Hospice care

U.S.A. Massachusetts

Published

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.

Specializes in They know this too!.

Everyone is making me think when I left my last job if my boss thought I reported them. She called me a month later asking if DPH called me because they got into trouble. Of course they didn't call. I was wondering why in the heck she would call me and ask. Wow... After that I never used them as a reference because I didn't know what happened, especially when it had nothing to do with me. :mad:

It was a nursing home, for profit I am sure of it. These are the places that hire all the time and have high turn around. They wonder why no one stays.

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"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."

Thank you, this is one of the many reasons that I believe patients and families need hospice. I was a hospice case manager for 2 years, and I still work PRN for a for-profit hospice company. The hospice that I work for has home patients and nursing home patients. The majority of my patients were home patients, and their families needed hospice to understand the death and dying process. I never had a family that wasn't truly grateful for having hospice. A day of hospice costs under $50 at my office, it would cost Medicare at least 10 times that much for the patient to stay the day in a hospital for symptom control.

Now, for the LTC facility patients, I will say this...in MOST LTCs I think that hospice is unnecessary. I feel like it is a slap in the face to the LTC nurses to have hospice come in. That is basically saying that they don't know how to care for their patients. However, I did have about 5 patients at a very run-down facility. This LTC accepted most of their patients from the streets or the state psych facility, and their funds were very limited. The MD there was an old MD, he was rarely in the facility. He was very hesitant about ordering comfort meds, UNLESS we (hospice) asked for them. Some of the patients did not have family, and the ones that did never visited. In this case, they felt like we were their family. They looked forward to visits from our nurses, CNAs, chaplains, social workers, and volunteers more than any other patients I had. I think that all people deserve to have someone care for them, and I (as well as the other staff) made a difference in their lives. Amazingly, a lot of times you see patients improve when hospice 1st comes in because patients are getting a lot more TLC than they were before. This is what keeps us all alive, being loved by others! Even patients that were not on hospice looked forward to us visiting the facility, it was a place I dreaded going to in the beginning, but probably also one of the places that I had the most impact. And, knowing that I was making a difference made it worth going!

At another LTC facility, I think the nurses that worked there were afraid of the medical director. This was a chain of LTC facilities. I had a 39 yo patient there with Huntington's that had a PEG tube and was on a feeding at a rate of 90ml/hr for 20 hours per day!!! He went to the hospital at least 3 times (for 2-4 weeks at a time) for aspiration pneumonia, yet when he would come back to the facility, the MD would increase the rate again because he was losing weight (which is normal due to his continuous movements)! I don't know how many times I had to go around and around with that MD until he finally agreed to keep the rate at 60ml/hr for 20 hrs per day. The patient hasn't been back to the hospital since then! He was more likely to die from that tube feeding than any amount of morphine he was ever being given! Which brings me to another subject about the MD wanting to hold the morphine if the pt's RR was below 12, but I will save that rant for another time! I finally got appropriate pain control for him, too! So, sometimes you need a nurse that will come in and isn't afraid to advocate for the pt in the LTC setting! The LTC nurses were so overwhelmed and working so hard that I felt like it was a relief for them to have us handle some of these things.

It was the most rewarding position that I have ever had, but I got burned out because of an unmanageable caseload.

To the original poster, I am sorry that you had to witness these things. That is unimaginable to me! We did manage wounds in the home. I know of one nurse that was fired because she had not been doing thorough skin assessments. The pt had been complaining of her feet hurting. Another nurse discovered stage 4 pressure ulcers on the heels of one of her home pts, and that was that. It is unacceptable to let anyone suffer like that.

To the poster with the 90 year old mother, I am sorry that you had a bad experience. It sounds like the ALF jumped the gun by attempting to put your mom on hospice. Hospice should not have even been looking at her until the facility and the MD talked to you about it.

I didn't mean to go on for so long, but I am definitely PRO-HOSPICE. :redbeathe:redbeathe:redbeathe

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I am pro hospice in the correct setting. I do not believe just because one is at end of life one must have hospice. This is comfort care and comfort care can be done with out any nurse, social worker, head of hospice, (they have a lot of staff that do a lot of little) and without a hospice doctor. A good primary care doctor who knows the patient better than any hospice doctor can give appropriate medications for family to give. When my dad was in board and care on hospice, we had to pay 1K more /month just because he was on hospice. Why??? Made no sense. He was an easy patient. That hospice lasted 1 week and off he was and there was not one change in anything. I took him off as I saw no reason to put someone on hospice just because it appears he is not going to live more than 6 months. My only regret is that I did not take him home here with me. Sometimes I think that hospice is sort of a "cult like" organization. Good for some yes. But not necessary for most.

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Specializes in Hospice.

If your pro-hospice, you need to check out the hospice patience alliance on line. They are an amazing group and help people navigate the hospice system. They get 9000 hits a day on their website. As I've said in an earlier post, I became a whistleblower and they helped me tremendously and have even found me a new job!!! Thanks Dance for the other referral ;)

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Yes, hospice is great in the "correct" situation. And I agree, it is a waste of funds and poor judgement at times to have hospice at a hospital BUT we do not have that at our hospital. Instead it is comfort care. For example, after weeks and weeks of trying to "salvage" a patient by doctors at a HUGE cost to medicare and obviously not possible, but docs too weenie to tell family, perhaps because they enjoy their $ off medicare, the pt was sent home on hospice and guess what? He lasted at home 36 hrs before expiring. This person ought to have been on comfort care weeks before going home on hospice and having a decent death. This is when the hospital works best.

If someone does not need a hospital bed why do they need hospice if there is family that can administer meds, and care? For ones who cannot or have a problem, how are they going to do it anyways? Having a nurse step in for 30 min. here and there for support helps of course, but let's look at the whole picture. I am not dissing Hospice; I am just saying that often hospice is what doctors say when they want to stop caring for the patient and leave it to someone else.

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Specializes in Hospice.

One of the biggest scandals in healthcare is providing hospice care in assisted living. These days the hospice aides are traveling 100-200 miles a day to see patients, it doesn't leave much time for patient care. The assisted living staff as wonderful as they may be, are not trained to care for hospice patients. The facilities themselves do not provide medical care including putting a bandaide on a cut, their nurses are "wellness nurses" which go home at the end of the day. So when a patient needs pain medication, who is there to provide it. Who is there to turn a patient every 2 hours to prevent pressure ulcers, and so much more. Hospice is wonderful, for some, not all. And when hospice has grown from a small community based care provider, to multi-state corporations, focas has chaanged. 50% are now for profit some making over a billion a year in profits. Hospice is not for everyone.

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Civilized, could not agree any more.

I have a nurse friend who believes Hospice is sort of "cult like" and I have to agree. But, again, for those of you out there thinking I am dissing Hospice, think again. It appears Hospice is needed "sometimes" but not "always" as it has started and again, in my humble opinion, to let the docs off the hook. They do not want to deal with it so they just pass it to the hospice who make a ton of $. Remember, "non profit" does not mean "low salary". Along with my "packet" of info, etc. about the program, was a beautiful little brouchure about donating $ to hospice. It is perfect. It is so easy to think of hospice when the loved one dies, and the hospice have gathered at the bedside "nicey nicey". I only wished I had had the guts and the time to take what happened to my mother with hospice to the papers. Well, now almost 18 months later, the almost 91 yr old is at the moment all dressed, make-up on, did the dishes, made her breakfast, made it up the stairs and is waiting for a ride to the senior center. She also folded the clothes in the basket that I leave with her. She needs to be needed, and have a purpose in life and now she has it. She hates my oven/stove as it is difficult for her to work, so this weekend she is buying us one she likes and can use. I give a huge THANK YOU to Hospice for opening my eyes as they almost killed her and would have gotten away with it, being hospice.

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Well there is good and bad with anything. I could say the same about hospitals. Hospitals can be killers. Some of them I would not send the lowest of the low to. You all know the ones I am talking about. Hospice, home health, nursing homes, all have good and bad. That is why we advocate for our families- we do not want them to be the next victim.

I ask you not to assume that hospice=evil. It does not. The hospice concept is that the person is going to die, they have accepted that and are now going to focus on how to live well for the rest of their days. Many people do not need hospice. I agree with that. It is best for those who need support and symptom control. You get more than you do with home health, without so many hoops to jump through. Some people need only personal care or even family support until their dying day. It is a matter of determining what is appropriate.

I agree that hospice should be very limited in LTC. It is a duplication of services and should only be permitted in a case management role to make sure that patient gets the pain and symptom control that he needs. I worked casual at a local LTC facility and the hospice patients there seldom saw anyone from hospice. They were useless and did not even return our calls. Unfortunately it was a shaky company that marketed heavily in local nursing homes. I saw the darker side of it there and would never want to work for them.

If you have suspicions or concerns about any agency, you need to let Medicare know. They are the ones who are looking for fraud, abuse, poor care issues. They hold it all together.

Your mom is blessed to be doing so well at her age! I think so many people out there just need a good nurse behind them to advocate for them and help them navigate the system. I am a firm believer that a good nurse is worth her weight in GOLD.

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Specializes in Hospice.

God Bless your Mom who is doing so well. I just read that 50% of Hospices are for profit now, and they are growing. I worked for one that made 1.4 BILLION dollars profit in 2010. The largest Hospice in the country "suncoast hospice" made famous by the Terri Schivo case, was found guilty of Medicare fraud for patient brokering (paying hospitals & nursing homes for patient referrals) back in 1997 and medicare has been trying to re-coup 14.8 million since. At the same time medicare hired Mary Labak the administrator from Suncoast as a consultant. Medicare certainly has problems. Meanwhile, the families of the patients where hospice worked well, are donating money to them all the time. It's sad.

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Civilized, you ought to know as you work hospice or worked hospice for years.

To think that there are kickbacks is a new thought for me!! Another poster said to call medicare. That is a bit of a joke sorry. There are too many cooks in medicare as in so many other fields that complaining of this in my opinion is like complaining that the weather ought to be better. I see the "medicare fraud" in the hospital almost every time I work. I work at a very good hospital (in top 5% CA) but that seems to mean not much other than less death? Less infection? We are a top heart hospital and alas now it seems we are a geriatric skilled nursing. Medicare bilking at its best. Old, demented, incontinent, unable to get out of bed patients, whom docs continue to treat with more and more procedures, blood transfusions, etc. So, in my opinion, medicare bilking. As for Hospice? If Hospice was so great, why is it not in an acute hospital like ours? Answer: because no medicare involved when someone on hospice, so no profit for hospital even if non-profit hospital which means little anyways. I work at non-profit hospital and I earn over 100K so one can imagine what top dogs are earning?

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Home health is required to give the Medicare Hotline number to all patients to call and report any complaints. You can call 1-800-HHS-TIPS- the Inspector General office to report fraud or suspicious activity. There are strict rules and I am sure they apply to hospice as well.

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Yes CXG there are strict rules but but who is even going to think of calling when one is in such a stressed out situation and when we all believe health system and rely on them? It does not happen that easily. It is not just medicare and hospice but the U.S. health system totally.

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