Hospice in LTC.................

When I worked LTC we cared for them right until the end. If treatment was required in Acute Care, they were 99 times out of 100 sent back to us.

Yeppers the hospice I volunteer for does all that working with the facility. I imagine both of you would fill out incident reports depending on the policies in each place.

Volunteers might be able to help with things like that. keeping the patient company and such.

renerian

We have two hospices that service our facility and they both provide the same services. They provide a nursing assistant (one hospice provides five times per week, the other three) to come in and bathe the resident. They provide a nurse who visits two to three times a week to do assessments, review meds, etc. She is always available by phone to consult with staff on med changes, change of condition etc. They have a social worker who visits weekly and a chaplain who visits as needed. They provide meds and equipment related to the hospice diagnosis. The rest of the stuff related to day to day care ~ we do! We love :) our hospice, but they are still our resident!

We have two hospices that service our facility and they both provide the same services. They provide a nursing assistant (one hospice provides five times per week, the other three) to come in and bathe the resident. They provide a nurse who visits two to three times a week to do assessments, review meds, etc. She is always available by phone to consult with staff on med changes, change of condition etc. They have a social worker who visits weekly and a chaplain who visits as needed. They provide meds and equipment related to the hospice diagnosis. The rest of the stuff related to day to day care ~ we do! We love :) our hospice, but they are still our resident!

That is what we do, HHA, Nurses, Chaplain and SW's and anything related to the diagnosis we take care of. I was just curious how other hospice's handle non related diagnosis issues. I feel that if they are in the nursing home and there are nurses their day to day issues can be taken care of by the facility. Thanks for the input!

Hospice organizations should work with the nursing home to collaborate the care. Example:If patient's bath is routinely given on MWF at the facility, a CNA can be sent on Tu & Thur or Tu, Thur, Sat & Sun to give baths, feed pt, etc. The RN Case Manager orders how often she feels the CNA is needed.

An incident report should be filled out on any hospice patient, for ANY injury, by the facility (for their use & using their unique form) and by the hospice provider (for their use & their unique form). You were correct in going out to access the wound of the CHF pt & I'm sure the facility appreciated your assessment. If the wound was not related to the patient's hospice diagnosis, the facility should be responsible for contacting the patient's attending physician to obtain orders for wound care & carrying out the orders for such. The blood sugars are not related to a diagnosis of Dementia and should be addressed by the facility.

Hospice organizations should work with the nursing home to collaborate the care. Example:If patient's bath is routinely given on MWF at the facility, a CNA can be sent on Tu & Thur or Tu, Thur, Sat & Sun to give baths, feed pt, etc. The RN Case Manager orders how often she feels the CNA is needed.

An incident report should be filled out on any hospice patient, for ANY injury, by the facility (for their use & using their unique form) and by the hospice provider (for their use & their unique form). You were correct in going out to access the wound of the CHF pt & I'm sure the facility appreciated your assessment. If the wound was not related to the patient's hospice diagnosis, the facility should be responsible for contacting the patient's attending physician to obtain orders for wound care & carrying out the orders for such. The blood sugars are not related to a diagnosis of Dementia and should be addressed by the facility.

Thanks, thats what we do. Just wanted some feedback to what other hospices are doing.

Question for all ya hospice nurses out there...............Our hospice has several LTC patients. On for things such as Dementia and CHF. My question is.... do you take over complete care for that pt? Let me give an example. My CHF patient in the nursing home fell yesterday and got a laceration to the head. The nursing home called and we went out to assess and cleanse the wound. The fall really wasn't CHF related but do you still go out to assess or would you let the nursing home handle it? Or the dementia pt that also has diabetes and their blood sugars are out of control. Is it hospice's responsibility to get the blood sugars under control or is it the nursing home's since they are the primary care givers? Just curious and needing some input.

Thanks

We take care of these things in my facility. If a treatment needs started for

a bad skin tear etc that would qualify as skilled we call in the Hospice nurse,

but still do initial care and prn. We do however inform Hospice of any changes

ie falls, etc.

Are you kidding me? Most of the time I cant get hospice to come and be with the family during or after death much less come out for wound care.....

Question for all ya hospice nurses out there...............Our hospice has several LTC patients. On for things such as Dementia and CHF. My question is.... do you take over complete care for that pt? Let me give an example. My CHF patient in the nursing home fell yesterday and got a laceration to the head. The nursing home called and we went out to assess and cleanse the wound. The fall really wasn't CHF related but do you still go out to assess or would you let the nursing home handle it? Or the dementia pt that also has diabetes and their blood sugars are out of control. Is it hospice's responsibility to get the blood sugars under control or is it the nursing home's since they are the primary care givers? Just curious and needing some input.

Thanks

Question for all ya hospice nurses out there...............Our hospice has several LTC patients. On for things such as Dementia and CHF. My question is.... do you take over complete care for that pt? Let me give an example. My CHF patient in the nursing home fell yesterday and got a laceration to the head. The nursing home called and we went out to assess and cleanse the wound. The fall really wasn't CHF related but do you still go out to assess or would you let the nursing home handle it? Or the dementia pt that also has diabetes and their blood sugars are out of control. Is it hospice's responsibility to get the blood sugars under control or is it the nursing home's since they are the primary care givers? Just curious and needing some input.

Thanks

Our philosphy is to ask yourself what would you do if the patient were in their own home? Of course, you would go out to assess and dress the wound. You would probably teach the family how to do wound care and you would follow the wound and look at it when you visited. The patients in the nursing home pay the same amount of money for hospice care and deserve the same treatment. We will have the facility do the wound care on our nurses non visit days. Again, if you had a diabetic dementia patient at home and their BS was out of control you would call the physician and get orders to take care of it. You would not expect the patients family to call the doctor. While it is not related to the terminal diagnosis, our job as case manager is to manage the patients care - period.

Our philosphy is to ask yourself what would you do if the patient were in their own home? Of course, you would go out to assess and dress the wound. You would probably teach the family how to do wound care and you would follow the wound and look at it when you visited. The patients in the nursing home pay the same amount of money for hospice care and deserve the same treatment. We will have the facility do the wound care on our nurses non visit days. Again, if you had a diabetic dementia patient at home and their BS was out of control you would call the physician and get orders to take care of it. You would not expect the patients family to call the doctor. While it is not related to the terminal diagnosis, our job as case manager is to manage the patients care - period.

I don't agree with managing a dementia patient's diabetes in the nursing home. The nursing home is ultimately still the primary caregiver who spends the majority of the time with the patient. Of course in the home I would take care of the diabetes or any other problem that arises. Because they are in the home and have no round the clock medical staff to take care of their needs. JMO

The nursing home staff is totally responsible for these things. Hospice is just an extra support.

question for all ya hospice nurses out there...............our hospice has several ltc patients. on for things such as dementia and chf. my question is.... do you take over complete care for that pt? let me give an example. my chf patient in the nursing home fell yesterday and got a laceration to the head. the nursing home called and we went out to assess and cleanse the wound. the fall really wasn't chf related but do you still go out to assess or would you let the nursing home handle it? or the dementia pt that also has diabetes and their blood sugars are out of control. is it hospice's responsibility to get the blood sugars under control or is it the nursing home's since they are the primary care givers? just curious and needing some input.

thanks

i look at the delegation of care of patients in an ltc much the same as i do patients in our hospice residence. the primary nurse in the case functions as the case manager, while the staff nurse delivers the care. if a resident gets a skin tear, for example, the staff nurse assesses and does the documentation, including filing the incident report. he or she also dresses the tear per palliative care protocol/standing orders. the primary nurse is notified and may make adjustments in the care plan (and must at least change it to include skin integrity after doing a wound assessment on the next visit), but we don't see a need for the pn or the on call to immediately respond. we want to be notified when there are status or order changes, but it's up to the staff nurses in an ltc or our residence to do the hands-on part.

as far as unstable bgs in the demented patient, i would expect the staff nurse to assess and note a bg outside perameters and respond appropriately per orders, and notify the hospice if it was an acute issue, but the pn would need to collaborate with staff nurses and the pmd to develop a plan to keep the bgs within a more appropriate range. it would be the staff nurse's responsibility to notify the pn if it was a chronic issue, but also up to the pn to review the chart to look for this. the bg issue is part of the care plan, and she needs in her weekly assessment to review the care for an appropriate response to the problems noted in the care plan.

it can be challenging, especially with the varying skill levels of clinicians, to get the best care possible delivered. but we prefer to teach and support good decision making on the staff nurses' part rather than attempt to have the pn do all of the care. not only would that be unworkable in terms of care load, but it would not foster very good collaborative relationships with the snf staff or our residence staff nurses.