Discharge from Hospice

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I have a question regarding hospice nursing which I've wanted to ask for a while, and I'm hoping for a little insight on the usual care for patients in hospice.

How often is it that a patient is d/c'd from hospice? From experience, I know that the patient has a life expectancy of 6 months to a year and will not be persuing methods of treatment for the given disease. Hospice is geared to comfort measures during the patient's time in hospice. I'm wondering if I'm understanding this correctly.

I'll give you this scenario: said pt. has been receiving hospice care for three years after physicians counsel that nothing further can be done for her eating disorder. Pt states she is in her late 30's. The physicians involved in her hospice treatment have ordered Duragesic 150mcg along with an unspecified amount of Dilaudid. All of the sudden, pt states that doctors are withdrawing all her meds and are recommending an ileostomy (and beyond that I'm not sure).

I've been following this patient's progress and it seems like she's been on and off hospice in the past and states at times that she has no longer than a few weeks to live.

This is not a question for myself, family, a friend, or a homework assignment. Somehow I started following this patient's story online and I'm truly beginning to smell a rat. If it was just someone going on with a story I wouldn't be so suspect and let her fantasize or whatever. However, in the past she has stated that she doesn't have the money to pay bills (medical, utility, etc), people have raised money for her online, sent her gifts, and hinted how she doesn't have $$$ for Christmas, etc.

I feel that she is taking advantage of people and I'm truly wondering if the above scenario is possible in hospice care. Why would they put her on all those strong meds if there is no hope of recovery? Why are they now withdrawing these medications stating there is treatment? In the very recent past I have fallen for an Internet scam (more emotional/friendship, not financial) but was suspecting that the story wasn't straight. Once again, I'm beginning to think that this is not on the up and up.

If someone could please help me with my questions, I would appreciate it very much. :)

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Specializes in ER and Hospice.

I think you are correct in thinking that you may smell a rat. In order for this person to be on hospice for 3 years, she would have had to show a continued decline. There are federal guidelines that must be followed when a patient is admitted to hospice. The only possible diagnosis probably was Failure to Thrive (given her alleged eating disorder). If that were the case, she would have to be severely disabled and barely able to care for herself, let alone solicit money on the internet. I'm not sure why this person would need such strong pain medications for this diagnosis.

I would be very wary indeed. If she were truly on hospice and in need of such assistance, a hospice social worker could help her out. Patients are discharged from hospice when they cease to show a decline and no longer meet guidelines for continued hospice care.

It's too bad if she has taken advantage of peoples' kind nature.

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You can "flunk" hospice if you get better and no longer meet their criteria. Art Buchwald famously did this; when hospice managed the symptoms for his terminal malignancy, he felt so much better he left their care. Someone who does this can re-enter without penalty if s/he meets criteria again. Art did do this and died at home with hospice care. The lady you describe has something else going on.

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Specializes in LTC,Hospice/palliative care,acute care.

Does this person post a blog or something? I'd like to read it if you can post a link -if it's not private.

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Sorry guys in getting back to you. Strep rules the house. :(

But anyway, I'm not sure if she's made it private or not.

I'm thinking that it is a scam. I wanted to see what you all thought, but I've come across some new material that may expose this scam.

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Specializes in Hospice.

Been there, done that. Shame on the hospice companies for continuing to allow this abuse of the system. It is actually fairly common in the hospice I work for to d/c pts. The primary reason is all those debility pt's that are losing weight until hospice comes and provides that little bit of support and suddenly weight loss stops. They tend to go on and off service before they really start the decline that keeps them service.

Reading just the first paragraph of this blog makes me think of several pt's that came onto hospice for legitimate reasons, and where d/c'd within the first cert period. These people are master manipulators, and it is often difficult to tell in the admit interview that they are providing misleading information.

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Specializes in Oncology; medical specialty website.
I have a question regarding hospice nursing which I've wanted to ask for a while, and I'm hoping for a little insight on the usual care for patients in hospice.

How often is it that a patient is d/c'd from hospice? From experience, I know that the patient has a life expectancy of 6 months to a year and will not be persuing methods of treatment for the given disease. Hospice is geared to comfort measures during the patient's time in hospice. I'm wondering if I'm understanding this correctly.

I'll give you this scenario: said pt. has been receiving hospice care for three years after physicians counsel that nothing further can be done for her eating disorder. Pt states she is in her late 30's. The physicians involved in her hospice treatment have ordered Duragesic 150mcg along with an unspecified amount of Dilaudid. All of the sudden, pt states that doctors are withdrawing all her meds and are recommending an ileostomy (and beyond that I'm not sure).

I've been following this patient's progress and it seems like she's been on and off hospice in the past and states at times that she has no longer than a few weeks to live.

This is not a question for myself, family, a friend, or a homework assignment. Somehow I started following this patient's story online and I'm truly beginning to smell a rat. If it was just someone going on with a story I wouldn't be so suspect and let her fantasize or whatever. However, in the past she has stated that she doesn't have the money to pay bills (medical, utility, etc), people have raised money for her online, sent her gifts, and hinted how she doesn't have $$$ for Christmas, etc.

I feel that she is taking advantage of people and I'm truly wondering if the above scenario is possible in hospice care. Why would they put her on all those strong meds if there is no hope of recovery? Why are they now withdrawing these medications stating there is treatment? In the very recent past I have fallen for an Internet scam (more emotional/friendship, not financial) but was suspecting that the story wasn't straight. Once again, I'm beginning to think that this is not on the up and up.

If someone could please help me with my questions, I would appreciate it very much. :)

I saw a Law and Order episode that followed the same storyline.

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Specializes in Med Surg, Hospice, Home Health.

i read just the intro of her blog.......i smell a rat as well.....

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Specializes in Med Surg, Hospice, Home Health.

[h=3]OMG-today there is an Adele song uploaded.....

"Monday, 12 March 2012[/h] Warning: Some parts of this journal may be triggering. Please stay away if you think this will trigger you in any way. If I can help in any way, just please let me knwo and I am there.-Nanny" OMG-today there is an Adele song uploaded.....

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Hi AtlantaRN -

I'm just wondering, what was the Adele song about? I know very little about Adele, but how was the song tied in? I know that Adele had cancer at one point I believe, was she comparing herself with Adele?

I think that she may be stalking this site somehow and in her blog on March 16, she was mad. She refers to a "nursing site" but I'm not sure it was this one. I believe she realizes in the past 8-9 years she's had that blog that she's not dying, and has to come up with a reason why (the doctors were wrong! Hallileuah!) Now she's on a sob story about coming off the meds and starting what sounds like Suboxone. It's kind of like when someone says she's pregnant, wants the attention, then realizes there's not a baby coming after a certain point, she has a traumatic miscarriage or stillbirth.

I haven't read the rest of her post from March 16, so I'm not sure if she's stalked AN. I'd really like to know, but really don't care... if that makes sense. :)

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Specializes in Med Surg, Hospice, Home Health.

i don't really know, i just know adele music is dramatic, so i would believe that is why it's on the site

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Specializes in ER/Tele, Med-Surg, Faculty, Urgent Care.

Im new to hospice nursing but she's 40 and claims a 32 year battle with eating disorders lists both bulimia and anorexia. I found it very strange that she lists her favorite foods:

  • Favorite Cuisine: White beans
  • Favorite Desserts: Brownies
  • Favorite Drinks: raspberry smoothie
  • Favorite Junk Foods: PopTarts
  • Best meal ever: Dads White Beans
  • Foods I hate: peas
    I don't know much about eating disorders but this seems weird. Munchausens syndrome maybe? One way to figure it out would be to admit her to a inhouse hospice that could monitor meals/tube feeds and have video cam in the room if possible. I too agree, I smell a rat.
  • Also there are other criteria ,such as adls, able to walk, feed self etc, and yes if she stabilizes, she can be discharged for extended prognosis.

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