Just when you think you've seen/heard it all.........

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It is rare that I will go "WTH" but today reading something on a referral history gave me pause. A potential admit to use had somehow wrangled his way onto hospice so he could get narcotics.

Wonderfully stated.

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Why are you surprised? End stage liver dx. And what is the etiology of the liver dx? ETOH?

I'm thinking...perhaps a long term alcoholic? Now realizes he/she has an end stage dx, and is scared to death, and using typical long term coping mechanisms.

I watched my father smoke while succumbing to lung Ca at age of 46.

I did not judge him. The time for that had passed. He was terminal. While it hurt me to see him smoke, I knew that he was addicted, and dying. I only felt...so very sorry for him, and the demons he just could not fight. Despite some very fine qualities/gifts. Just very sad.

Hospice is all about end of life comfort. The time for shaming is over. They lost their battle against their disease.

While the pt. may be compensated now, they will be back. And they will die from their disease. And they will need compassionate care. In spite of their addiction. Maybe even because of their addiction.

I really don't see how anyone can wrangle their way into Hospice care. The criteria is there, or it is not.

I really caution you to be careful....suspend judgement. And amp up the compassion. Because you will need to do lots of both to be a good hospice nurse.

Some human beings are just less equipped to deal with...life. Let's help them deal with the scariest of all...death.

What a privilege.

Wonderfully stated.

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Specializes in Hospice / Ambulatory Clinic.

I'm going to give the OP the benefit of the doubt and assume that the patient was not an appropriate candidate for hospice.

However hospice patients and addiction aren't mutually exclusive however you need to treat them the same as the addiction becomes a secondary concern if a concern at all in the EOL process.

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Specializes in Emergency & Trauma/Adult ICU.

I'm not quite understanding this scenario. This patient has a dx of end-stage liver disease, and requires control of pain & other s/s ... but is being denied hospice.

What am I missing here?

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Specializes in Hospice / Ambulatory Clinic.

From what I can understand the patient didn't really met the criteria and admitted to manipulating his way onto the hospice service to get drugs by his own statement. Hospice reevaluated his suitability and took him off service.

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even if he's not a hospice candidate, he would still be a candidate for palliative care...

in which pain meds would be indicated as part of his tx.

this sounds like one of those stories, where pertinent info may be missing.

all i have to hear is esld, and i don't care if he's med-seeking or not.

all i care about is his comfort.

lesie

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Specializes in Emergency & Trauma/Adult ICU.
From what I can understand the patient didn't really met the criteria and admitted to manipulating his way onto the hospice service to get drugs by his own statement. Hospice reevaluated his suitability and took him off service.

I referred back to the OP's 3 posts:

It is rare that I will go "WTH" but today reading something on a referral history gave me pause. A potential admit to use had somehow wrangled his way onto hospice so he could get narcotics.

They quickly booted him off- he had end stage liver disease but well compensated. He was quite terminal looking apparently and rallied after a bit. That's the jist of what I know.

Hospice terminated his status with them and referred him to our ECF.

They were the one who determined that he was not fitting their category after taking him on.

I was just blown away in that particular moment that someone would actually seek hospice for the narcotics alone. (Which was the implication in the information presented.)

I read that the hospice service determined after re-evaluation that this particular patient did not meet criteria for admission to their service.

I also read references to information "implied" in documentation, but not to any statements from the patient.

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Hospice terminated his status with them and referred him to our ECF.

They were the one who determined that he was not fitting their category after taking him on.

I was just blown away in that particular moment that someone would actually seek hospice for the narcotics alone. (Which was the implication in the information presented.) I also had the same reaction when I found a set of parents having sex in their child's room when in the hospital many years ago.

i suspect this pt didn't want to dc tx for his liver disease...

which would render him unqualified for hospice (but not for pall care).

it *sounds* like he may be anxious and fearful, and not fully accepting of his terminality.

i do hope he is properly medicated at this ecf...i really do.

lots of knowledge deficit amongst us/healthcare workers.

leslie

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lesson learned about "implications" just yesterday,,new admit hospice,,was "implicated" in last facility nurse notes that this 90+ woman was living alone in a trailor without running water or electricity in the desert..family was investigated by police to discover the woman owned a fine large home and was cared for closely by her children..another implication was a pt has munchausens because she had frequently complained of headaches to neurologist who according to him apparently nothing was wrong with her,,she has a brain tumor.. i pay attention to what I read but I reserve judgements

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Specializes in LTC.

I have to give the benefit of the doubt to OP.

A pt the other weekend told me he wanted on hospice, because he "heard hospice gives out the good stuff, and I want the good stuff!" Also wanted to know if he got on hospice, if he could have as much "morphin" as he wanted.

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Specializes in Hospice / Ambulatory Clinic.
i referred back to the op's 3 posts:

i read that the hospice service determined after re-evaluation that this particular patient did not meet criteria for admission to their service.

i also read references to information "implied" in documentation, but not to any statements from the patient.

i think i misread admit to admit to service for admitted to using hospice for drugs. the sentence below is less than clear which i think is causing all the confusion.

"

[color=#333333]a potential admit to use had somehow wrangled his way onto hospice so he could get narcotics."

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i'd probably be "seeking meds" if i was ESLD too.

i was "seeking meds" after getting my wisdom teeth extracted...literally. i showed up at the dentist's office before they were even open so i could be the first one in and get a refill bc i was in so much pain.

i'm not a "wuss" either. i've had children via c-section and didn't even use the pain meds they gave me to take home after being discharged...and they gave me a lot. having those teeth out hurt ten times worse than having my abdomen cut open.

everyone's pain is different and i can't begin to imagine what it's like for an ESLD patient.

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