Hospice?

[RNeyeam]

Hi,

I have been a nurse for 18 years, but am perplexed by my neighbor that has end stage renal disease, is still getting dialysis, but has just been accepted by Hospice. Her only other co-morbidity is diabetes. I thought Hospice was for end-of-life, and the patient needed to have stopped all treatment? Don't get me wrong, this lady deserves the best, but I am confused. She said they told her you can still have hospice even if you are getting chemo??????

Did things change or is this Hospice being unethical?

[nrsang97, BSN, RN]

The same if a patient entered hospice and was on a tube feed. They don't stop the tube feed right away. Maybe the patient wasn't sure weather she was ready to stop dialysis or not just yet. Chemo can be done for palliative measures also.

Here is a link explaining that ESRD patients can receive dialysis and hospice care.

http://www.kidneyeol.org/hospice.htm

[lesrn2005]

Hospice can be there for "support" while the patient seeks treatment. We won't pay for meds and such.

[tencat]

I thought that the hospice had to pay for medications/treatments related to the diagnosis. We don't tend to admit patients to our hospice for kidney failure if they are still doing diaylisis. If they have other comorbidities, then we might admit under debility.

[leslie :-D]

The same if a patient entered hospice and was on a tube feed. They don't stop the tube feed right away. Maybe the patient wasn't sure weather she was ready to stop dialysis or not just yet. Chemo can be done for palliative measures also.

Here is a link explaining that ESRD patients can receive dialysis and hospice care.

http://www.kidneyeol.org/hospice.htm

wonderful, wonderful link nrsang!!!

guys, you really need to read it.

all questions are addressed in this link.

leslie

[nerdtonurse?, BSN, RN]

Great link -- I was thinking if someone's in ESRF, wouldn't dialysis be considered a pallative "keep'm comfortable" kinda thing? I mean, that would be like withholding breathing treatments just because someone's dying of COPD...

[leslie :-D]

Great link -- I was thinking if someone's in ESRF, wouldn't dialysis be considered a pallative "keep'm comfortable" kinda thing? I mean, that would be like withholding breathing treatments just because someone's dying of COPD...

i was thinking that too.

there are hospice benefits that now include palliative care, in which tx can be continued.

and, i'm not sure if facilities do this?

but there were some who used to double bill...

in that they would charge for the esrd benefit and the hospice benefit.

just saying...:omy:

leslie

[GrumpyRN63, ADN, RN]

Maybe it depends on the agency, where I work the hospice benefit will not pay for active treatment, incl, chemo, rad rx, even procrit. The dx is a terminal prognosis of 6 months or less, with the acknowledgement and agreement that active treatment efforts have ceased and the goal is comfort care. That being said, some pts who have signed on for Hospice decide down the road to try chemo again, we switch them over to certified, as well as the pt who stays on hospice. outlives the prognosis can be recert , end up staying on for a year= sometimes two.

[leslie :-D]

yep, an awful lot of recerts in hospice.

leslie

[heron, ASN, RN]

I could be wrong, but it seems like the issue of dialysis/no dialysis hinges on the official "hospice diagnosis".

If the hospice dx is ESRD, then dialysis is life-prolonging and not covered.

That means the hospice provider must absorb the cost of dialysis or forego the sign-on until the individual decides to stop dialysis. (If the hospice continues the dialysis, I would think there would be some questions as to the legality of the sign-on.)

If the hospice dx is something unrelated to kidney disease, ie breast cancer, COPD or CVA, then dialysis could continue and would be billed to the person's regular coverage by the dialysis provider.

As Leslie pointed out, it's getting trickier these days, as palliative care, which is different from comfort care, becomes more widespread. Palliative care is intrinsically more aggressive, thus more expensive, than comfort care.

I'm still unclear how hospice companies plan to turn a profit on palliative care using a benefit designed to provide strictly low-cost terminal comfort care in the home - or at least outside of the hospital. Is it legal for hospice organizations to bill regular coverage as well as hospice coverage? This is not my area of expertise, since I do not do hospice evals or sign-ons ... so I could be all wrong.

As for dialysis being a comfort measure, I'm not so sure. It isn't an easy way to live. Of course, most of the ESRD people I've met have decided to stop, so my sample is skewed.

[traumaRUs, MSN, APRN]

I'm a nephrology APN and I frequently order hospice for my dialysis patients - sometimes they continue dialysis, sometimes not. Depends if there is another diagnosis for the hospice. For instance, I have a pt with multiple myeloma who does not want further chemo but does want to cont dialysis - no problem, she can still be hospice.

Plus, even my dialysis pts can be admitted to hospice if they have another diagnosis and almost all dialysis patients do.