Hospice Vs Home Health

pagandeva2000, LPN · Jan 16, 2008

I have never done hospice, but did home care. Home care is great, but you have to know the family dynamics...it is extremely important. You are coming into their space and at times, there may be issues of housekeeping-they may not be as sanitary as you would expect. Make sure that all of the emergency equipment is present and in working order. Have the phone number to the doctor, pharmacy and nearest hospital. There should be a plan of care with nursing diagnoses and care plan made available with the diagnosis of the patient, the MAR and make sure that all of the medications are in the house. If not, make sure that you know if the patient has insurance coverage or money available to pay for the script (YOU should not have to pay out of YOUR pocket).

You will be pretty independent, so, be sure you know CPR, and what to do for that particular patient in case of emergency. The agency RN should let you know that. Also, before you go, ask the agency RN what meds they are on so you can look them up, as well as study their condition. And, if you are able, try to see the client with another nurse present to see if you can handle the case. I did all of that and had a pediatric trach patient for about 10 months. And, know the activities and expectations of the agency and family. For example, do they expect you to escort them to social events (and are you comfortable doing that?), or do they have family drama going on? If it is a pediatric case, make sure that you are not the designated babysitter when the siblings come home from school. That should not be your responsibility. Tell the parents they will have to make other arrangements for those children, even if the babysitter is sitting right next to you. I had small issues like this that needed to be addressed and eventually, I resigned from the case because there was too much risk involved.

I do plan to return to home care once I get more med-surg under my belt. It was peaceful and I had more autonomy than in the hospital. Good luck!

wonderbee, BSN, RN · Jan 16, 2008

I could share some of my experience with you as I left hospice for HH and have equal time in both. The pros of hospice are that you usually have time to get to know your patients and develop a relationship with them. You often follow the same patients for weeks, months and possibly even longer. You will grieve some of them and will have to find your way to do it, bowing out of the family dynamic with a sense of grace. As much as you may feel like you are part of the family, you are not. This is sometimes an issue. You will want to remember that the goal is not to save the patient, but to bring comfort and consolation. Hospice seems to be more of a team effort with each discipline finding equally important roles. The team has to be able to work together well and communication between the disciplines has to be a top priority and it can be time consuming and tedious. Then there is the on-call aspect of hospice. People suffer and die at all hours of the day and night. It's not necessarily a 5-day, daylight job. I was told when I came to work at hospice that it was a "lifestyle". The meaning became clear to me that the job and my patients had to come before everything in my life. So off to HH I went.

Care is intermittent in HH and short term. The care plan is focused and goal specific. Your goal is to help the patient get better. There is a lot of education and it is welcome wherein in hospice, I found families to be caught up in the death process and anticipatory grief, and often too paralyzed to understand the education. The family dynamic is usually less intense. There are few middle of the night calls since emergencies are for EMS though there is the occasional leaking foley or wound vac gone awry. Patients are usually alert and oriented or at least their caregivers are.

Hope this helps.

pagandeva2000, LPN · Jan 17, 2008

That was one dynamic that I had to face. As intimately involved as I was with the patient and their family, I had to constantly remind myself that I, myself am not part of the family. Not that I wanted to be, mind you. But, it took discipline for me not to get too involved with things that were family oriented. I had to catch on to cues that this is a time for me to leave the room, or to not offer an opinion because it was not my business as long as the patient was not harmed. In my own life, I don't visit people very often because I am a private person. I felt that I was sort of invading their personal space at times.

Once, with my pediatric patient, I had an issue where her older half sister used to visit and would do a few things that were not quite safe. My client had a jeep that was battery run, but since she was 4 years old, she was not able to control the way it was steered. Her sister pulled the jeep out of the garage for the client, and my patient almost ran it into the street. I had to intervene and tell the sister that this is not safe for the child and then tell my client's mother how I felt. My client ADORES her sister. I felt like I was interfering with their sisterly interaction. But, at that time, it was a safety issue, and as a nurse I had that right to limit certain things.

There is a fine line with the home. Yes, you are intimately involved and are privy to many priviledged things. But, you have to know when it is acceptable to intervene and when you can't, but keep the client safe and cared for.

jdeez42 · Jan 17, 2008

thanks for the responses from both of you, im looking to see other people's views though.............thanks!!