Communication w facilities

nutella, MSN, RN · May 9, 2017

Hello! I was wondering if anyone would be willing to share any practices or forms their agency uses to facilitate good communication with SNF or ALFs... it's consistently an issue for us. Thank you!!!

Could you elaborate on the kind of issue - and are you a hospice nurse?

Good communication can be a challenge between hospice and SNF/ALF because of the constant issue related to role boundaries and role understanding as well as territorial nurses ("protective" nurses...).

Often enough, the hospice nurse is seen as an intruder who has the "easier" job and "tries to boss the staff around."

aphillipi · May 9, 2017

Could you elaborate on the kind of issue - and are you a hospice nurse?
Good communication can be a challenge between hospice and SNF/ALF because of the constant issue related to role boundaries and role understanding as well as territorial nurses ("protective" nurses...).
Often enough, the hospice nurse is seen as an intruder who has the "easier" job and "tries to boss the staff around."

Yes exactly and yes I'm a hospice rn.

Our CAHP survey scores show there is an issue with families receiving conflicting information from hospice and facility. So we are trying to brainstorm on how to fix that...

We are offering an educational presentation that explains what hospice is and isn't and have a list of contacts which is left in the facility chart.

nutella, MSN, RN · May 13, 2017

Yes exactly and yes I'm a hospice rn.
Our CAHP survey scores show there is an issue with families receiving conflicting information from hospice and facility. So we are trying to brainstorm on how to fix that...
We are offering an educational presentation that explains what hospice is and isn't and have a list of contacts which is left in the facility chart.

I think this is a very common issue nowadays because

1. people hear what they want to hear

2. everybody is pushing their own agenda.

What I ran into frequently for a while was assisted living and some nursing facilities viewing hospice as "extra help that will give me the CNA and the broda chair I want" and not as "comprehensive care by an interprofessional team that helps to navigate the EOL process and to die in peace."

I would suggest a methodological approach:

1. know your audience : who are your clients? What do families and nursing homes/ AL expect? look at surveys, do your own or do some informal polling/meeting. By talking to nurses in facilities you learn a lot about how they view hospice and their understanding of what it is and what it isn't.

2. Where is the misalignment? when your liaison or whoever goes out to facilities meets with with families - what do they communicate is their understanding ?

If you review the reasons for consultations and how many times your hospice had to say this patient is not appropriate or had to D/C due to not declining - that gives you an idea.

Strategize.

Realistically speaking - most facilities are so understaffed and assisted living is often not the most appropriate setting when one is dying - so they look at it as "extra help". In assisted living, the facilities often try to keep the patient there although the patient needs 24 h care and the family is not able to provide this extra help. In my areas, there are companies (for profit most of them) that cater to those facilities knowing that this is what they want the most and communicate accordingly. Is that good? No - because it gives conflicting messages about what hospice is about.

Depending on your companies strategic goals and such you want to provide an education that stays true to the message of hospice and is positive at the same time.

If your company is a member of the national hospice and palliative organization you could use their marketing and info material for presentations and flyers.

What helped me the most when I worked as a liaison was to find out which facilities we were having the best relationship with and the most clients and work with the charge nurses/ unit managers. You have to give the same consistent message about what you are doing and where your line is. Plus nurses in facilities often feel that hospice "comes in and tries me what to do" and does not acknowledge their expertise. I worked with all nurses to reframe what hospice is and also explained to them the criteria for admission to hospice and what I am looking at so they understood that dementia itself is not a reason for hospice.

When meeting with families I usually would sit down, introduce myself and ask them first about their perception of how things are going. Usually you get a lot of info right away. Then I talk about why the facilities thought meeting with me would be a good idea. I go about it by looking through the patient-centered care lens. What it means is that you have to explain to people hospice care in a way that makes sense because healthcare has gotten so complicated.

I explain it like:

Nowadays healthcare providers aim to provide care in a way that aligns best with a person's goals, wishes, preferences and values. When a doctor estimates that the life expectancy may be six months or less because that person has an illness, there are different choices for care. Which care plan you choose depends a lot on your overall goals. If your goal is to focus on maximizing comfort and least aggressive care because at this time in your life your comfort is most important, hospice may be the right choice.

After that I explain what maximizing comfort means more in detail.

Sometimes I start out by explaining patient-centered care and ask "what do you think is most important to you (or your loved one)" and "how much are you willing to go through in order to get more time" and once I figure out what the goals and values are I can say that based on that information this or that care plan matches your goals best or aligns best. I give families room to ask questions because it is confusing.

I found that while the first approach works for certain people - the second one is the better one because it makes most sense to people plus you do not look at it purely from a medical perspective but use a holistic approach.

It is also something that makes a lot of sense to nurses and staff in facilities. Because what you are saying is

"we are here to provide a service that aligns with patient and families wishes if their goal is to maximize comfort" - shifting their thinking from "i just want the CNA and the chair and do not bother me" to "the right thing is to provide a care plan that aligns best because we want to do the right thing and by the way we also get other things we need for this patients"

That would be a win-win.

Families are most angry when they sign up for something and did not understand or where told something different. Disclosure and full information is very important. When the staff understands, they will start to refer patients that are appropriate and will prepare the families in a different way for the conversation.

You can also tell the facilities that you are offering different approaches based on the family needs:

- information meeting just to get out the general information - which could be a once a month presentation /brochures/ meetings

- and individual evaluation for hospice meetings in which the evaluating person comes out and meets with a patient and family to discuss hospice admission. You still go through the information of course.

Unfortunately - it is a very long road and persistence and consistent messaging will be most helpful...

tyvin, BSN, RN · May 17, 2017

Could you elaborate on the kind of issue - and are you a hospice nurse?
Good communication can be a challenge between hospice and SNF/ALF because of the constant issue related to role boundaries and role understanding as well as territorial nurses ("protective" nurses...).
Often enough, the hospice nurse is seen as an intruder who has the "easier" job and "tries to boss the staff around."

This is it in a nutshell...:)

Ahospicenurse · Jul 17, 2017

As the RN case manager, I'm good friends with the facility nurses. I make a point to bring them cookies or treats weekly and talk to them at every visit. I get report from them when I arrive to facility them tell them what I see when I leave. We have a great relationship.

elimayrn · Sep 10, 2017

This gets complicated for me also. Where i have trouble is when the facility staff are not providing the best care such as not turning my Pt through the night or wound dressings are not changed. You would think the nurses would want to know and correct the problem and most of them do but often after mentioning the issue my relationship with the facility is damaged.