After Hospitalized, Patient goes to another hospice

[AtlantaRN, RN]

Question. Has this happened to one of your patients, and if so, what did you do?

I had a patient who has end stage alzheimers, history of ileus, who has been doing well since june of this year (after putting her on reglan 4 times a day). She had gastroenteritis and went to the ER (she had projectile vomiting as well).

I went with her to ER, stayed with her. Got her settled in when she got admitted. (now, at this point, she is admitted and I have no reason to have access to her chart-but I did have my companies pens and post it notes and I asked them to put a sheet with our phone number under case management, so they would know that she is a hospice patient and we had hoped to continue her care upon discharge).

I checked on her last one week ago Tuesday (I have 15 patients)., also I had given the son a company card with my office cell phone number on it. He verbalized an understanding that we would pick up services when she is discharged.

I call the hospital today, as I had not gotten a call all week; and she had been discharged, last WEDNESDAY. Discharged to an Inpatient Hospice....a competitor.

I called them and asked them what the deal was...."oh, it was the families choice...." well if that is the case, why did NO ONE call me from this hospice for a change of designated hospice form or the like. In fact, when I called, I was at the patients previous home--an assisted living facility---when I got off the phone with the competitor hospice, the assisted living facility received a call from competitor hospice asking if this patient had been on MY service...........

anywhoo. I faxed a change of designated hospice with the appropriate information. It would have been nice to know. I was just so busy with 15 other patients and new admissions.....

Thank you for your input.

[caliotter3]

Whenever I heard about a client changing agencies or facilities it usually included a rendition of the big blow-up where the client or family gave the old providers a big, 'ol piece of their mind. Once, when this happened, someone at the losing office jumped down my throat as if they were blaming me because the client went to a competitor that I happened to work for. I got accused of sending the case to the competitor, when I had nothing to do with it. The mother of the client just was sick and tired of 11 years of hearing about how her child could not receive the help that was needed. The gaining agency was quite happy for the business, and promptly provided the family with nurses. Enough said. But in your case, it sounds as if the family should have shown some consideration and made a phone call, whether they were dissatisfied or not. Chances are likely, that a rep from the new agency just happened to meet up with them in the hospital and stole the case. It does happen.

[ray2512]

First of all do you have a inpatient hospice? Secondly do you have an inpatient contract with the hospital?

Maybe they just wanted the client to go to an inpatient unit instead of back to assisted living or a nursing home.

If your agency has a inpatient contract with the hospital you can just keep the patient on hospice and all you have to do is make daily visits to the hospital. The contract involves receiving inpatient reimbursement from the medicare hospice benifit, then paying the hospital that rate.

Another thing is I dont recommend reglan for hospice clients, when there is something preventing GI movement or an obstruction thats what reglan does, reverse peristalsis.

Question. Has this happened to one of your patients, and if so, what did you do?

I had a patient who has end stage alzheimers, history of ileus, who has been doing well since june of this year (after putting her on reglan 4 times a day). She had gastroenteritis and went to the ER (she had projectile vomiting as well).

I went with her to ER, stayed with her. Got her settled in when she got admitted. (now, at this point, she is admitted and I have no reason to have access to her chart-but I did have my companies pens and post it notes and I asked them to put a sheet with our phone number under case management, so they would know that she is a hospice patient and we had hoped to continue her care upon discharge).

I checked on her last one week ago Tuesday (I have 15 patients)., also I had given the son a company card with my office cell phone number on it. He verbalized an understanding that we would pick up services when she is discharged.

I call the hospital today, as I had not gotten a call all week; and she had been discharged, last WEDNESDAY. Discharged to an Inpatient Hospice....a competitor.

I called them and asked them what the deal was...."oh, it was the families choice...." well if that is the case, why did NO ONE call me from this hospice for a change of designated hospice form or the like. In fact, when I called, I was at the patients previous home--an assisted living facility---when I got off the phone with the competitor hospice, the assisted living facility received a call from competitor hospice asking if this patient had been on MY service...........

anywhoo. I faxed a change of designated hospice with the appropriate information. It would have been nice to know. I was just so busy with 15 other patients and new admissions.....

Thank you for your input.

[aimeee, BSN, RN]

I went with her to ER, stayed with her. Got her settled in when she got admitted. (now, at this point, she is admitted and I have no reason to have access to her chart-but I did have my companies pens and post it notes and I asked them to put a sheet with our phone number under case management, so they would know that she is a hospice patient and we had hoped to continue her care upon discharge).

I checked on her last one week ago Tuesday (I have 15 patients)., also I had given the son a company card with my office cell phone number on it. He verbalized an understanding that we would pick up services when she is discharged.

I call the hospital today, as I had not gotten a call all week; and she had been discharged, last WEDNESDAY. Discharged to an Inpatient Hospice....a competitor.

I called them and asked them what the deal was...."oh, it was the families choice...." well if that is the case, why did NO ONE call me from this hospice for a change of designated hospice form or the like. In fact, when I called, I was at the patients previous home--an assisted living facility---when I got off the phone with the competitor hospice, the assisted living facility received a call from competitor hospice asking if this patient had been on MY service...........

anywhoo. I faxed a change of designated hospice with the appropriate information. It would have been nice to know. I was just so busy with 15 other patients and new admissions.....

Thank you for your input.

Hospital discharge planners have no idea that a change of designated hospice is needed. Most of them are not very familiar with hospice rules and regulations. This discharge planner may not have even informed the inpatient hospice they referred the patient to that they were under hospice care before...hence the call to the facility checking things out from the competitor hospice. We finally learned to put a question right on our forms..."have you ever been a hospice patient before" after having taken on patients a number of times where nobody bothered to mention this to us!

Next, I would suggest that that you never rely on any other organizations staff to get a message to the right person. Who knows if your sticky note was even there by the time the discharge planner saw the chart? I would suggest that any organization have daily contact with both the family and the assigned discharge planner while a patient is hospitalized, both for support and to help ensure that you are actually involved in that discharge planning process, as well as building a rapport with that discharge planner for the future.

I would also suggest that someone from your organization call the POA and thank them for the opportunity to serve them and ask if there was specifics about your organizations care which they were dissatisfied with. If you don't have your own inpatient unit, they may have just found that that setup better meets their needs right now, but if they did find your services lacking, you will want that feedback.

[AtlantaRN, RN]

We contract with a facility for inpatient hospice.

Thanks for the input, I've not had this happen before.

linda