Can a LTC facility do this?

Specialties Geriatric

Published

I have been working at a ltc for the past year and half and have seen this for the second time now. We recently lost a patient who was admitted to the facitly 1 mo prior. When she came the Dr told the family she was a good canidate for Hospice. Family didn't want her put on at the time and the patient wanted to live. After a week at the ltc the patient gave up and started to decline really fast. At this time family felt hospice was best. At this time the census is really low at the ltc and the DON and Admin both say she has medicare days left and it's not time for hospice. Needless to say after a week of the family talking with the Dr and fighting with the facility the patient was put on hospice and died on the 2nd day of hospice. Now we have another patient that staff feels should be on hospice but you get the same response from the DON and Admin that they have too many medicare days.

I know I don't fully understand the whole medicare thing and was wondering from other point views. :confused:

Specializes in Med Surg,.

The client was denied the rights and benefits of hospice care. The question should be, how can we advocate for clients and families without ramifications? Call medicare and explain the situation.

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Specializes in Gerontology, Med surg, Home Health.

Although I am a huge proponent of Hospice, let's not all beat up the facility until we know all the facts.

If the patient doesn't have Medicaid and goes on Hospice, the family will have a financial responsibility. Many facilities elect to keep someone on Medicare BECAUSE the family doesn't end up with a bill. We discuss it with the family and let them know all the options. If they want the person to stay on their Medicare benefit, we can skill them for pain management and/or symptom management.

Gee...all y'all are awfully quick to judge.

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Yes, I agree with CapeCod.

It's not a case of medicare fraud, it's a case of the family having NO PAYOR SOURCE for the hospice and not wanting to end up paying thousands of dollars out of pocket for their familiy member's last days.

We will DC PT/OT and we are very, very good at managing CMO/DNT/DNR patients and ensure they are comfortable and very well taken care of even if the family can't afford to pay for hospice care out of pocket.

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The MD is the one who is responsible for writing a referral for a res. to be on hospice. After that the facility has to notify hospice. The MD is the one who determines if the res. is not expected to live. The families can always call the MD them self and ask for a res. to be put on hospice or ask the charge nurse to do this. In other words if there is no order from the MD for the res. to be on hospice then the facility is not liable, if there is an order from the MD for the res. to be put on hospice then the facility and the nurse who took the order could be liable for not carrying out an MD's orders.

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Specializes in LTC, Hospice, Case Management.
Although I am a huge proponent of Hospice, let's not all beat up the facility until we know all the facts.

If the patient doesn't have Medicaid and goes on Hospice, the family will have a financial responsibility. Many facilities elect to keep someone on Medicare BECAUSE the family doesn't end up with a bill. We discuss it with the family and let them know all the options. If they want the person to stay on their Medicare benefit, we can skill them for pain management and/or symptom management.

Gee...all y'all are awfully quick to judge.

I was looking to see if you had posted yet as I knew you would have an answer that I would agree with.

To the OP - Medicare if the RESIDENTS BENEFIT. It is a benefit that they have paid into most of there working lives. Many times the resident &/or family do not understand the financial implications of changing off medicare to hospice. They do not understand that by choosing hospice they are foregoing their right to medicare benefits AND THEY WILL BE REQUIRED TO PAY PRIVATELY. Think of your own paycheck and that medicare deduction you see every time. Are you really going to want to give that up and pay privately for care? Now the admin should have a conversation with the family and explain their options but in my experience, once the family hears the cost of private pay they almost always opt to continue medicare benefits.

Actively dying residents can qualify for daily skilled care due to need for observation of pain management, nutritional needs, wound care, respiratory concerns, etc - whatever is relevant to the resident.

Hospice is a wonderful, fantastic service that can be provided in a LTC. The extra support personnel is great for the resident and their family. But really...what are they doing that the facility is not capable of doing.

Look for greater understanding and less bashing of what you may not fully understand.

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Specializes in school nurse.

Hospice will come in to an LTC and provide services to the patient there, so I am confused why it is an "either/or" situation.

That being said, administrations' position is disgusting.

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Specializes in LTC, Hospice, Case Management.
Hospice will come in to an LTC and provide services to the patient there, so I am confused why it is an "either/or" situation.

That being said, administrations' position is disgusting.

It is an either/or situation by regulation. Medicare pays or you give up your right to receive medicare benefits to receive hospice benefits. Hospice benefits will pay for things like medication & some equipment - but it does NOT pay for room and board - that gets paid for privately by the family.

Is it disgusting that floor staff does not understand benefits that effect their residents lives?

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This pt has Medicare, and hospice is a Medicare benefit. I do not understand the thinking that the pt would have to pay for hospice when it is a Medicare benefit.

Hospice pays for room and board in Medicare certified hospice inpt units.

See pages 22-23 of this brochure:

http://www.medicare.gov/publications/pubs/pdf/10116.pdf

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Specializes in LTC, Hospice, Case Management.
This pt has Medicare, and hospice is a Medicare benefit. I do not understand the thinking that the pt would have to pay for hospice when it is a Medicare benefit.

Hospice pays for room and board in Medicare certified hospice inpt units.

See pages 22-23 of this brochure:

http://www.medicare.gov/publications/pubs/pdf/10116.pdf

Yes that is true...but it does not pay for room and board when the resident remains in a skilled long term care bed.

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So, the pt would have to be in a LTC, Medicaide/county bed, or at home.

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Specializes in LTC, Hospice, Case Management.
So, the pt would have to be in a LTC, Medicaide/county bed, or at home.

Not sure...is this a question?

If they qualify for an inpatient hospice center...they could go there. In my community we have only a very limited number of inpatient hospice beds therefore they only accept those that they feel are very close to death (often a week or less). As you said, the room and board is paid for once they are in an inpatient hospice center.

If they stay in LTC & also qualify for Med A then it is more beneficial for the family financially if they remain on Med A until the benefit exhausts or they no longer qualify. If they are in LTC and on medicaid then medicaid picks up the tab for the room and board.

I have no idea how hospice is reimbursed if the patient remains at home.

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Specializes in Critical care, trauma, cardiac, neuro.

That is a citable regulatory offense. Make a call to your state agency over LTC facilities and they will review all recent patients in similar situations and determine trends and offenses. There are a few F tag cites related to this offense. You may make the call anonymously.

If us nurse do not stand up for patient rights, who will?

Kudos to you for bringing this up!

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