Hospice Charting and Recertifications

[abcwood]

I am new to Hospice and our Palliative doctor will be giving an inservice on "Hanging the crepe" to assist us RN's in charting for the hard recertification. I was wondering if there were any other suggestions out there?

Thanks in advance!

[Allow Mystery]

Hi ABC,

"Hanging the crepe", eh. Is this the same as "stretching the tape"?

A hard recertification doesn't need to be, you may always do an easy discharge if patient doesn't meet Hospice criteria. Please let us know

about your inservice.

Best wishes!

[uahrn915]

Sounds more like "stretching the truth".

I agree with Mystery. A hard recert is a discharge. If the powers that be are pushing to recert and you feel the pt is inappropriate, ask that the patient be reassigned to another case manager. If that line of thinking continues, start fixing up your resume'. Medicare and Medicaid don't play.

Jeff

[dosamigos76, RN]

I would agree with everyone else. If your hospice is wanting you to be creative with your recertifications, I'd be looking for another job. If they're wanting you to create a total picture regarding patients that are eligible d/t their dx and co-morbities, then that is a bit different.

Sometimes we forget to note that patients have extras that have prevented declines in areas, such as a low air loss mattress and why the bedbound patient doesn't have breakdown. Or the COPD pt that also has an irregular heart rate, htn that has been hard to control that is declining overall.....

Cheryl

[shrinky]

If you are charting the little declines that you see in your visits thus should be easier. If no decline the discharge is the only option. we have had to discharge several patients recently. However the patient with COPD I have had for a long time has not been denied yet. She recently started seeing and talking with dead people even though she is still ambulatory and eating fair. She also has increased need for Morphine due to dyspnea so I document the little changes she makes each visit. This makes it easier when it is time for recert because it is all there in my notes.

[abcwood]

Thanks everyone for your input. I guess I should have been more clear. I was interested in help with the patients that we are aware of a decline but not an obvious decline. I appreciate all your help!

[Sabby_NC]

If there is no obvious or steady decline and that patient does not meet the medicare guidelines or LCD's then they need to be discharged and readmitted when there is a steady 6 month or less diagnosis.

It is better to discharge and readmit than get caught and have money tied up in ADR's trust me LOL

From the time we admit we always inform families that if there is an improvement and the pt is no longer appropriate we will need to discharge and readmit.

I prefer to discharge than to 'fudge' the recert because it is hard to come up with documented proof of decline if there is none!! :)

[malex107, LPN]

I am new to the hospice field of nursing. I need help with the documentation. If someone can provide me with example. Thank you:nurse:

[tewdles, RN]

Use the Medicare hospice guidelines for your recertification. Debility is the hardest diagnosis, IMHO.

I agree that it is best to discharge than to be charged with fraud.

I started a new hospice job once, my first recert I recommended DC for dementia patient in LTC. I had spent time for the several weeks prior having freq contact with family pointing out ways that their mother was doing well, too well for hospice. They appealed, of course, but were denied. I was a bit concerned about how my new employer would feel about that being my first "official" act as a case nurse. They thanked me, actually.

[New nurse ABC]

Hi all,

I'm a new LVN grad, about to take boards, learning so much but still so much to learn. I'm trying to create some forms to streamline my (new, again) job. In doing so, I realized I do not know what LCD means.

Can someone translate for me?

Thank you - New Nurse ABC

[SuesquatchRN, BSN, RN]

http://www.nhpco.org/i4a/pages/index.cfm?pageid=5580

local coverage determinators

[ErinS, BSN, RN]

Example of charting to decline.

Mrs. Smith has:

-Needed increased x to manage symptom y

-Had a x cm mid arm circumference loss and a x number of pound weight loss

-needed increased assistance with x number of adls

-has had a decline in her karnofsky score from x% to y%

In a pt who is declining, but in a not easy to chart kind of way, we will often pull back hospice services. So often hospice pts are only doing well because of the support they are getting, but often in only 1 or 2 weeks with no aide services and only 1 every other week nursing visit we will see bedsores, falls, increased confusion, appetite changes. It is incredible, and makes it easy to recert someone.