Hospice agency shutting down - help!

Updated | Posted
by mslavender1982 mslavender1982 (New) New

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The hospice agency in my small remote town is shutting down next month.  They stopped taking new admissions a month ago.  I am a nurse case manager at our hospital, and we are trying to come up with a short-term solution for our end-of-life patients until we can put together a more long-term solution.  (I was a home health and hospice nurse for 10 years, so I'm coming at this with a little bit of a knowledge base.)  Any ideas or advice from this group would be much appreciated!

Some things we are working on so far:

- Palliative packet for patients discharging home - education sheets on symptoms (pain, dyspnea, constipation, anxiety/agitation), medication instructions in plain English, basic skin care, short booklet about the dying experience and what to expect, important contacts (physician, pharmacy, mortuary); our SW team and chaplain are also contributing to this packet

- Doc-to-doc handoff between hospital physician and patient's PCP

- Post-discharge - a couple of phone calls from an RN within the first week to make sure they picked up their meds from the pharmacy and understand how to use them

- Community partners - we have a small mobile integrated health team that consists of an LVN, an EMT, and a paramedic that can offer check-ins and limited assistance

Some concerns:

- The physicians in our community are worried about the burden this will put on them and the clinic staff

- There is no nighttime or weekend coverage for these patients/families

- Hospital admissions and hospital lengths of stay will increase; our facility only has 40 medical beds that service our town and the surrounding villages

Some questions:

- Is hospice/palliative services via telemedicine an option? 

- Is there some sort of phone-triage service that can offer support or advice during the night and weekend?

LVN_IAM

LVN_IAM

4 Posts

mslavender1982 have you tried to reach out to surrounding counties to see if there is any Hospice agencies that can pick them up? When my company closed in 2018 they were responsible for getting each patient assigned to a new company. 

mslavender1982

mslavender1982

3 Posts

Our town is landlocked and you can only enter by boat or plane (Juneau, AK).  So there are no surrounding counties that could formally pick them up on their service.  Our team has pondered seeing if other hospices in our state could be a remote resource for our end of life patients. 

LVN_IAM

LVN_IAM

4 Posts

Wow that's a tough one. Yes even remote/telemeds maybe an option. Wishing you the best. 

sleepwalker

sleepwalker, MSN, NP

Specializes in Occupational Health. Has 18 years experience. 331 Posts

On 9/17/2022 at 8:22 PM, mslavender1982 said:

Our town is landlocked and you can only enter by boat or plane (Juneau, AK).  So there are no surrounding counties that could formally pick them up on their service.  Our team has pondered seeing if other hospices in our state could be a remote resource for our end of life patients. 

Have you reached out to the Public Health Service regarding options, information, etc.  Can the village health clinic provider assist?

pmabraham, BSN, RN

Specializes in Hospice, Palliative Care. Has 3 years experience. 2 Articles; 2,558 Posts

As a visiting hospice RN case manager, I don't know how much I would trust cameras in order to be able to properly see the condition of the patient.  While vital signs, in my experience, are often not the main factor for me to determine estimated end of life, most family members are not trained on how to properly take vital signs... and while this part can be easier if the patient is at a facility, there is still the issue of not being able to properly see the patient (more often than not, I know if a person has <= one month based on visual presentation).