Has anyone read this?

indigo girl · Aug 5, 2006

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

It sounds like the job is a great fit for you. When I was on staff as a unit manager in LTC, I worked with one particular hospice nurse, and her staff.

It was a wonderful experience. (You remind me of her, and that's a compliment.) It was a great relationship. I felt that patients and their families were getting what they needed, and both of our staffs supported each other.

CHPN1680 · Aug 20, 2006

The mega corporate hospices - Vitas, Odyssey, Vistacare, all do about 80% of their business in nursing homes where the length of stay is much longer. They mostly invest their marketing dollars in the nursing facilities. They hire nursing home medical directors to be their medical directors which gets them more patients at an earlier time. All of the mega hospices tell you that they do charity care and they do, but this is very limited because patients in nursing facilities are 100% funded.

I just wanted to take the opportunity to go on record since I work for one of these "mega hospices". The 80% statement is not even close to correct. I would say that if you averaged the nursing home among all of our programs, you might get a figure of 20-30%. The majority of our patients are at home. I would be interested to know where the 80% figure came from.

It seems that there is a prevailing opinion that for profit hospices are "bad" and not for profit hospice are "good". My experience with a for profit has been very positive. I have never found the company to be unethical or unwilling to take the tough patients. If your prognosis is less than 6 months, then you are eligible for service whatever treaments you may be receiving. That means the expensive patients on vents,TPN,radiation, etc...

Now, neither a for profit or not for profit hospice could survive if all patients on service were this complex. That's why you have a balanced approach to marketing that assures that you have enough profitable patients, so that you can provide care to those that are not profitable.

Our "mega hospice" has a heart and does the right thing by it's patients and families. I can't speak for all of the large companies but please know that there are some large companies who provide equal or better care than some non profits. It is all in how the programs are managed.

aimeee, BSN, RN · Aug 21, 2006

Its good to hear that Bob!