Hospice patients living alone

[finn11707]

Our agency is with increasing frequency, admitting to the Hospice program patients who live alone. It can then become quite difficult to engage the patient, the "identified caregiver" and our team in comittment to a safe level of caregiver presence - not to speak of the instruction and preparation for the 'good ending'. Our MSWs often report (living alone) patients do not want their visits. Do other Hospice agencies often encounter this? What are the policies and guidelines you are supported with when safety becomes a problem?

[shrinky]

We always discuss care giver issues on admission and have our patients sign a plan of care for when they are not able to be left alone. They have to choose whether they will go to a SNF, a relative and are informed that we will assist with placement. We have had 1 or 2 patients refuse the MSW but they were not live alones. I infrom patients on admission that the nurse cannot do everything for them and that we need at least the nurse and MSW in every home. I usually do not get flak from them. As long as the patient can get their own meds, meals, etc we feel they are safe alone for short periods of time. We definitely look for someone to care for them usually with family meetings. If I get the referral from the hospital I can discuss this before they go home and try to get a caregiver before discharge.:redpinkhe

[finn11707]

Thanks for your input Shrinky. We have the start of care guideline on must have a caregiver when we deem patient can no longer safely care for himself...My agency however frequently admits and keeps patients who are definitely not safe caring for themselves, decline placement and adequate caregiver presence. These patients often have high levels of 'crisis' around decline and symptom management. I cannot seems to elicit concern on the part of MSWs and management team on this issue. How can we prepare for a peaceful and good ending when there is no caregiver as a part of the support?

The hospice I worked with before rarely had a patient on service who did not have many hours of caregiver assist or 24/7 coverage. I am told "...we serve a different population and so we need to lower our expectations..." Something is missing. I think we need to develop an effective plan of care for 'preparation of the patient dying alone'. Ethically, I believe these cases are quite complex.

Any input on how to get patients, families, management to accept caregiver need?