I am curious about this. I just discharged a patient who was on service for 9 months. She left the area and moved back to our service area. I just saw her last week or so. Yes, it;s the same patient I am wishing would just go away lol.
None the less, she is so NOT appropriate for hospice its' not funny. She is a dx CHF. Thin, no edema. walks around her house with no o2 and biggest issues is a regular bowel movement. LOL no kidding.
None the less, I got the call from the patient asking if I could come by and "readmit her". Just to show you how much the family listened to me, I advised them to call our office and get admissions to assist them whenever they were ready to return. They got my cell phone number due to me not blocking it and hence the call I told them not to make.
I called our admissions dept and made the referral. I told them about this case, about how she maybe not found appropriate per Medicare Guidlelines. I was told, well, because Dr. N referred her, we HAVE to admit her!
OMG... this is not the first time Ihave heard my agency say this. Is this clearly medicare fraud?? I have seen patients admitted just o appease the doctor and not really have any declining need. THis also might explain why my soon to be old agency is being ADRd by Medicare?
it is what it is......I've worked for a company in the past that would admit anyone for anything it seemed.....If someone admits the patient, and you are a case manager, you can't legally document a decline....discharge them at the next certification....
Having been with hopsice only a wee while, it seems to me that sometimes MD's refer "needy and annoying" patients to hopsice in order to get a break from them. Please understand that I'm not judging the patients; I'm sure that all nurses have noticed that some patients and patient families require more attention and time than others. It appears that the MD would rather deal with the hospice nurse who's "running interference" than to deal with the patient or patient's family directly. The referral is made with little consideration of hospice appropriate criteria. Just an observation from a hospice novice.
OH you don't understand.. you can't admit patients on being needy. They have specific guidelines. If they don't meet the criteria, they can't legally be billing for services.. I am more leaning on the agency who admits them vs. the MD who is sick of seeing Mrs. Smith once a month or whatever.
I had one patient who openly asked if I could just come when they called. They didn't want me coming weekly or biweekly but as needed! Now THAT is an inappropriate patient.
The "needy" patients to which I refer are made to "appear hospice appropriate" upon admission. During hospice admission these patients gain weight and have stable VS that are WNL. There is NO decline of any sort to be documented and these patients are discharged as they can not be recertified.
Our agency is a non-profit agency, and we are told that on most medicare pt's we lose out, counting on gifts and fundraising events to make up the difference to continue to provide service to the rest of the community. I am new to hospice nursing in the last 6 months, but I am starting to see some of what you all are saying. I don't feel that we blindly accept patients, though. I think that a short admission assesment doesn't always reveal the total picture like a case manager sees over time. I document what I see and convey this to the team manager and doctor. Our Hospice physicians make the ultimate decision to recert or not, and now medicare requires this anyway.
Specializes in LTC, assisted living, med-surg, psych.
I am astounded at the lengths that a particular hospice with patients in my ALF will go to in order to recertify this one resident, who has been on service for TWO. SOLID. YEARS. She is as demented as they come---totally inappropriate for assisted living IMO---and she's no more actively dying than I am, but somehow when she comes up for recert, their medical director finds some way to do it. Which is great for us, because the extra help she receives with feeding and ADLs makes it possible for us to keep her instead of outplacing her to an ICF.
Still, I don't see how it can possibly be right for this hospice agency to keep her on service when she's so bloomin' healthy, even at age 99, that we swear she's going to bury us. She no longer even fits the failure-to-thrive criteria, which usually is what keeps people on service when nothing else works. The other hospice we work with, however, is more stringent and will d/c patients from services if they're no longer appropriate........sometimes sooner than we think is proper (one of our residents died two days after hospice was withdrawn, and she'd been on service for only a few months).
Makes you wonder, though, how some agencies can get by with keeping patients on for years while others will d/c them when they get close to six months and don't look like they're going anywhere for a little while.
I am astounded at the lengths that a particular hospice with patients in my ALF will go to in order to recertify this one resident, who has been on service for TWO. SOLID. YEARS. She is as demented as they come---totally inappropriate for assisted living IMO---and she's no more actively dying than I am, but somehow when she comes up for recert, their medical director finds some way to do it. Which is great for us, because the extra help she receives with feeding and ADLs makes it possible for us to keep her instead of outplacing her to an ICF.
Still, I don't see how it can possibly be right for this hospice agency to keep her on service when she's so bloomin' healthy, even at age 99, that we swear she's going to bury us. She no longer even fits the failure-to-thrive criteria, which usually is what keeps people on service when nothing else works. The other hospice we work with, however, is more stringent and will d/c patients from services if they're no longer appropriate........sometimes sooner than we think is proper (one of our residents died two days after hospice was withdrawn, and she'd been on service for only a few months).
Makes you wonder, though, how some agencies can get by with keeping patients on for years while others will d/c them when they get close to six months and don't look like they're going anywhere for a little while.
The things that must indicate appropriatemess for hospice here anyway.
weight loss? What was it? What is it now?
Skin issues? everything from a skin tear to a red bottom counts here DId she then have one, does she have one now?
FAST SCALE Reference. What was it, what is it now?
VIsual weight loss or documented weight loss and MAC scores.
Infections of ANY kind. Conjunctivitis? UTI? URI LRI? Any infections at all? Yeast rash??
If your questionable resident does not or has not met these basic signs of decline. Unlikely she is appropriate.
I have seen many many patients admitted who were not appropriate as well as MANY patients being recerted who are not at all appropriate for hospice care. There is nothing I can do. I document what I see and no noted decline. I have brought it to the teams attention during IDG that I continue to feel that this pt and that pt are not appropriate and nothing changes. C'est la vie!
AtlantaRN, RN
763 Posts
it is what it is......I've worked for a company in the past that would admit anyone for anything it seemed.....If someone admits the patient, and you are a case manager, you can't legally document a decline....discharge them at the next certification....