Hospice care

[civilized]

I have worked in Hospice for 29 years. It has changed over time, some for the better, some no so much. Mostly I worked in small community based organizations, but recently moved and was offered a position with a corporate owned Hospice that also owns most of the facilities where our patients are located. Good pay, NO weekends or on call. How could I not accept.

The facilities were not the best, but the staff seemed friendly. From the first week on the job the aides started complaining about the patients being abused. I started looking into it and discovered the abuse was rampart. Patients in urine soaked beds for long periods of time, no supplies or linens for the hospice aides to do personal care, pressure ulcers left untreated, it was a nightmare. I went to the DON of the facility who was friendly and pretended to be concerned, but I could see it was fake. I went to my boss who basically told me our companies were married, there wasn't much they could do, and to my surprise the aides who had come to me with their concerns were fired.

I spoke to one of the social workers who told me there were lawsuits against the Hospice for wrongful termination, and the staff never lasted long because whenever they spoke or filed a complaint they were fired. I was totally shaken to the core by what I witnessed. I wonder what price I will pay for going to the department of public health. I'm told dozens of complaints have been filed by the staff before me and everything has come back unfounded. Please say a prayer for me.

[joleej]

How could you not know, after 29 years in Hospice, that the big corporations are all about the $$$$$? Also, being a non-profit doesn't always make it a bed of roses either. Find a small, locally owned hospice.

[HangInThere, BSN, RN]

Have you thought of contacting a television or newspaper reporter? This story needs to be told, and the corporation would have no choice but to clean up their act.

[Wishinonastar, BSN]

dance4life, I was very shocked about DPH myself. I always assumed they really investigated complaints. Now I find out they only investigated "serious" complaints. Giving a copd patient who was eating PO and walking, morphine to help with her was not considered serious. She lasted 2 days! "

Just so you realize that morphine is a wonderful drug for end stage COPD- this is a normal practice and relieves a lot of anxiety and dyspnea. My mother is on it currently under hospice care and it has helped so much.

[sznwhi]

you don't need prayers, you need a lawyer get one ASAP

[Psychtrish39, BSN, RN]

I am so sorry civilized but I believe you my last LTC job I worked night shift and I and the aides would find bruises, a broken toenail down half way across the nail and assorted other injuries on doifferent residents. I would of course write an incident report which is law for my state and the DNS would go write a note in the chart behind me saying what she believed happened which the last time I was taught you cant write down what you think happened you write the facts . Well anyway I was later fired for a mess- up in scheduling and the state unemployment judge didnt go for them saying I was a bad employee and called off alot which they had no paperwork on . I got unemployment finally and I also reported all these incidents to the state right after they fired me and the state went to the facility and found no evidence . There were nurses there changing 0800 meds as ordered by a doctor to 0600 so I could give them and they changed them directly on the MAR. Yet when state went there they saw no evidence of it so they said my allegations were unfounded. I want to know how the MARs were fixed and the other things skimmed over. ?

The facility which is owned my two physicians and is located in the state capitol might have had something to do with it I do not know but state either told them they were coming or something of the sort. I lost my faith in the state DHHS here after that. I know what I saw and what they did and how the residents were treated. I really think the corporate ownership of long term health care is why it is the way it is today. I am so sorry that happened to you. I still feel the pain of that and the position I have now I like my coworkers and my residents but the corporate part is just awful. Nurses to corporate are seen as liabilities and to tell you the truth I have been respected more by my employers when I worked in housekeeping as a young mom and military wife. I am so burned out by corporate ran healthcare I am looking into home health where I will do private duty with one patient. I dont even care I am not going to make as much money . I wish you the best and I just had to respond because I have been burned like that too for doing what I am supposed and most of all what is right. I hope things work out and you decide what you need and want to do... sorry post so long.. but know you are not alone this happens everywhere even in so called progressive states which brag how they take care of the elderly and mentally ill while cutting services. Take care and good luck...

[Guest372004]

For those Hospice Lovers out there.....this is not intended to put you down. This is just fact.

Almost two years ago my mom was put on hospice. She did not have cancer but suffers from chronic pain.

In two weeks she went from being in poor shape to almost dead. She was in Assisted Living and the RN's were passing her meds, as usual, but now Hospice came in and change it all. Now Hospice is in charge. And I, being an RN look to them for guidience? Yes. One week into their "treatment". (they want to put her deep into pain control, and then slowly take the meds away to find the correct amount) I get a call from the assisted living RN. I am told my mom "is going, come quick". I arrive 1 1/2 hrs (drive) later, and the hospice nurse is hovering over my mother saying "your mom is going". I said, "going where"? Hospice said she had a stroke. So I decided to move in. The nurses at assisted living knew me as an RN and I would go to the desk to get her meds. Then I threw them down the toilet. Guess what? Mom woke up one day later. I moved mom into my home and almost two years later as we speak, mom is downstairs (she takes the stairs and is 90) making her breakfast. She does not wear diapers. Her ONLY problem is that she is hard of hearing. I have no clue as to why we need hospice. If someone is dying, and in pain, can't a MD order liquid medications? Is hospice there to give out a hospital bed? When family is able to do the job, there is no need for hospice, a huge organization that makes a lot of $. At one point I had 3 hospice people interviewing me and my mom. That is a lot of $.

[HangInThere, BSN, RN]

Hi Needshaldol. Wow. Feel for you and your mother, and glad you stepped in

Just curious, which doctor gave what diagnosis to your mother to qualify her for hospice? Or did hospice make something up? Sheesh!

[Sharry RN]

This makes one wonder how far the corruption extends. What a nightmare for you, the aides and the patients. Depending on how far you would want to take this, you might consider going to the newspapers or TV news.

[Psychtrish39, BSN, RN]

For those Hospice Lovers out there.....this is not intended to put you down. This is just fact.

Almost two years ago my mom was put on hospice. She did not have cancer but suffers from chronic pain.

In two weeks she went from being in poor shape to almost dead. She was in Assisted Living and the RN's were passing her meds, as usual, but now Hospice came in and change it all. Now Hospice is in charge. And I, being an RN look to them for guidience? Yes. One week into their "treatment". (they want to put her deep into pain control, and then slowly take the meds away to find the correct amount) I get a call from the assisted living RN. I am told my mom "is going, come quick". I arrive 1 1/2 hrs (drive) later, and the hospice nurse is hovering over my mother saying "your mom is going". I said, "going where"? Hospice said she had a stroke. So I decided to move in. The nurses at assisted living knew me as an RN and I would go to the desk to get her meds. Then I threw them down the toilet. Guess what? Mom woke up one day later. I moved mom into my home and almost two years later as we speak, mom is downstairs (she takes the stairs and is 90) making her breakfast. She does not wear diapers. Her ONLY problem is that she is hard of hearing. I have no clue as to why we need hospice. If someone is dying, and in pain, can't a MD order liquid medications? Is hospice there to give out a hospital bed? When family is able to do the job, there is no need for hospice, a huge organization that makes a lot of $. At one point I had 3 hospice people interviewing me and my mom. That is a lot of $.

I have found as a nurse in LTC I have had issues with hospice at times . We have to call them for supplies and or medication changes and it is always a hassle they never want to come out and they want us to call the doc for the pain med changes. I feel like with a load of 20 some patients they could do it. Some hospices are great but the ones corporately owned by hospital systems want to delegate care to the nurses in the facility and not do anything until the residents pass away. I had one tell me to call the families myself so what is hospice for ? Although my mom had hospice when she passed away from cancer they were great and I wasnt a nurse yet then but she died at home. I have always thought it was weird as a nurse that ltc gets hospice patients because we cant do the hands on close care that the dying need. I mean I have taken care of their bodily needs but could not help much with the spiritual but that is just my two cents from where I live now. It always isnt that way depends on the state I think sometimes .

[Wishinonastar, BSN]

For those Hospice Lovers out there.....this is not intended to put you down. This is just fact.

Almost two years ago my mom was put on hospice. She did not have cancer but suffers from chronic pain.

In two weeks she went from being in poor shape to almost dead. She was in Assisted Living and the RN's were passing her meds, as usual, but now Hospice came in and change it all. Now Hospice is in charge. And I, being an RN look to them for guidience? Yes. One week into their "treatment". (they want to put her deep into pain control, and then slowly take the meds away to find the correct amount) I get a call from the assisted living RN. I am told my mom "is going, come quick". I arrive 1 1/2 hrs (drive) later, and the hospice nurse is hovering over my mother saying "your mom is going". I said, "going where"? Hospice said she had a stroke. So I decided to move in. The nurses at assisted living knew me as an RN and I would go to the desk to get her meds. Then I threw them down the toilet. Guess what? Mom woke up one day later. I moved mom into my home and almost two years later as we speak, mom is downstairs (she takes the stairs and is 90) making her breakfast. She does not wear diapers. Her ONLY problem is that she is hard of hearing. I have no clue as to why we need hospice. If someone is dying, and in pain, can't a MD order liquid medications? Is hospice there to give out a hospital bed? When family is able to do the job, there is no need for hospice, a huge organization that makes a lot of $. At one point I had 3 hospice people interviewing me and my mom. That is a lot of $.

Most people do not have a devoted loved one such as you to look out for them. I don't know how people manage who do not have a nurse in their families!

My mother was just the opposite. The doc kept adding meds until she was so sick from the meds that they were killing her. In and out of the hospital. Totally unstable. Finally, I asked for hospice. She had had enough and was refusing dialysis. We cut two BP meds since her diastolic was constantly low, cut the two cholesterol drugs- who cares about cholesterol when you are dying? I started her on some B complex for energy. And now she has ativan and morphine that no PCP would EVER order- she might get addicted after all! Now she is in great shape (for her), much better than she has been in months.

Now if she dies it will be with comfort and dignity instead of with IVs, blown up like a balloon, black and blue, frightened and suffering. I, like you do not trust anyone to care for my mother as I would, but I need the hospice to get her what she needs. I will say that this company is hospital-affiliated, non-profit. They don't make big promises, but they are there when you need them and they are flexible and easy to deal with. I had the same company for my father- pancreatic CA. It was a good move then too.

Doctors tend to ignore chronic pain and suffering unless they are familiar with palliative care or hospice. I have seen so many older people suffer with unrelenting, untreated pain out of ignorance and fear of addiction by their physicians.

[Esme12, ASN, BSN, RN]

As expected, after 30 years as a Hospice RN and I get fired for reporting abuse. Very very sad.

((HUGS)) I too got fired after some whistle blowing. I stilll have not been able to get a lawyer to take the case nor was I able to find a job......after all the stress my MS has relapsed with a vengence and I am now on disability. Good luck and have peace in your heart you did the right thing!!!!!!!!!

[Guest372004]

Amazing. I thought I was going to get "blasted" by 100% pro hospice people. Thanks for listening.

My mom was in assisted living with my dad and doing well until my dads dementia started causing issues. So she started having hypertensive episodes that were out of control with 4 high blood pressure meds! She had sort of a nervous breakdown from all the stress, and being 88 at the time, you can imagine how she looked in a hospital bed. Weighs about 98lbs but she is 4'11" if she stretches. So these docs see her like this and think "oh she needs comfort care, or hospice" and I, being so upset with a dad with dementia and having surgery (I was talked into carotid surgery by the surgeon, who I now believe just wanted to make a few more payments on his expensive home, as homes in this area are outrageously high) went along with the "experts". Then to top it off, every doc that came in to see her added more drugs to her profile. I told the nurse "no more meds added" and the doc told her that the med he had added was helping her. Give me a break.......one med, one time? It was cymbalta and my mom at 88 was already on morphine, vicodin, xanax, celexa, amitriptyline, and the list goes on. That is why I started tossing her meds and today at age 90 3/4 I dropped her off at a restaurant to meet friends for lunch. Her BP is fine with 2 meds, and I keep her on a tight rope with all the other meds and this old woman is great. Oh, I forgot, she had to have her hair done before lunch. And yes, I wanted to go to the papers about "hospice" just as I would love to go to the papers about "medicare bilking by MD's" but alas, I have no time and instead I just watch the show go on and on. And I agree regarding the LTC ahhhhhhh I could go on and on about that too. The bottom line is $$$$$$ and the LTC calls 9-1-1 in a flash if the resident is not on hospice as it is too time consuming for them to evaluate and they do not want to be sued, so 9-1-1- it is.