average # of nursing home patients

Hospice Nurse LPN, BSN, RN · May 13, 2008

Depends. I see 6 n.h. pts. in a day. They are at 2 different facilities. If they were all at one place, maybe 8.

aimeee, BSN, RN · May 14, 2008

6 if in two facilities, 8 if in one sounds possible to me. I suppose one might be able to do 10 if they were all in the same facility and all very stable, but when does that ever happen? And that would definitely be a max, not an average.

Passion for the Job · May 23, 2008

:banghead:

Does anyone know the average # of nursing home hopsice patients seen in a day? I find 6-8 very do-able.

I am part time hospice nurse and casemanager. I have about 7 on my case load and we are required to do the "standard" of 6 visits a day. 1/2 are home patients, the other half are nursing home. We feel we are drowning trying to keep up with a case load and visits. We also do our own admits, set up HCA, go to the IDT meetings, and update care plans. :banghead:

Em1995 · May 23, 2008

Are you guys serious? Our nursing home nurses are expected to see only 4 patients a day in a nursing home. I was told by someone at work that the national standard is 4 nursing home patients in one day. I have fellow colleagues in hospice nursing in different parts of the country and they have told me our nursing home expectation is extremely light.Most nurses in other hospices tell me they also see 6-8 nursing home patients per day.

aimeee, BSN, RN · May 24, 2008

There's another factor in here and that is how often you visit those patients. If I'm going in twice a week or more I have a pretty good handle on what is going on and I don't need to take as much time reviewing things as I might if I go in weekly (or let's hope its not once every two weeks! Awful, but I've heard of it happening)

The numbers I suggested above reflect the idea that there are 2 visits/wk + prn for unexpected changes and that there is an admission nurse to do any new admissions. They also reflect the idea that in nursing homes there is usually a mix of acuity, but generally patients have fewer acute needs (more debility, dementia, and FTT rather than cancer) and I spend a lot less time teaching because I am just reinforcing the teaching I have already done with the facility staff before not starting from zero like I do with a home caregiver. There is still some teaching with family, but its more likely to focus on explanations of our interventions and disease trajectory.

Patti SW · Aug 15, 2008

To all hospice nurses on this site. Does Medicare pay for the care of the pts in your NH? I am a hospital social worker and I have been told that Medicare only pays for the pt whose death is anticipated within seven days. The pts who have a qualifying diagnosis but, are expected to live longer are considered ICF pts so, medicaid is responsible for the payment. Please tell me what you know about how their care is paid for by medicare or medicaid. I want to advise the pt and family about financial concerns.

hospicemom · Aug 19, 2008

Hospice never pays for the patients "stay" in the nursing home. If the patient has money he/she is "private pay" in the nursing home for room and board. If the patient does not have money they will be medicaid(T19) and they will pay the room and board. If the patient has some money but not enough to last him until his last days then he will be required to use the money he has and be private pay until his money runs out to where medicaid takes over. So basically, hospice gets "paid" from either medicare or medicaid and then divides the money up to the proper places. So Hospice never pays for the room and board but does pay for all other care related to the terminal diagnosis. This is what I understand of it thus far anyway:)

Patti SW · Aug 20, 2008

Thank you so much for your input. I have tried to explain on other forums that sometimes the pt may need hospice but, the family requests P.T. so their loved one can be a skilled care pt. Though wrong, in my opinion as well as medicare fraud, the family wants to preserve the pt's money as long as possible.

aimeee, BSN, RN · Aug 20, 2008

Its my understanding that following a "qualifying" hospital stay, Medicare will pay for 5 days of observation under the skilled care benefit.....after that they would have to be able to show that the patient would benefit from PT or whatever else might "skill" them. We frequently get patients referred on day 6....if they last that long. Hard to blame families for not wanting to pay that room and board out of pocket when it can be avoided. Most cannot afford it.

There are some rare circumstances where a patient could be under the Medicare skilled benefit for one diagnosis and yet be qualified for hospice under another unrelated diagnosis. While this can theoretically happen, I have never actually seen it occur and it is little understood and fraught with difficulty to figure out how to actually do the billing and coding so that everybody gets paid without a hitch.

Patti SW · Aug 20, 2008

Aimeee,

I agree with you about the family's fraught. As I had mentioned before on another forum, the family had told NH staff they wanted Hospice but the NH was blamed for being greedy. It really was not the NH pushing for skilled care. The family, as they have the right wanted skilled care.

Medicare rules are,in my opinion, like the bible. Everyone inteprets it differently. I have found Medicare will also be on the side of the pt as it well should. I find not fault with the families who are already going through a very hard time. I was just having a hard time with everyone always blaming the NH.

I always thought "observation pts" had 14 days to be observed. I have found in the hospital setting each NH will only push the limit so far. Some of them will allow 14 days and some follow the rules of Medicare to the book. Again, just like the Bible.

aimeee, BSN, RN · Aug 20, 2008

14? Huh. That's a new number to me....I'll have to check with one of our gals who used to work in the admissions department of the nursing home. I have never read the nursing home skilled care regs myself so I can't really speak with authority on it. Maybe there are ways to automatically activate additional days to stretch it out....like getting an order for some sort of IV?