LPN doesn't want dying patient to go to hospice.

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I have a patient who is dying. At the suggestion of nurses on here I went to the DON today and suggested the patient be discharged from home health and referred to a hospice service. She thought it was a wonderful idea and wanted me to call the patient's oncologist and tell him exactly what I told her: that the patient was now going downhill rather quickly and I felt that hospice could offer her a better service than home health.

The patient has 24/7 private duty LPN's. I called the LPN who is the regular at that patient's house and asked her who the oncologist was. She asked why and I told her I was going to talk to him about switching the patient to hospice care and the LPN screeched into the phone "WHY? WHAT ABOUT US?!?!?!?We're doing everything they would do!!!" She got really angry. She said, "Don't call the doctor until you talk to the patient and her family first! So I said I would come by tomorrow. I have a feeling this LPN is "working" on them and telling them that bringing in hospice would be ridiculous, etc. etc. etc.

Can you hospice nurses help me? I would like to explain to the patient and her son what hospice will do for them that we can't do. One thing I can think of right away is that when the patient dies, home health will be out of there right then. With hospice, I believe there is back up support for the family after the patient dies.

Thank you in advance.

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Specializes in Med-Surg, Rehab, MRDD, Home Health.

Good job, and Bravo for your DON; Caregiver need not worry about her job,

she'll be needed more with Hospice as symptom management may/should be

more intense/time consuming. Sure Hospice will provide support after the patient dies, but more important, they shall better manage symptoms to assure patient will die a comfortable death and have a peaceful transition

into the next life. By all means, discuss with patient and family, and don't concern yourself with the self-centered private duty. Best wishes!

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There's no reason why the patient cannot have hospice and around the clock nursing care unless her health insurance is paying for the nurses (which is unusual.) The private duty nurses can continue to stay and this gives the patient even more support.

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There's no reason why the patient cannot have hospice and around the clock nursing care unless her health insurance is paying for the nurses (which is unusual.) The private duty nurses can continue to stay and this gives the patient even more support.

Oh wow, you mean, the private duty LPN's who are under our company can stay AND she can get hospice care? That would be wonderful! She has Medicaid (TennCare).

I hope this is the case! That would erase a lot of the tension if I could suggest she keep her current nurses and get hospice involved, too. That way she wouldn't feel like she is being pulled in two different directions.

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Oh wow, you mean, the private duty LPN's who are under our company can stay AND she can get hospice care? That would be wonderful! She has Medicaid (TennCare).

I hope this is the case! That would erase a lot of the tension if I could suggest she keep her current nurses and get hospice involved, too. That way she wouldn't feel like she is being pulled in two different directions.

absolutely!!!

hospice will come in as deemed necessary, and make the recommendations for pain mgmt and any other recommendations.

the lpn will be following through with what hospice recommends.

it's really an ideal situation.

plus the pt/family members will get all the benefits of hospice care, which only hospice can offer.

does your pt and this lpn enjoy a therapeutic relationship?

leslie

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absolutely!!!

hospice will come in as deemed necessary, and make the recommendations for pain mgmt and any other recommendations.

the lpn will be following through with what hospice recommends.

it's really an ideal situation.

plus the pt/family members will get all the benefits of hospice care, which only hospice can offer.

does your pt and this lpn enjoy a therapeutic relationship?

leslie

I'm very excited to find out about this. As for the LPN, even though I'm supposedly the "RN in charge" she is 30 yrs. older than me and I don't think very eager to accept my word as final. I respect that. I may feel old but to her I'm just a kid.

I will go in tomorrow and explain this to the LPN and I hope she doesn't give me a hassle. I'm doing what I hope someone would do for me if I was in the same situation as the patient is.

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I'm very excited to find out about this. As for the LPN, even though I'm supposedly the "RN in charge" she is 30 yrs. older than me and I don't think very eager to accept my word as final. I respect that. I may feel old but to her I'm just a kid.

I will go in tomorrow and explain this to the LPN and I hope she doesn't give me a hassle. I'm doing what I hope someone would do for me if I was in the same situation as the patient is.

and i would certainly hope the lpn would want only what will benefit your/her pt.

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I'm very excited to find out about this. As for the LPN, even though I'm supposedly the "RN in charge" she is 30 yrs. older than me and I don't think very eager to accept my word as final. I respect that. I may feel old but to her I'm just a kid.

I will go in tomorrow and explain this to the LPN and I hope she doesn't give me a hassle. I'm doing what I hope someone would do for me if I was in the same situation as the patient is.

Someone would need to check with Medicaid. If Medicaid is paying for the private duty, then there may be a problem - but the hospice business office can check on that. I'm not sure how the medicaid works in your state. Definitely, if the 2 cannot be in there together, she is better off having around the clock nursing care - as Hospice cannot provide ATC care.

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Specializes in Med-Surg, Rehab, MRDD, Home Health.

Doodlemom is correct. If Medicaid is paying for the private duty LPN, they

may not pay for Hospice (nor Medicare). In my state, the regulations are not

very clear, and also, this state Medicaid would not pay for 24/7 private

duty nurse. Good Luck!

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There was a big mess over my suggestion of hospice. The LPN (I say she is the one who got the mess started) but apparently every doctor the patient has ever had was called and the main office this morning called me and said doctors had been calling the home health office to let us know the family did NOT want hospice...come to find out, one of the nurses working private duty on nights also works for hospice and she made the same suggestion I had to the oncologist before I even thought about calling him.

But at any rate, I made a huge mistake. Shame on me for trying to be a do gooder, I guess.

I really want to get out of this business. It just has me torn up all the time.

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Oh well. You really tried to help the patient. It sounds like the people around her are running the show. If the family ends up wanting hospice, the request would have to come from them.

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Yes, good for you for advocating for the patient. When people who are hurting "don't want hospice" I always wonder if they really understand what they are rejecting or if they think accepting it means "giving up". Its unfortunate that often the people who need it most emotionally cannot accept it. When you couple that with all the misinformation that people have about hospice (some of it from their own doctors!) it can be very challenging to even get to the informational visit stage.

I do wonder who is paying for the round the clock nursing staff. I have never heard of Medicaid being so generous as to pay for that kind of one on one nursing care.

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