Dialysis 9 yrs, but terminal illness is COPD???

heron, ASN, RN · May 1, 2009

The question is, does the copd meet criteria for hospice admission? That would mean that hospice is on the hook for just meds to treat copd and all the renal-related meds as well as the dialysis itself would be covered by the pt's other insurance. If admitted under esrd, then hospice has to eat the cost of the dialysis, since it's life-extending treatment, so I can see the md wanting to avoid that.

So, how advanced is the copd?

MississippiSweetpea · May 7, 2009

I didn't know you could have someone on dialysis in hospice. I was always told that it was not allowed since it is considered aggressive treatment.... :confused:

Trauma Columnist · May 7, 2009

Nope - you can be on hospice and still dialyze. I have two current pts considering hospice for metastic Ca but both are ESRD on hemodialysis. Medicare allows this.

gt4everpn, BSN, RN · May 7, 2009

Seems like some kind of scheme to my by your exec.. the husband wants dialysis stopped but she will still be getting dialysis??? Seems like a plot to keep the patient admitted although she has a terminal illnes (ESRD) they want to keep her for dx of COPD.. more $$$$ for the hospice or less money lost, idk, just my guess.

gt4everpn, BSN, RN · May 7, 2009

you'd be surprised the things some hospice patients recieve.. i work in hospice from time to time (float through the unit) until now i can't understand why hospice patients are:

[color=#48d1cc]1.hospice with no dnr

2.life-preserving med (bp meds, iv flds for hydration, etc..)

[color=#48d1cc]3. tube feedings usually at the request of the families in my experience.

[color=#48d1cc]does anyone know why?

nope - you can be on hospice and still dialyze. i have two current pts considering hospice for metastic ca but both are esrd on hemodialysis. medicare allows this.

AtlantaRN, RN · May 7, 2009

what really gets me on this one is one of the higher ups in the company chose copd as her terminal diagnosis, not her physician. Physician usually writes "evaluate and treat if appropriate." frankly she has more pointing to chf than copd as I don't have any pft's. I guess it's because she is on more meds for heart failure, and is only on 2 meds for neblulizer? sometimes I just don't get it.

thank you for listening.

BandEmom · May 7, 2009

gt4everpn,

I think that people who are on hospice with DNR are really just not still there emotionally. Comfort care is acceptable to them but accepting the full implications of DNR is just out of their comfort zones. Some people and families worry that it may compromise their care. Many of them end up changing their code status down the line. Of course, all of my hospice patients are living at home. I can see how it would be much more frustrating to see full code hospice patients in an inpatient setting.

gt4everpn, BSN, RN · May 7, 2009

and i completely understand and respect the decisions the families and/or patient make, but it does pose such a dilemma for staff members, i haven't been in the situation of a full code on a hospice patient with no dnr, but i did have a patient who was dying and the wife didn't sign a dnr (and not to be mean, she was a hard family member to please), i was advised by my nm to call the wife should he expire or code and ask her what to do because she knew he was dying and might have changed her mind, but thankfully my shift ended and he was still breathing.

gt4everpn,
i think that people who are on hospice with dnr are really just not still there emotionally. comfort care is acceptable to them but accepting the full implications of dnr is just out of their comfort zones. some people and families worry that it may compromise their care. many of them end up changing their code status down the line. of course, all of my hospice patients are living at home. i can see how it would be much more frustrating to see full code hospice patients in an inpatient setting.

MississippiSweetpea · May 7, 2009

Ya'll have just blown my mind.........I am still reeling from this revelation. Medicare will allow dialysis. WOW. I just had a pt revoke Monday because the doctor was referring him for dialysis.

We had him for COPD.

heron, ASN, RN · May 8, 2009

I didn't know you could have someone on dialysis in hospice. I was always told that it was not allowed since it is considered aggressive treatment....

It depends on the condition under which the patient is admitted to hospice. If admitted as an end stage renal disease patient, then dialysis is not covered by medicare. It can continue, but the family has to pay for it, or the hospice eats the cost. Thus, we tend to discourage pt signing on for renal disease unless he/she is ready to stop.

If, however, the hospice diagnosis ... ie the official terminal condition ... is end-stage cardiac disease, or copd, then dialysis is covered by the pt's other insurance ... usually regular medicare.

Does that make sense?

MississippiSweetpea · May 8, 2009

Yes, thank you. That answered a few questions. Thanks.

I worked hospice in 1998 for about a year, then went back to local hospital on night shift. I got tired of resisting God's plan for me, so I came back to hospice about 1 1/2 years ago.

Several changes in my state during that time. Or maybe, its just a difference in the companies. Before, we had cancer pts only. That's all. And they were all DNR. That was explained on admission. Now, we have full codes, speech therapy, physical therapy, etc.; CHF, COPD, Alzheimers, even had a 96 y/o with Failure to Thrive. She was a sassy little thing, and at 96, I though she had "thriving" figured out.

But as the old saying goes. "You learn something everyday".

Thanks again.