to be the hospice of choice for their residents...but the process you outlined seemed almost a bit ghoulish. I am more familiar with a much less "formal" approach where the facility contacts the hospice to interact with the family...to perhaps sit in on a meeting to discuss treatment options...or to give the facility staff an appraisal of the patient (informally) as to hospice appropriateness so they can formulate a plan for further care.