Can a patient be a full code and a Hospice patient in NY?

TazziRN, RN · Aug 19, 2007

Hospice is end of life care. In order to be a hospice pt, the pt is determined to have a certain length of time to live, length of time may be different in each state. In CA I believe it's 6 months.

Since Hospice is end of life care, I don't understand how a pt can be a full code and Hospice at the same time. DNR does not mean Do Not Treat, remember, it means treat to the point of arrest. I don't understand why the wife rescinded the DNR status, but yes, that would get him removed from Hospice.

JohnBearPA · Aug 19, 2007

Hospice is end of life care. In order to be a hospice pt, the pt is determined to have a certain length of time to live, length of time may be different in each state. In CA I believe it's 6 months.
Since Hospice is end of life care, I don't understand how a pt can be a full code and Hospice at the same time. DNR does not mean Do Not Treat, remember, it means treat to the point of arrest. I don't understand why the wife rescinded the DNR status, but yes, that would get him removed from Hospice.

I've both worked with hospice pt's, and also had a family member on hospice. It's true that it's end of life care, with a prognosis of 6 months or less, but you CAN be a full code. At least that's so with every hospice I've dealt with, in PA and FL. I realize that it sounds a bit conflicting, but in my experience, you can be a hospice pt and still be a full code.

TazziRN, RN · Aug 19, 2007

I've both worked with hospice pt's, and also had a family member on hospice. It's true that it's end of life care, with a prognosis of 6 months or less, but you CAN be a full code. At least that's so with every hospice I've dealt with, in PA and FL. I realize that it sounds a bit conflicting, but in my experience, you can be a hospice pt and still be a full code.

Wow....okay, I need to do some research. All my Hospice pts have always been DNRs so I assumed it was part of the criteria. Thanks!

NeosynephRN · Aug 19, 2007

I am not sure of all the legalities...and hospice, but I did respond to code the other night in the hospital that was a hospice patient. He had not even really coded...but that is a whole other story.

lsyorke, RN · Aug 19, 2007

The hospice philosophy is death with dignity. I don't remember ever having a hospice patient who was a full code. Yes, you can still treat. I guess the confusion would come in if the patient coded from another diagnosis other than the hospice related one. Once coded I'm almost positive that Hospice would no longer be involved in the care.

I don't know why someone with a documented terminal illness would want to be coded....

UM Review RN, ASN, RN · Aug 19, 2007

It's a long story, but basically the family member assumed that if the patient was Hospice and a DNR, he would not get treated at all and would be "allowed" to die.

Trouble is, he came out of the seizures a/o X 3 and didn't really feel he was ready to "go" yet, so he decided he wanted to be treated for, let's say, urosepsis.

His terminal Dx is MS, however.

So they rescinded the DNR and suddenly that makes him not a Hospice candidate any more?

Like I said, I've taken care of full code Hospice patients whose terminal Dx was Lung Ca and who came in to be treated for pneumonia and that did not disrupt their Hospice status, so that's why I was baffled.

Any information about that is welcome.

EmmaG, RN · Aug 19, 2007

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

I suspect, as in most other cases, it involved the 'bottom line' as dictated by the patient's insurance.

leslie :-D · Aug 19, 2007

this link is from the Hospice & Palliative Care Assoc of New York State.

#4 of common misperceptions:

The patient must have a DNR to elect the hospice benefit.

"In the past, many hospices required a hospice patient to have a signed DNR to enroll in hospice care. This requirement has been discontinued.".

http://www.hpcanys.org/about_hp_misperceptions.asp

i'm not sure what's going on with your pt., angie.

the lic sw should be able to help.

the pt's pcp should resubmit dx/prognosis and he will be recertified.

we treat for urosepsis frequently, as well as other unrelated crises.

esp where many hospice agencies are adding on palliative care services, which gives a lot more leeway in provision of and length of services.

leslie

leslie :-D · Aug 19, 2007

i just realized why hospice was revoked.

(talk about being an airhead!)

his seizures were r/t his primary dx of ms.

changing to a full code would then deem him ineligible for hospice services.

had the seizures been r/t any process unrelated to the primary, admitting dx, then he'd still be eligible for coverage.

leslie

caroladybelle, BSN, RN · Aug 19, 2007

Since Hospice is end of life care, I don't understand how a pt can be a full code and Hospice at the same time. DNR does not mean Do Not Treat, remember, it means treat to the point of arrest. I don't understand why the wife rescinded the DNR status, but yes, that would get him removed from Hospice.

In Georgia, you can be in hospice and a full code. In fact, from what I have been told, it would be a breach of law (bias in health care issue) to not permit a fullcode to be in hospice care, despite it being presumed that hospice care is end of life care.

It seemed odd to me so I asked - such is the answer that I got.

tencat · Aug 20, 2007

Patients can be full code and hospice (Yes, I think it's weird, too....). We have a BUNCH on our service who are. I've understood that if they get admitted to the hospital for anything related to their hospice diagnosis (CHF, for example) then they have to revoke hospice benefits until they are out of the hospital again. Our hospice will sign them back up as soon as they are officially discharged from the hospital. Now if they go in with, say a UTI, then they may not have to revoke as it probably wouldn't be directly related to the diagnosis (unless diagnosis was something like bladder cancer?).