Hate to discharge a patient that is hospitalized

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Specializes in Med Surg, Hospice, Home Health.

I know patients are supposed to call hospice first......i have a patient that family continually calling 911. I am charged with the task to have them sign a discharge form today.

She is end stage copd and refuses to use morphine sulfate for dyspnea. She goes to at least 1 doctor appointment a week, casemanager is having a difficult time keeping up with medications because with doctor appointments come medicine changes.

We have had this patient in the past, and discharged her because of no decline......this time she has been on service just 2 short months, and in that time she has gone to the er 3 times for "anxiety"......what is so frustrating is the meds are in the house to take care of the anxiety....she is in her 18th recert period and meets criteria for hospice, her pps is 30%

What will happen if patient doesn't sign discharge form? Will she have a 30 day period where her discharge will be planned? I asked my branch director and she hasn't called me back yet.....

This just makes me feel bad, especially since she was admitted.......I feel like a heel....:confused:

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Specializes in Hospice.

You actually can not make them sign the discharge form. If they will not choose to revoke (which I have found most patient's will choose to revoke when faced with paying out of pocket for huge er bills), then you need to give them a 48 hours notice of non-coverage form. This form essentially tells them that you are discharging them in 48 hours, like it or not. Hope this helps!

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Specializes in psych, addictions, hospice, education.

The reason for discharging is that insurance won't pay both Hospice and the other caregivers. Discharging the patient if he or she seeks care for the condition Hospice is helping provide comfort for, is a favor to the patient who wants such care. The patient can come back to Hospice later. I think the forms are rather impersonal and hope whoever gives them explains the basic reason behind such things.

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The reason for discharging is that insurance won't pay both Hospice and the other caregivers. Discharging the patient if he or she seeks care for the condition Hospice is helping provide comfort for, is a favor to the patient who wants such care. The patient can come back to Hospice later. I think the forms are rather impersonal and hope whoever gives them explains the basic reason behind such things.

How has this patient been on your service for so long? No offense. curious though.

I am going to ask some hard questions. Has the talk.. I'd don't think hospice is right for you happened? I have had to do this several times the most recent just a few months ago. One of my patients. chf actually would not call us, but rather 911 it to the hospital. Her family would NOT allow comfort meds in the house. I actually asked them, why am I coming in if there is a clear issue with what we provide and what your wishes are? The answer???

We want a weekly visiting nurse to see my mom. Maybe we can just call you when we think she needs you! THis was a patient on hospice for almost a year.. and was under the care of a previous RN. I pushed to get her discharged and finally did when the patient left the area to visit family for the holidays. I don't know if she ever came back but families and patients like this SHOULD NOT BE ON HOSPICE. It;s clear that they have other ideas which is fine. I always say. The service that we provide and the care you wish to recieve are not the same. Our presence in you home, will cause stress for you, family etc.... this ALWAYS worked when having the talk. :clown:

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

The patient may choose to revoke their hospice benefit to seek treatment for their disease which lies outside the POC and goals of care. If the patient chooses not to revoke and is hospitalized, the hospice may opt to discharge in order to maximize medical control of the care in the acute care setting.

Care that is not part of the POC is not paid by the hospice. Trust me, at least 2 sets of eyes are looking at bills...more if they are "big" bills. When hospice doesn't pay it becomes the responsibility of the family. It is extremely important to be very clear about this with patients and families. Language of this type is a part of most of the "consents" that I have seen.

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Specializes in Med Surg, Hospice, Home Health.

she was on for a year, 3 years ago and she was discharged because no decline....then she was on again with another company and was discharged because no decline, then she came back to us.....

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