Discharge from Hospice

Specialties Hospice

Published

I have a question regarding hospice nursing which I've wanted to ask for a while, and I'm hoping for a little insight on the usual care for patients in hospice.

How often is it that a patient is d/c'd from hospice? From experience, I know that the patient has a life expectancy of 6 months to a year and will not be persuing methods of treatment for the given disease. Hospice is geared to comfort measures during the patient's time in hospice. I'm wondering if I'm understanding this correctly.

I'll give you this scenario: said pt. has been receiving hospice care for three years after physicians counsel that nothing further can be done for her eating disorder. Pt states she is in her late 30's. The physicians involved in her hospice treatment have ordered Duragesic 150mcg along with an unspecified amount of Dilaudid. All of the sudden, pt states that doctors are withdrawing all her meds and are recommending an ileostomy (and beyond that I'm not sure).

I've been following this patient's progress and it seems like she's been on and off hospice in the past and states at times that she has no longer than a few weeks to live.

This is not a question for myself, family, a friend, or a homework assignment. Somehow I started following this patient's story online and I'm truly beginning to smell a rat. If it was just someone going on with a story I wouldn't be so suspect and let her fantasize or whatever. However, in the past she has stated that she doesn't have the money to pay bills (medical, utility, etc), people have raised money for her online, sent her gifts, and hinted how she doesn't have $$$ for Christmas, etc.

I feel that she is taking advantage of people and I'm truly wondering if the above scenario is possible in hospice care. Why would they put her on all those strong meds if there is no hope of recovery? Why are they now withdrawing these medications stating there is treatment? In the very recent past I have fallen for an Internet scam (more emotional/friendship, not financial) but was suspecting that the story wasn't straight. Once again, I'm beginning to think that this is not on the up and up.

If someone could please help me with my questions, I would appreciate it very much. :)

The blogger clearly state's they have been off hospice for 2 years *shrug*

Her mom said that "Hospice came into our lives in Sept '07." It seems to me that her objection of the facts of the case do not co-exist. First she's dying and she's on her journey to Neverland. She got to meet the group "I Can Only Imagine." Next she's really really dying because of a PICC line infection. Her mother's words: "Pray for Nanny. This one could kill her and she's on death watch." I kept away from her blog but now, doctors want to do a ilioestomy and she has to come off all her pain meds. I'm not trying to start something here, but something just isn't right. She says that her last meal was in 2005, but she posted a youtube of her and her sister eating at Starbucks. On public assistance? Even I don't go to Starbucks because it costs too dang much. Something is wrong here and I'm wondering from a medical perspective was this is all about? Can this be possible? Thank you all for your help.

Specializes in PICU, NICU, L&D, Public Health, Hospice.

Be cautious, babyRN2Be, of judging people from a blog. Perhaps there is something "wrong" with this story, perhaps not. We cannot possibly know by simply reading words on a website.

Eating disorders are often chronic and related to mental illness. The fact that a person is in Starbucks says NOTHING about her personal financial situation. When I was flat a$$ broke, my friends would take me out to a nice place for a meal occasionally. I got to enjoy myself, but I was still poor as a church mouse (as my grandmother used to say). A PICC line infection in a debilitated patient can easily be fatal. Some patients who have extreme and prolonged bulemia cause permanent physical damage to their esophagus and must begin to rely on some sort of tube feedings to maintain adequate nutrition. People with eating disorders are sometimes as fixated on food as they are on weight.

Again, as a professional nurse you must learn how to assess, gather facts, and create a plan for restoration of health. Speculation and judgement have no place in the nursing process. Be careful what things you practice because they will become habit.

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