Hospice DX not dementa

[Kerber]

So I heard as of oct 1 st we can't use dementa or failure to thrive as DX. I have a 100 yr old lady with dementa DX I was told to dig deep for another DX she has no other health problems! She's home bound can't transfer alone or amubualte. It takes 2 to shower her she gets combative. She lost weight but has good appetite per son. Incont bowel and bladder so what DX can I change it to?

[QuiltDog]

My understanding is that you need to specify the type if dementia (Alzheimer's or Lewy body), not just "dementia"

AFTT can be used as a secondary dx but not the primary

Same with debility

See if you can get some medical hx regarding her dementia

[ktwlpn, LPN]

Just wondering what symptoms is she exhibiting that would need to be managed by hospice? Is she truly hospice appropriate or does the family just want support with her ADL's?

[westieluv]

Just wondering what symptoms is she exhibiting that would need to be managed by hospice? Is she truly hospice appropriate or does the family just want support with her ADL's?

That's exactly what I was wondering when I read the OP. If she has no other health problems besides her dementia and she has lost weight but has a healthy appetite, then she doesn't really sound hospice appropriate per the true definition of hospice. Not only could she very likely still be here in six months, she could still be here in a couple of years, unless there is something that the OP forgot to mention.

While it's nice for the family to get help with ADLs, especially if they are time consuming and the patient becomes combative, she sounds like more of a candidate for an inpatient memory care unit.

I would not presume to know this patient's family's motives, but I know that I have known more than a few families who want their family member on hospice service as opposed to inpatient care because they don't want the cost of a nursing home to empty the patient's bank account before they die. I have actually seen family members become upset when the patient improved and "graduated" from hospice after the initial six month period was exhausted and the patient had not declined at all, because they had no intention of doing any hands on care and having hospice staff in the home several times a week negated the need for an expensive nursing facility.

[Kerber]

Well I just started with this company a month ago the lady is 100 yrs old can't ambulated needs assist with transfers, talks in word salad. Incont of b/b.

[ktwlpn, LPN]

I would not presume to know this patient's family's motives, but I know that I have known more than a few families who want their family member on hospice service as opposed to inpatient care because they don't want the cost of a nursing home to empty the patient's bank account before they die. I have actually seen family members become upset when the patient improved and "graduated" from hospice after the initial six month period was exhausted and the patient had not declined at all, because they had no intention of doing any hands on care and having hospice staff in the home several times a week negated the need for an expensive nursing facility.

I have seen this as well.Additionally in our LTC we have family who simply want their loved one to have the "extra one to one attention" from the hospice staff and demand the CNA as often as they can through each eligibility period and when true EOL finally does arrive they assume a 24 hour vigil at the beside will occur despite what they have been told.

[BerryhappyRN, MSN, RN]

Doesn't your MD have to sign the order to change the Dx? Consult with the MD. Also, at 100 there must be some vascular issues.

[trayp33]

You can still use these:

331.0 Alzheimer's Disease

331.1 Frontotemporal dementia

331.11 Pick's Disease

331.19 other frontotemporal dementia

331.2 Senile degeneration of brain

331.7 Cerebral degeneration in diseases classified elsewhere

331.82 Dementia with Lewy Bodies

331.89 Other cerebral degeneration

331.9 Cerebral degeneration, unspecified

We are mostly coding for Alzheimer's dx or 331.9

[toomuchbaloney]

It seems perfectly reasonable to me that a 100 year old dementia patient who has experienced a recent decline could conceivably be dead within 6 months and I could easily imagine two physicians making that statement.

Hospice care could absolutely improve the caregiving situation for both the family and the patient and would be a reasonable consideration for this elderly patient assuming that the family is of the mindset that their loved one is at end of life and no life prolonging measures should be employed.

[Chrissyw]

You can't use dementia with codes in the 290 or 294 but you can use Alzheimers, Lewy body dementia and I think there's a degenerative brain These do not have those codes. With someone this age we know her brain has atrophied it all does as we age. Your medical director should help you with this. Hope it helps

[Kerber]

I talked with doctor at our IDT meeting we are changing it to Alzheimer's. Doc wanted cbc and cmp but I couldn't get it she was hitting and spitting. Honestly I don't think she has Alzheimer's. Now I just signed a patient Friday with late stage Alzheimer's and you can tell the difference. I didn't use Alzheimer's has primary though he also has CHF I used that instead although he didn't have a lot symtopms some edema in lower legs feet and he was on bunch heart meds. Was that a good decision?

[edmia, BSN, RN]

Are you discussing this on the phone with the hospice MD during the actual admission? This is not your decision to make alone, but rather a discussion to be had. The MD is who sets the diagnosis -- especially on complicated cases. Plus, you need MD orders to admit. Don't admit anyone without having that MD discussion and obtaining admission orders. That would be practicing out of your scope as an RN.