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?

[Kerber]

THe way I was shown was the owner said to pick a DX that will end life the soonest and then write a order - open to hospice with terminal DX of CHF. Then that order gets faxed to the medical director to sign or if they have PCP it goes to them. Is this how others do it?

[edmia, BSN, RN]

THe way I was shown was the owner said to pick a DX that will end life the soonest and then write a order - open to hospice with terminal DX of CHF. Then that order gets faxed to the medical director to sign or if they have PCP it goes to them. Is this how others do it?

Absolutely not! What if you pick a dx that's not the right one and the MD disagrees with you? You as an RN cannot admit a patient to hospice. An MD has to give the order. We do verbal orders via a telephone call to the MD after assessing the patient -- while the patient is still in my presence.

They are cutting corners and you're ending up with the liability. Hospice eligibility is not about picking a dx that will "end life the soonest". That sounds like money is running the show instead of sound clinical judgement.

What resources have you been given to "pick this dx"? Any guidelines?

[Kerber]

Oh boy! The owner told me and these are her words pick Dx that will kill them the fastest. Then write a order and fax it to Doctor. She just hired a DON I think I will talk to her tomorrow about this. I had a feeling something wasn't right. No guidelines I was just told to look at symtoms and decide what would end life the fastest. Such as if a patient had COPD and CHF but the COPD was worse we would use that one.

[edmia, BSN, RN]

That's a bit cavalier. Hospice eligibility is tricky and has guidelines that are directly related to reimbursement -- especially Medicare patients. If the patient is later on deemed not eligible, Medicare won't pay and can actually ask to audit the agency and ask for money back. This is a big deal and there are strict guidelines. They should not have just sent you out like that without any clear guidance.

CHF for example, is one dx that is hard to qualify for. The patient needs to meet criteria for NY heart association Class IV. That means patient is unable to carry out any physical activity without symptoms and symptoms are present at rest. There are other things that will support the dx, but just having edema is not enough unless they have symptoms -- ie: SOB at rest, O2 dependence, angina, etc.

Ask for more education on this. Good luck! I hope the DON has hospice experience...

[Kerber]

The new DON is a OB RN oh boy I didn't realize this. I bet I have been doing this all wrong. I had little to no orientation on hospice 1 day was read this manual and 4 days following another nurse who is a home health nurse on visits. That was it! My other hospice nurse they hired has experience in inpatient hospice so I ask her too. We both got our butts chewed when we did continuos care over a weekend because we didn't fill papers out right but no one showed us! I think I have a lot to learn. Is there a good web site that covers hospice eligibility with Medicare?

[edmia, BSN, RN]

I was given a lot of written material during my 6 week orientation. I did a search online and this guide seems to have the basics (except it includes debility and adult failure to thrive; these are no longer acceptable in general): http://www.vnsnet.com/files/VNS_Hospice_Care_Reference_Guide.pdf

I'm sorry you're not getting proper training, but this owner wants to get paid and if the admission documentation isn't up to par, she won't. She should want to get this right.

[Kerber]

6 week orientation wow I got 1 day and I couldn't keep any reading materials I try to take Manuel home to read and was told to bring it back!! Thanks for the link! I wish I had more information

[lifelearningrn, BSN, RN]

Wow- I guess good orientation is everything. I'm still orienting (and flying solo, but I have all the resources I need a phone call away) with hospice and have been given some good charts to follow. I have to get ready for work, but later I will try to post some links (I know most of the charts are available online) for you.

[lifelearningrn, BSN, RN]

Ohhh- what Edmia posted is a really good guide!

[lifelearningrn, BSN, RN]

http://www.hospicebythebay.org/images/pdf/hospice-diagnosis-guidelines-2014.pdf

This seems to take the new guidelines into consideration. It's a pretty good, printable guide!

[lifelearningrn, BSN, RN]

Here is another good general guide.

Diagnoses | Pacific Hospice

[Kerber]

Thanks!!!