Continuous/Crisis Care; CNA, Home Makers (??)

[lifelearningrn, BSN, RN]

I was hoping you all would share the services your company provides and how those services are provided. I have been a bit surprised by how different different companies seem to provide hospice services. It seems that some of the bigger named companies in the area provide services such as CC for active patients, even when symptoms are well managed. I was informed that often these companies provide the service to LTC facilities as an incentive for the facility to use their services. Since you have to justify the patient has uncontrolled symptoms with medicare, are these companies just not billing for CC and eating the costs?? We try to be there as much as possible for our patients and families when a pt is active, but we can't provide 24 hour CC unless we can justify it with medicare.

I'm curious if your company offers aide services for 6-8 hours day 3-5 days a week and/or free sitter/home maker services? This is another "incentive" it seems some of the bigger named companies are offering.

Finally, what are your company's home maker/sitter services?

Thanks for sharing you guys! I work for an awesome small hospice company that really does things by the book. Our patients get great care, but there is no way we could afford to offer 30- 40 hours a week of CNA services (per patient) and 24 CC when the patient's symptoms are controlled.

[ShesanRN]

My hospice is the same as yours, in that we only do continuous care if/as long as a patient has an unmanaged symptom. We also do not provide that level of CNA care. I'm not certain how the other companies are able to offer what they do legally or while remaining solvent!

[toomuchbaloney]

how do those hospice providers do it?

they eliminate ethics and bend legalities and operate on the edge...

[softrbreeze]

I've wondered the same thing, newhospicern. The largest hospice company in my area has been rumored to provide a FT CNA for one of the LTF in the area. I've even heard they provide a FT volunteer to visit the patients there as well. I work with a hospice in a nearby city and one of the NHs there was putting pressure on my company trying to get similar coverage. We tried to comply, at first, but eventually had to say "no" as there was no way we could figure how to do that without making fraudulent claims. We are a small company too and CC is a real hardship for us. It's usually the FT employees that end up volunteering for those CC shifts because the PRN nurses seem to never want the work...

[lifelearningrn, BSN, RN]

Wow- full time volunteer? I couldn't imagine having those kinds of volunteers. We're lucky to offer a hand full of patient's a volunteer and are always trying to find qualified people will to volunteer their time. How on earth are these big companies doing it?

[okielpn75, ASN, RN]

Our Hospice will only do continuous care at the end of life for unmanaged symptoms. There is a huge Hospice here that does it all the time but does not bill Medicare for it. It is an incentive given to the LTC facilities to go with them as their Hospice of choice,

[PomMom65]

We rarely do continuous care because we have a general inpatient unit. If symptoms cannot be managed in the home they come onto the unit for symptom management. Continuous care would be done in the event that our unit is full AND the patient has uncontrolled symptoms. We do not have CNA service like you described. We do (in some places) have a nurse or CNA assigned to one LTC facility but that would require numerous patient's residing at the facility. We do use volunteers to visit patients and as sitters but this is certainly not full time. Any type of home maker / non medical care providers are provided at the patient / family expense.