So i have a scheduled admission today. I was a few minutes early. Met family member, who lives out of state-he is poa and he is well organized. He provides a copy of his power of attorney, a list of medications, a list of daily duties he expects the nurse, hospice aide, and volunteer to provide DAILY, and a 6 page set of instructions of physical therapy exercises he expects nurse to complete every day with patient..............................family member reiterates and requests writer to agree to implementing each page duties to be incorporated into patients care plan.
I educate that we expect our patients to decline, that hospice is for patients that have a 6 month or less life expectancy, should the disease process take a normal course. He stated "i expect her to make a full recovery." Writer educates that if a patient is improving, that legally we have to run the course to discharge the patient. He states "i've heard of patients being on hospice for years..." Yes, back in the day, you could have a patient take a decline, then improve, decline and improve-but with changing healthcare regulations-the company may be fined 3 times what we received in payment should we keep a patient on service that is not declining, or is not going to pass in 6 months.
wait for it.....it gets better.......
Patient with stage IV lung cancer, family member states she currently walks with a walker, but "i expect her to make a full recovery...." Writer attempts to educate what hospice is.....comfort measures until nature takes its course. ((i'm a weekend on call nurse-my job is to put out fires, control patient symptoms, and generally help to keep the patient out of the emergency room)).....Family member tell me that he expects "daily nursing visits," writer educates-when a patient is receiving daily nursing visits-they are experiencing uncontrollable symptoms or a rapid decline (pt pps is still 50%), Family member then states that he expects a home health aide or volunteer for 6-7 hours a day as this is what he was "promised" by marketing..."
This is where we hit an impasse.....
I called my clinical manager (who just happened to have spent an hour with this family member yesterday, attempting to educate about what hospice IS and what it ISN't..........clinical manager said yesterday, on his list was "daily watering of plants"..........My clinical manager spoke with him on the phone and reiterated that hospice does not provide a sitter for 6-7 hours a day.......Family member reiterated"my mother is expected to be alone every day!" ((family member has a sister that resides with patient and we don't replace the family.....family members response is "yes, but she leaves to go shopping and such....)).
SO, family member was pleasant about it but said to me "i don't have time for your apologies....I have to call home health so they can visit today." He walked me to the door......
Sometimes i just feel like I am spinning my wheels.....This family member is needing senior sitters or similar. No healthcare plan is going to cover sitters.........we do range of motion, but we don't do 6 pages of physical therapy exercises with a patient. At the greatest, a nursing visit may take 45minutes to an hour.
Thank you for listening. I was so frustrated, I took another blood pressure pill. My face is still red and I can feel the heat coming off of it...I know that marketing has to "sell" a service, but I can't provide what this man is wanting for his mother--hospice works in partnership with the family-not as a replacement for the family...
Specializes in PICU, NICU, L&D, Public Health, Hospice.
My manager would call them and speak about the language and interpersonal expectations of the hospice. Heck, I would be speaking with them about that...life is too short to tolerate abuse.
Can you please be my mom's family member, maid, pharmacist, doctor, gardener, beautician, podiatrist, and best friend? Also, I need this all for free. And can you cure her too?
Ah, yes, a day in the life of a hospice nurse. When a client elects hospice, they need to be informed that triage must be performed (needy family in immediate bereavement trumps 'I need my jammies on'). Yes, I have found that admission staff (intake) make many promises that are impossible for the field staff to fulfill. Perhaps kicking it back to the admission staff ("you call them and inform them that I will be there in ______hours") may help them to realize that we nurses cannot yet clone ourselves at will. Sadly, sometimes clients are happy and sometimes they are angry, no matter what we do. You attended to the client with the more pressing need; if the jammie family finds another hospice provider, God help them!
Specializes in ER, Cardiac, Hospice, Hyperbaric, Float.
*SIGH!!!* Although I UNDERSTAND why hospices have "marketers", it still leaves a bad taste in my mouth that Hospice is "marketed". It is a disservice, not just to the nurses (and CNA's, and SW's, and Chaplains) to "recruit" people that are INAPPROPRIATE for Hospice, but it does the patient and the family a disservice as well!!!! Hospice is not just a SERVICE, there is a PHILOSOPHY involved, and it is ESSENTIAL that patients and families SHARE that philosophy in order to get the services they need and want!!! If a person has stage 4 metastatic cancer and has been told they are terminal, etc., if they STILL want to "do everything they can" and go to the ER and try experimental stuff, and be hooked up to everything, etc., THEY ARE NOT READY FOR HOSPICE!!!!!!! There are people on this planet who will DIE before they are ever ready for Hospice - they will die long, slow, painful deaths, and they (and their families) will CHOOSE this! These folks need home health, long term care, or another service THEY DO NOT "NEED" HOSPICE!!!! I get so SICK AND TIRED of hearing from Marketing and from the ED that we "just need to educate the patient/family" when we get these kind of admissions. B*##!T! Yes, I think that education needs to be done, but at some point, out of RESPECT for the patients and families (as well as respect for the folks who work in Hospice), there are folks who, no matter HOW MUCH education is provided, WILL NEVER BE READY FOR HOSPICE! NEVER!!!! And these folks need to be referred to another agency/service to help them. Sorry, I know that makes the "census go down", but it's the RIGHT THING TO DO. I love Hospice, and I think it is a WONDERFUL thing (if I didn't, I wouldn't do it), and it makes me sad sometimes to see the choices that some folks make for themselves and for their family members - but I just have to DEAL WITH IT because that is THEIR CHOICE!!! And, as wonderful as Hospice is, IT IS NOT RIGHT FOR EVERYONE WHO "QUALIFIES" FOR IT PHYSICALLY!
Somehow, there needs to be a way to educate and market to the public in such a way that the folks for whom Hospice can be of benefit, they get it - but without essentially forcing people to take/accept a service they don't really want.
we didn't accept this patient, thank you JESUS!!! my manager is great, and my clinical manager, although not wanting to be bothered on a weekend, was good enough to speak to the son who was poa (power of attorney.....not the acronym for what we are ALL THINKING .
I don't like when marketers sell hospice by calling it "home health plus......" plus what?? we are not home health-but marketers tell patients we are "better" than home health because if you have already had 2 visits with home health and you have a problem, your nurse can't come back out....but with hospice, a nurse CAN come out.....
Marketers can sell what they want, but as nurses we HAVE to tell patients and families the truth....
Specializes in PICU, NICU, L&D, Public Health, Hospice.
Sounds like your marketers are selling hospice to home care patients. Give the marketing staff some other selling points. They should appreciate insight you can give them about what patients like about hospice...what works.
Does the client in this scenario lack the mental capacity or physical ability to make and communicate her/his own decisions and choices? Because, if not, the POA isn't in effect and this family member really has nothing to say about anything.
Does the client in this scenario lack the mental capacity or physical ability to make and communicate her/his own decisions and choices? Because, if not, the POA isn't in effect and this family member really has nothing to say about anything.
My experience has been that either the patient is in a condition where they lack the capacity to say yea or nay (advanced dementia, difficult to care for and family wants full-time bedside care for free) or they are competent but go along with their family in wanting all of these extra services because they are "free".
Marketers are the main reason why I got out of hospice nursing. it sickened me to hear comments from the marketer of the last company I worked for such as, "Don't worry about getting their doctor to agree to hospice, I have ways of getting around that (wink, wink)", and, "This will be easy! The patient and her daughter are from Viet Nam and they barely speak English and don't even know what hospice is. I should be able to sign her up, no problem." Yes, these are actual comments from a hospice marketer trying to make a buck for the company by tricking patients and bribing their doctors. It makes me sick when something like end of life care comes down to $$$$$.
What's even better is when you do a Meet & Greet and discover that while the patient is appropriate (but not close to bring imminent), the family member isn't ready yet, but willing to keep in touch and will sign when they ARE ready (hopefully before the patient is actively dying), and the NP screams at you that "I ordered Hospice! Why wasn't Hospice started like I ordered?"
No. You don't "order Hospice" like you would order Home Care. You put in an order that is a request for an evaluation. If they are found to be appropriate, based on the guidelines we follow AND the approval of our Medical Director AND the patient and/or family are emotionally ready, then we admit.
I get tired of people who are referred because there is no longer a skilled need for Home Care, and are strictly custodial, but the family doesn't want to pay for private homemakers or 24 hour caregivers (and it's always the ones who have the money but their kids don't want to use up all the inheritance they're expecting) and like all the "free stuff" about Hospice that some marketer/liaison has promised them. Total. Waste. Of. Time.
I think marketing (and others) do make unrealistic promises, but I also think that the people exploit the promises as well. I've had some funny ones but nothing so serious as the man with 6 pages of PT instruction. He is also grieving and doing what he thinks is best. The stages of grieving have kicked in and denial is at it's best in the first stages. Educate, understand; perhaps the social worker would have a better time with teaching him the ins and outs of it all.
As for you, just let it roll off your back. Life is too short. Don't look at him as a difficult family member; look at him as someone who is going on a life changing journey and isn't prepared. His coping skills are an attempt to save his family member and go deeper into that world of denial IMO.
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tewdles, RN
3,156 Posts
My manager would call them and speak about the language and interpersonal expectations of the hospice. Heck, I would be speaking with them about that...life is too short to tolerate abuse.