Hospice in Assisted Living Facilities

[LookUp2Sky, ASN, RN]

Hi All - Whenever I have a question, and attempt some research on finding the answer, I envitably find myself right here. Guess I will have to learn to start here from now on.

We have many patients in various assisted living facilities around town. I'm wondering if any of you find it more challenging to provide care for your hospice patients in these facilities (in general)?

I have been told that they only prefer hospice agencies that will provide everything from Boost/Ensure, to dressing supplies, briefs, etc. I am employed for a not-for-profit hospice who will provide some of those items, usually on a case-by-case basis...keeping in mind we also provide care for those in need, free of charge.

I have had a recent situation, where the assisted living facility management, is requesting that I no longer be allowed to come into their facility. I have a well-established relationship with the pt's daughter and family, not to mention the patient herself. The daughter (of the patient) is unaware that this has transpired yet. They are meeting with my boss to complain about me communicating things about their care to the daughter, i.e., unreported falls, unreported fever. (I'm thinking, if you don't have anything to hide, why would you be so bothered). My obligation is to the patient and her respectful family members! I have always been very professional and respectful while in any facility, and am not sure what this is all about!

My question is..is the facility allowed to ban me from coming to see my patient? The daughter pays a large sum of money for her mom to be there, and there are no relationship problems between us. Does she have the final authority of which nurse is able to visit her mom?

This same facility is part of a chain of facilities from around this area, and over time, have all developed the same type of reputation...sad.

Any feedback would be greatly appreciated. In the meantime, I still love hospice nursing!:redpinkhe

[tewdles, RN]

ALFs are privately owned businesses and they may "ban" people or organizations from their property. The families have the option to change nurses, change hospices, or to change ALFs.

You are stuck. Your employer will likely re-assign you unless the family demands that the facility allow you to continue, that will then be out of your agency's hands.

We (hospice professionals) occasionally encounter less than stellar situations with our patients in their living situations. While the patient is ALWAYS our primary "customer" and focus it is important to remember that your agency probably considers the ALF a customer as well and will likely want to maintain a workable relationship to insure that future referrals will flow from their resident population...and this happens, in large part, based upon the relationships developed between the care delivery team and the ALF staff.

How we communicate the type of events that you described can absolutely affect our relationships with those facilities and requires a nuanced and careful approach. I cannot know the specifics of your communication and certainly would not suggest that you withhold that information. However, I would recommend that you consider who you talked to, when, and with what info.

Perhaps you could change your communication style or process to make the ALF feel that they are partnering in that disclosure...sounds like they may feel that they were "tattled" on. Of course, in the marketing world, perception is everything.

The bottom line is that you were acting to advocate for your patient and that is good. You may have alienated a potential referral source and that is bad. I hope your employer recognizes your intent and doesn't "react" to this situation.

Good luck!

[Hospice Nurse LPN, BSN, RN]

twedles summed it up well. I always communicate w/ the facility nurses before making my weekly phone calls to the families. I also stress to the nurses and families that hospice is there to compliment the care the pt is already given....not to take over.

[LookUp2Sky, ASN, RN]

Tewdles and Hospice Nurse - Thank you both for your responses. I totally grasp and understand what you are saying Tewdles! It is a very delicate situation.

My employer had a meeting with the facility DON, and backed me as a professional. They truly felt that the family member misconstrued simple conversation between us, to lash out at the facility due to unhappiness with the pt's care. My employer felt that changing case managers would not be good in this instance due to my solid working relationship with a challenging family member.

There is a large turnover at this facility, which makes it even more challenging!

I thank you both, again, for your prompt feedback, advice and support! Have a great weekend.

[SoCalRN1970]

I have been in similiar situations. WHat I have done is the daily calls with my visits to update family. I have seen unreported falls, skin tears etc. ALL have been reported to family or DPOA so THEY can take it up with the ALF. I try to remove myself from that whole situation, but often can not.

In the end. The family has the pull... and most recently I had a very bad situation at an ALF. I was doing 2-3 times a week visits to this ALF. EVERY time I showed up there was an un reported change. I called the family every time. I finally said, I understand you like this facility, but from my point of vieiw, they are not meeting her basic safety needs and not partnering up with hospice to provide care per our plan of care. I left it up to her at that point... within a week patient had a CVA and ALF was asking if they could get her up to feed her!

Keep in mind.. ALFS are non skilled individuals hired to be care givers.. Usually little to no medical experience. I have to remind myself this every time I work with one.. You are the expert,do not relay upon these folks. You are it.

Keep in mind that the above situation is very extreme. Most often ALFS welcome hospice, and are very flexible to meeting their residential needs. I love working with facilities, but often there is a bad apple out there. Building and keeping a working relationship is key. However, as stated the above scenario is rare. Most ALFs are a pleasure to work with... they really are.