Hospice Help: Speech Therapy and Hospice?

[Leda1st]

I am very new to hospice nursing - just started 5 weeks ago, came from ER/Urgent Care and Med surg, so I am really having to work on "shifting my focus". Just had a conversation with a speech therapist who basically made me feel like I wanted my little patient in her 90's with a history of aspiration pneumonia to get it again and to die of it! The family (and patient) signed a waiver a few weeks ago because the patient was put on puree diet and was hating it - she was depressed and not eating. It was explained that she could get pneumonia again with a regular diet (she is pretty "with it") and her POA/NOK was there also. Anyway, this all happened before I took the patient as mine, and I found out the waiver was signed when the speech therapist was out of town. When the therapist got BACK in town, she had a total COW and talked the patient back into a mechanical soft diet. The patient is happy with this particular diet, and after talking with the physician, the patient and POA/NOK, and with my director, we terminated speech therapy services. (I tried calling the therapist, but she didn't call me back). Anyway, the therapist DID call me today when she found out about services being terminated, and basically chewed me a new one. How do I explain that although this patient IS at risk for aspiration, she is happy with the diet as it is, so there is not really any point to continuing speech therapy? Am I wrong about this? HELP! I work with a great staff, and my director is aware (as is the lead social worker), but I just wanted some feedback from other hospice nurses who may have dealt with this situation. THANK YOU!

[leslie :-D]

you have no idea how many physical, occupational, speech therapists, that i have told to take a walk.

usually, i'll look at them incredulously, if it's anything other than an eval or consult.

to sign up a hospice pt for tx, to me, is freaking ludicrous and usually end up calling md to dc all skilled txs.

politely tell the slp that pt is very satisfied w/current diet, and her services are no longer required.

(this crap really bugs me...esp when pt is bedbound and deteriorating, w/precious time left...i just cannot hide my exasperation when these folks come in)

leslie

[elkpark]

If the OT/PT/speech therapy services can make the client more comfortable and/or improve her/his quality of life for the time remaining, I can see that -- but, if the client doesn't want the interventions, that's that, in hospice or any other healthcare setting. The client (or POA/NOK, if appropriate) always has the right to refuse treatment.