Duplication of services

[ostomyrn2b09]

I work for home based primary care and I make home visits on a monthly basis. Our program now may include following our patients to the end of life even if they are on hospice. There has been recent discussion about our program's RN case manager to make home visits and treat non hospice diagnosis. Hospice nurse will also make home visits and provide hospice care of the related hospice diagnosis. Personally I think it is a duplication of services and I feel my license is at risk. I feel confused, helpless, frustrated, and scared. I also don't feel confident visiting hospice patients since I do not have any hospice care experience. Help, where do I go from here?

[jadelpn, LPN, EMT-B]

You could work as a team. If the patient needs med boxes filled, any changes reported to the hospice RN, that type of thing, then your visit would do that. I would also think monitoring pain control, educating the family....

There are lots of "non-hospice" things that you could do. But what will be the main thing I would think is to see patients, assess them, and notify the hospice RN should there be a change in condition or the need for extra support for pain, education and the like.

And I would also think that you would do a supervisory on the CNA's that are there. Just to be sure that the patient is made comfortable, and the patient and family's needs are being met.

Maybe to suggest an inservice on how to make it work--and on basic hospice concepts. And the need for case management meetings so that you all continue on the same page.

[Libby1987]

Who is being billed for your services?

[lifelearningrn, BSN, RN]

It's not a duplication of services if you're addressing all non-hospice related issues and the hospice nurse is addressing hospice dx related issues. For example- if a patient is on hospice for cancer, but also has end stage renal and requires dialysis and care related to the renal disease, the home care nurse would address all those issues where is the hospice nurse would manage the patient's pain, nausea, and all other comfort and cancer related issues.

[BerryhappyRN, MSN, RN]

Nope. No biggie. Hospice nurse handles everything having to do with the terminal diagnosis, you will handle the rest. Believe me (coming from a hospice RN), your hospice nurse will be thrilled to have you, and you to have her. I ABHOR getting dermatological phone calls, URI phone calls, ear wax phone calls etc. Give me your dying, nauseated, pain filled issues and I will give you my ear wax, nail fungus and toothache issues! We will work together and everyone will feel well cared for.