Admission Process question

tewdles, RN · Dec 21, 2009

When we go to meet folks in their homes, we document that they verbalize an understanding of hospice philosophy, scope of practice and that they agree with the care plan. If your family is not on board with hospice philosophy, do you document that as knowledge deficit and they require more education regarding hospice philosophy, and proceed with admission------or if they are flat out against hospice philosophy how in good conscience do we admit them? Alot of patients will verbalize that they want to stay home, but if they get bad, they are calling 911.
Just wondering how you deal with said situation. I thought i knew alot about hospice, but after my "denial" situation, i'm questioning everything now. Thank you for your assistance.
atlantarn

This is an interesting question. I may ramble, so apologies right up front.

If the patient is competent to make this choice and desires to provide informed consent for hospice care and services, I get him signed up. I make it a point to discuss, at that time with the family present, how hospice is committed to helping the patient achieve the comfort, dignity, and quality of life that the patient wants. I try to offer reassurance to the patient that we will try to help his family find peace with his process/journey. If the competent patient is "flat out against" hospice philosophy I will not proceed with admission.

Yes, that knowledge deficit becomes part of my initial POC, and I assign the goals directly to the family. This is a problem that can often be resolved and removed from the plan prior to death of the patient.

Many times people come into hospice unprepared to choose DNR and, instead, have the plan to call 911 if they get bad. My experience is that most of those patients change that plan as they become more sure of and peaceful about their impending death. For those that cannot make that transition, we can simply try to make that 911 process as okay for them as possible.

Surely you are just going through "a season" and you will regain your confidence and passion. What you do has great value. You are necessary.