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Hospice In-patient Units

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Is anyone else finding it hard to support in-patient level of care for your hospice patients? We are trying to follow NGS / medicare guidelines and try all interventions in the home first as well as trying not to transfer patients to in-patient unit (GIP) if actively dying and the patient happens to be 'comfortable'. This is particularly difficult as we also ask end of life preference (home/facility) and many pts / caregivers want to transfer to facility 'when the time comes' however NGS does not consider 'actively dying' a valid reason to bill GIP level of care. Of course if there is caregiver breakdown/stress we try to bring in at respite or routine homecare rate. Has anyone come up with another use for beds on inpatient unit if you are struggling to keep them filled? I work at a hospice with a homecare census around 100, and around 40 nursing home pt census. Our free-standing unit has 10 GIP beds. We also have 10 residential beds which remain 100% full 99% of the time.

Thanks for any suggestions / ideas!

You cannot bill for GIP level of care simply because that is what the family wants. You must bill as respite if there is a change in status. Some inpatient units fill their beds with folks discharged to the hospice unit from acute care hospital beds. The better your ability to manage symptoms in the home the less likely you are to need inpatient GIP beds.

Good job!

I work on a 12 bed inpatient unit. We are always full. We offer 1respite bed at a time. There have been times when we change a patient status to routine when they do not meet GIP criteria, usually these folks are waiting for placement.

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