Hospice and Full Code

[WittySarcasm, BSN]

So I had never seen this until suddenly two of our patients at the nursing home I'm at went hospice and remained a full code, which of course confused EVERYONE that was involved since when you say "so and so is hospice" you assume end of life care, not end of life care but if they code you better run in there and start bringing them back.

I was just wondering why do some people become hospice and full code. One nurse took a guess that since they get more services as hospice (like hospice coming to bath them and stuff like that) that they become hospice for the services. Anyways I was wondering if that's the really the reason or if it's something else.

Thanks!

[TheCommuter, BSN, RN]

During my years of working in LTC, I have also encountered hospice patients who remained full-codes. Sometimes the patient and family decide on hospice for the enhanced services.

At other times, the elderly hospice patient might have 7 or 8 adult children, and although they all know that their mother or father has expressed the desire to be a DNR, nobody wants to step forward and sign the out-of-hospital DNR order because they erroneously feel that they're 'giving up' on their loved one.

[klone, MSN, RN]

According to my husband, the hospice geek, it either lies with acceptance issues or not everybody in the family is on the same page. He said a patient will sometimes start hospice care as a full code but then "come around" and sign the DNR after a while.

He said that as far as seeking "enhanced services" he doesn't really see that but he does see drug- seeking.

[chevyv, BSN, RN]

I didnt' know you could be on hospice and still a full code. Hmmmm, I thought hospice didn't cover many of the usual tx to prolong life but I know doing CPR and intubating someone is not hospice. I'm so confused

[klone, MSN, RN]

I didnt' know you could be on hospice and still a full code. Hmmmm, I thought hospice didn't cover many of the usual tx to prolong life but I know doing CPR and intubating someone is not hospice. I'm so confused

Well, if they're full code and they go into arrest, by definition they would perform CPR on them, even if they're on hospice. So yes, a person can be in hospice care and still be full code. There is no law (or medicaid "law") prohibiting it, although the hospice agency will try to explain why it's better to sign the DNR orders. Generally it just takes a bit of time for everyone to come to acceptance.

[JenLPN001]

I've seen a few full codes on hospice at our facility. Usually it was because although the family is accepting that the resident is nearing end of life, they're not fully ready to totally let go. There's also a lot of guilt involved too. They feel that they're giving up by signing the DNR. Since our facility is all Alzheimer's and other dementias, it's usually pretty easy for us to talk about quality of life issues and help the families through the fact that the person they knew and loved their whole lives is already, in a way, gone. I find it a little easier to talk with families about hospice and DNRs and all because I just lost my mom to liver cancer last August and hospice made things a lot easier and helped us give mom her wish to die pain free and at home.

[OCNRN63, RN]

i didnt' know you could be on hospice and still a full code. hmmmm, i thought hospice didn't cover many of the usual tx to prolong life but i know doing cpr and intubating someone is not hospice. i'm so confused

not necessarily. people can be on hospice and still be a full code. if they go to the hospital and are coded, etc., then they're considered to have revoked the hospice benefit. if they want to go back on hospice, they can.

[NicuGal, MSN, RN]

We use hospice in the NICU and those kids aren't always a full code. We use them for the services they render to a chronic illness.

[NayRN]

I agree. Seems like an oxymoron to me. Must be an insurance thing.

[Daisy_08, BSN, RN]

Where I live (peds being an exemption) you must give up active treatment to get EOL care due to the "extras" in hospice. However I have had some pt come to my palliative unit with no dnr, we just make it a priority to get one. I would suggest do some teaching with the family about what the end result of chest compressions and intubation are. DNR does not mean no antibiotics ect. I think some people feel as if a DNR means we let the pt suffer, educate them on what it means.Good luck

[PetsToPeople]

I'm sure it's probably a legal/ethical issue...it would be unethical/illegal to tell someone that they can be on hospice but they have to die on hospice as in refuse them a full code. Just because someone chooses hospice does not mean that they have given up and are ready to die, just that they have been told they are basically expected to expire in about 6 mos and the patient wants to maintain pallative care and quality of life. Perhaps they have already tried all possible treatment or there are no treatment options for what they have...again, it does not mean they are just ready to die, they want to maintain their life in the highest quality possible for as long as possible.

[jadelpn, LPN, EMT-B]

Part of hospice care is teaching. Many family members (and patients) think that DNR=no fluids, antibiotcs and the like. And that their family members when accepting Hospice care are somehow signed up for the express train to death. Actually, hospice is a "state of mind" if you will and gives the patient the ability to make their own dying decisions, and when that is not possible, the family the ability to be educated as to what hospice provides, and then they can decide how to proceed. Hospice is generally for people who's terminal condition is expected to last no more than 6 months. A DNR, though important, is a small part of what hospice advocates. It is the services and education during the dying process that are the goals of hospice-- to get the patient/family to a place of acceptance or dying with dignity, as peaceful and pain free as possible.