GIP Criteria

coffeetalker · Dec 5, 2016

GIP level of care means that there is something that needs to be managed- ie- pain/agitation/anxiety/ nausea/ bleeding issues/ need for new route of medication/ LOC changes/ seizures/ ongoing constipation/ diarrhea/ extensive education needs of family/ psycho-social or spiritual crisis/ frequent med changes. Of course, having said all that, sometimes pts/ pt family will report new issues to hospice homecare staff and then miraculously they show up and look nothing like what you were expecting. With GIP status you are allowed 48 hours for monitoring of whatever brought pt in- but if you're not seeing it, then SW needs to get involved for potential level of care change to residential (transitional) or do whatever discharge planning issues need to be done.

SWBQACRN · Dec 5, 2016

Thanks for the reply coffeetalker. I'm not aware of any 48 hour observation period, could you tell me where that might be found? The problem seems to be with the hospice home staff making patients eligible that arent, not so much the families/patients. Its pretty self explanatory I think, but not everyone sees it that way.

coffeetalker · Dec 6, 2016

the 48 hours for observation---- to be honest, I don't know exactly where that is in guidelines, but at my inpt hospice we are told by our MDs that we do have 48 hours to observe (which makes sense esp as some hospitals have "clinical observation and decision units". As far as homecare staff 'making pts eligible that aren't"- keep in mind that all homecare staff knows if what family/pt is saying as they are not there observing 24 hours a day. Once a pt is in the inpt setting though and if what ever problem pt came into the inpt setting for management of is not presenting, then it becomes responsibility of MD and SW (with input from the rest of the team) to come up with a care plan or discuss discharge plans with family.

Arwin · Dec 7, 2016

http://www.nhpco.org/sites/default/files/public/regulatory/GIP_Tip_GIP_Sheet.pdf

The key issue, could the care be just as easily provided in another setting, such as a nursing home? If so, you're on thin ice.

Other factors, how long were they out of control and how long have symptoms been managed? What interventions, and at what frequency, were necessary to get the patient to a comfortable state. Just because they are now comfortable doesn't mean they have to come off GIP if its taken incredibly hard work to keep them at that comfortable state.

There is no specified number of days but since its expected to be short term, each additional day increases the risk of scrutiny. Each and every day, even the first, should have documentation to justify this level of care and answer the why here question.

nutella, MSN, RN · Dec 17, 2016

I have written a couple of times about GIP - please search - you may find some of my posts....

TammyG · Dec 29, 2016

There is no 48-hour period stated in the regs, I think that is a policy of your hospice.

I have found the GIP criteria to be a bit variable based on the hospice. For those hospices that have their own inpatient facility and want to fill it, the criteria are sometimes a little easier to come by.

We have contracted for GIP services with several nursing homes, so those residents that qualify for GIP services can remain in their own beds. Only home patients are moved to an in-patient facility.