Hospice in group homes

[holistic1028]

I'm a little confused since I've never worked hospice with patients in group homes. It seems that my current agency have some kind of unwritten agreement that the hospice nurse will fill pill boxes scheduled AND as needed amongst some other things. Of course I don't mind filling pill boxes while im on my scheduled visit but if the patient was to start a new med and it would be delivered later that day or next day they are expecting the nurse to drive back out and add that med to the pill box as well. From experience they are adamant with this and unwilling to take instructions by phone if there is something they aren't sure on. One of the group home owners said hospice is required by state to fill pill boxes every time. I am a resourceful person but I have yet to come across this CMS guideline. From my understanding, PRN visits are written in the care plan and right now all of our PRN visits are for symptom management/acute distress. I don't get it? It seems like I'm butting heads more in group homes about hospice scope more than any other place. They expect hospice aides to be in the homes before sunrise to bathe and dress patient, make bed etc. I've always viewed hospice as added support not THE ONLY support. The agency is desperate for patients since their census is low so they will concur with jst about anything the group home owners request. I end up looking like an errand woman really.. Not a nurse.

One patient was started on duonebs and they expected the nurse would come out every time the patient needed one to give it.. Really? We can TEACH you how to give breathing treatments, do wound care etc, but it is not our responsibility to provide 24/7 nursing assistance. It sounds mean, especially coming from working on a floor in a nursing home bcause I would break sweats all day caring for my patients. But as a hospice case manager it is just not realistic to request this practice. Does anyone else have experience with working with group homes??

[ORGANICS]

In our hospice company i am 1 of 2 RN's who handle only group home patients. These caregivers in the group homes can be demanding and lazy. You have to remind the group homes that these patients pay for their care, these patients pay for caregivers who are available 24/7 and at least one caregiver must have a medication administration certificate or license to administer or deal with medications. If not, that group home isn't complying with state laws. Its not our duty as a nurse to go back and forth to do a little errand. Also remind them that CNA or AID services for patients are always just supplemental help, it is not their job to clean or wash patients before breakfast. I get that issue once in a while. Anyways, dont be afraid to scare the caregivers, they may be worn out from taking care of 5-10 patients in one group home but they signed up for that. They still have responsibility. What if the family came? Would they neglect giving the medication because a hospice nurse is "supposed" to do it? Or what if the patient is soaked in urine by 7:00 am and the family came to visit, would these caregivers not render care or change their pads because a hospice cna/aid is responsible for that? Its ridiculous!

Anyways, always make sure you make it clear to them their responsibilty vs a registered nurse's responsibility.