Has anyone read this?

[aimeee]

Journeying East : Conversations of Aging and Dying

by Victoria Dimidjian

I saw a reference to it on the growthhouse site and it looks really interesting.

[doodlemom]

I know that there is a way to bill a secondary insurance for a small co-pay but the hospices that I've worked for have never thought it was worth the effort. Medicare is a aware that a patient has another insurance and I would imagine that they would catch it if someone tried to bill both. If somehow a hospice were able to receive payment from both then they would get into a lot of trouble later on down the road. That is definitely illegal.

[EmptytheBoat]

LTC and Hospice? When I first got onto this Hospice forum it was with the

intent of posting about your experiences with LTC and Hospice, but I decided

to reply to a few other threads first to get my feet wet. So, I'm glad you

have gotten here.

My experiences with LTC facilities have not been very rewarding. LTC staff is overburdened and unable/unwilling to provide the care needed to provide actively dying patients an adequate transition. I live in Louisiana and since

Hurricane Katrina it is hard to get LTC staff, so maybe my experiences are

an exception. I'd be interested to know your experiences!

The market is inundated with Hospices trying to tap into LTC facilites, these

patients, no doubt, provide a solid base of operation.

Is Hospice in LTC facilities needed? I've mixed emotions! On one hand, I say

yes, because LTC staff usually do not have Hospice training and I believe

that everyone is entitiled to a comfortable, peaceful death if possible; but,

then on the other hand, I see too many LTC patients admitted that are

chronically ill and not Hospice appropriate. It is a slippery slope, and in my

opinion, one that needs to be leveled out. Your opinions please?

Thanks for reading/listening!

[doodlemom]

I definitely believe that patients and staff at LTC facilities benefit from hospice services IF it's done well. The key for the staff at the facilities is to be able to help them in any way that they may need - making their job easier. The patients in the facilities need you the most! They have no family around them except for the occasional visit. Having more visitors looking in on them is helpful to the families, as well. Our expertise helps the staff in the facility to better learn about end of life care and symptom management. The patients die more comfortably because we are there.

[leslie :-D]

i'm not totally convinced that all ltc facilities need hospice services.

those that are poorly run w/burnt-out staff and little pt interaction, would definitely benefit from hospice.

yet, there are facilities where the staff and residents coexist in a warm, therapeutic environment.

the nsg staff that looks after the residents tend to feel a bit territorial when hospice comes in.

furthermore, many of the older folk have s/s that are benign and well-contained.

for these folks, i think a hospice consult would suffice.

i'm fully aware that our elderly are a highly underserved population.

but as another posted stated, it is a slippery slope.

we need to be careful not to provide hospice care, just because 'we can' vs. providing it to those you need it.

leslie

[doodlemom]

I could not disagree with you more. I used to question Hospice's role in the nursing home and a very wise hospice nurse once said to me "There is no patient that needs you more than the patient in a nursing home." I have to agree with her after having done a great deal of work in nursing facilities. Even in the best nursing homes, patients are never nurtured to the extent that they are in a home environment. Much of the care that we give may not be symptom management but emotional and spiritual support, as well as disease process teaching to the family. I have had many family members cry on my shoulder because they feel so guilty about having to place Mom in a nursing home. Patient's do not need to have symptom management needs to benefit from hospice. I have gone into some of the warm and fuzzy facilities and have warmed their hearts to us. If we are all about customer service, then they can't help but accept us. Yes, there are some facilities that won't accept us, no matter if you put the best nurse with the best personality in there.

[indigo girl]

Quote from req read -- PPS: I read using a very large monitor screen… and by copy & pasting text into Word I can have it (Word) read to me. The voice is computer generated so takes some getting used to, but it works very well. Also, for those of you who don’t see too well, the Mozilla Firefox browser is much, much better at enlarging fonts than Microsoft Internet Explorer (free download.)

Thank you for explaining. I knew you must be using some sort of assistive device. I have never read your work, but this thread has sparked my curiosity. I have always been very interested in the dying process. I used to be a home health nurse, and now work LTC. Many of the facilities I work in, utilize hospice agencies. Some of them are wonderful, others, a waste of time. I wonder if you are familiar with the work of Angela Browne-Miller, in particular her book, "How to Die and Survive"? This expands on her earlier work, "Embracing Death". These are books about "enhancing consciousness during processes of profound transition including physical death". They are most unusual.

[leslie :-D]

Even in the best nursing homes, patients are never nurtured to the extent that they are in a home environment. Much of the care that we give may not be symptom management but emotional and spiritual support, as well as disease process teaching to the family. I have had many family members cry on my shoulder because they feel so guilty about having to place Mom in a nursing home.

i certainly don't profess to have the exposure to ltc facilities as your do, doodlemom.

the ones i have visited, these facilities were indeed a home environment. they received alot of emotional/spiritual support from nsg staff.

granted, these were residents who didn't have family; maybe an occasional sibling.

the residents who did have devoted family members, would often cry on the shoulders of the ltc nurses, expressing inconsolable guilt about ltc placement.

i am certainly not rubberstamping that all of the better run facilities, do not need hospice services.

i'm just very pleased to report that there are some top-notch snf facilities, where all of a residents' needs are met, and who are content to call home.

and among these residents, there will be some who don't necessitate hospice services.

leslie

[req_read]

indigo girl

I never heard of Angela Browne-Miller... but then I can't read. I will check to see if her stuff is on tape. From what you say it sounds a lot like mine, so now I am curious. Thanks.

One of my theories is that we are all connected... that there is a collective consciousness. So when "new" ideas pop up they usually do so pretty much simultaneously, all over the place... as opposed to in a linear fashion; i.e. one person has an idea and it gets passed to another and then another etc. A quantum physicist may get an idea and a couple of nurses in Seattle get the same idea and an author in Timbuktu gets the same idea... and who knows, maybe some old coot in the desert gets the same idea... all more-or-less at the same time. And none of them ever heard of each other (until after the fact.) Go figure! How do you explain that?

[indigo girl]

indigo girl

I never heard of Angela Browne-Miller... but then I can't read. I will check to see if her stuff is on tape. From what you say it sounds a lot like mine, so now I am curious. Thanks.

One of my theories is that we are all connected... that there is a collective consciousness. So when "new" ideas pop up they usually do so pretty much simultaneously, all over the place... as opposed to in a linear fashion; i.e. one person has an idea and it gets passed to another and then another etc. A quantum physicist may get an idea and a couple of nurses in Seattle get the same idea and an author in Timbuktu gets the same idea... and who knows, maybe some old coot in the desert gets the same idea... all more-or-less at the same time. And none of them ever heard of each other (until after the fact.) Go figure! How do you explain that?

Well, you are in good company with Jung (the collective unconscious) and Rupert Sheldrake (the hundredth monkey effect and morphic resonance). Many in the bioenergetics community believe in field theory. And of course, many do not.

My simple belief is that everything is energy including us. In this life, our bodies are are a denser, more slower moving (?) form of energy. When the essence of what we are, leaves the body behind, we are dealing with a higher, more sublime energy. But, we still exist, just not here.

I look forward to reading your work.

[river1951]

Finall I can thank all who have replied to my question about rural hospice. It is the nuts and bolts I need since the place I am moving is trying to start their hospice and I am concerned re: the problems they will have because the advantage is definitely to the urban guys. Knowing the intricacies will help. I am moving to the country as a gun refugee from California, so the firearms issue is no problem for me. I just want to be the best help I can be to those good folks.

[req_read]

river1951…

I wish you all the luck in the world. I do wonder how the price of gas will affect rural hospices. It would seem prudent to make the most of each visit; i.e. teaching, delivery of equipment & meds etc. all in one shot. Take the SW with you and do both initial assessments… heck take the Chaplain too and make it a day. Fewer, but longer visits would probably be good.

Another thing that strikes me as being potentially very helpful in the rural setting is technology… good ol’ email… a great way to communicate, especially if you have a wireless laptop connecting you to your clients and office data. Small websites are easy to set up… if you have host space and some web building software. When people need information right away I just whip up a temporary website for them… it takes about ten minutes. Just a thought.

Yea… one of my favorite pastimes used to be long range target shooting with black powder cartridge rifles (like in Quigley Down Under.) But when my vision went, that went with it.

indigogirl…

I never studied Jung, but have heard of some of his theories. I remember the 100th monkey thing… that was a few years back… never read the book but understood the concept (I think.) You sound quite well educated.

I wonder… I think in terms of everything being either consciousness itself, or a manifestation of consciousness. As I ponder, I suppose energy could be another manifestation of consciousness. Hm-m-m.

The great difficulty with consciousness of course, is that we simply do not know what it is. We have it, we are in it, but are virtually clueless as to what it is. Energy, on the other hand, can be measured… quantified & qualified… at least at its lower frequency levels here on the physical plane. Hm-m-m.

Much to ponder… much to ponder.

[RNDYN2CU]

Interesting stuff... I am new to hospice, my primary physician roped me in, she is the Medial Director of a hospice that needed Rn's. I was re-entering the field(topic for another interesting thread...) and I am so glad, I believe it was a God shot, because i wanted a job in Case Mngmt, there is no school or refresher for such a vocation, and I had just finally given my request to God, asking that he matches me and my gifts and what i can offer the field with someone who could benefit from having me. and I found Hospice and i LOVe it!! I used to drag myself to work at the Hospital, found it rewarding but just hard to get psyched up for every day. Today, I don't even notice the time and it is not a burden to get going each morning, and there is a new adventure each day!!! I IMMEDIATELY questioned my role in the SNF, kinda looking around like "does any one else wonder what i am wondering?" But as I am becoming a Hospce Nurse, and getting past all the practical aspects, schedule, papers, idt... time sheets... now I can dig in and feel I am really making a difference in these peoples lives, the lady down the hall who, while loved by her SNF staff, is quite forgotten by the world and I get to know her and she recognizes me in her demented way and the staff see the connection, and when they need something for one of our Hospice patients, they know they can ask me or my LVN and we get on it!!! and we meet with their greiving spouses and frustrated children and advocate for the hospice patient and support the family and on on on on on... Phew... so for the most part we are effective and i feel confident as a steward of the taxpayers money that I am providing a life helping service...HOWEVER... I am also the one who creates and qualifies the re-certs that the medical director signs and for this I am responsible also... I am currently reviewing several of my Dementia cases that have been on (I feel) tooooo long and need to decide to recommend that a few revoke and sign on when they truly decline. The disease processes are not the same for everybody... my main concern is the overuse and potential mis-use of the DEMENTIA diagnoses.

Nurse Leslie