I've been having what seems to be a run of difficult cases since I've joined with this hospice. I've done a lot of soul-searching, and I'm coming to the conclusion that the folks who live in this region of the country are just not ready for hospice. I've already written a posting called "Family Dynamics" about one such situation. I'm running in to more and more each day. Today, for example. The first patient I saw is an elderly female with dementia, not end stage but definitely mid-stage. Myself and another nurse have had her since February. She made it clear on the first visit that she "knows what hospice is, and I don't need it". Even since, she's verbally and sometimes physically abusive to me. We are at the point now where we cannot do a physical assessment at all. She won't let us touch her. She tells us to get out when we enter the facility, never mind her room. And on and on. Her son says "oh, she just gets this way. She doesn't mean it". Well, after I got hit in the face, I stopped believing him! She has ongoing skin tears and edema, for which we are responsible for taking care of. The family disagrees with most everything we recommend. Today, I found out that the facility Med Tech's think "hospice wants to keep her doped up because she doesn't like you. She likes everyone here but you people" And that with her boss sitting right there, saying nothing. The reason we recommended the patient take Ativan on a scheduled basis was due to their report that the patient was combative and agitated, refusing care and spitting pills out at the staff. And the family didn't want her on Risperdal which had been recommended by her Geri Psych MD. I give up!!!! How can the DON tolerate Med Techs holding orders because they don't agree with them???
The next person I see is concerned because her aunt may no longer be eligible for hospice, after 2 years on the program. Why? Because then she'll have to move her to a SNF because she can't afford 24 hour care that the facilty would require. Evidently we are considered an option for people who really don't need hospice, but want to stay where they are in an ALF so we're called in. And our managers not only accept it, I swear they promote that idea to keep the census up. And who ends up playing middleman?
I don't know. I'm just tired of all this b------. I think the people that truly need hospice aren't getting it until too late, because some holier than thou MD can't accept the fact that the patient might in fact be terminal. Pain management is atrocious here. All these docs here love Darvocet. Nothing else. Now, I see I'm getting cynical, and that's not good, either....
Well, thanks for letting me ramble on. Does anyone else have similar issues, or is it just this area of the country (mid-Florida). Or do I need a really long vacation? I just can't see myself doing anything other that taking care of my terminal patients.
