LTC challenges with Hospice providers?

[HazelnutCream]

Hello all! I am a Hospice Director of Nursing, working to improve our collaboration and coordination of services with both local skilled nursing facilities and assisted living facilities.

I have two questions/requests:

1. What are your current biggest specific challenges that you face with local hospices?

2. What strategies have you used that have been most effective in improving these relationships?

I'll include examples of some of our challenges in the comments.

Full disclosure: I imagine at some point in the future, I will put together a presentation or article on this topic. I have cross posted this question to the hospice speciality area to get their input as well. No specific details, challenges, or strategies will be included without prior approval.

Thanks!

[HazelnutCream]

Some of our challenges (from the perspective of a hospice provider):

-ALFs that refuse to allow any PRN medications

-ALFs that do not allow hospital beds or oxygen

-SNFs that expect hospice to perform all treatments (e.g. daily wound care)

-SNFs (and some ALFs) that contact their attending MD for orders without notifying or updating hospice of the concern or the new orders.

Not one I've personally faced, but have heard from other providers:

-ALFs requesting continuous care any time a patient has ANY symptoms

I'm sure there are more that will come to mind but these are the biggest ones that I can think of. Interested to hear what others are facing and what is working for you. If you have suggestions for what works great for you, I would love to hear that, too!

Thanks!

[CapeCodMermaid, RN]

I'm a DNS in the SNF world. I am a huge proponent of hospice care. I can't speak to what ALFs allow or don't. They operate under a different set of regulations. I usually have a great relationship with the hospice providers who come into my building. We set clear expectations when the resident is admitted to hospice. I expect clear communication on any recommendations in changes to the plan of care and I expect my staff to be clear with the hospice providers if they think the resident needs something they're not getting. At the end of the day, I am responsible for the residents in my building whether they are on hospice or not so I need to know what's going on with them

As with all things, there are good providers and not so good providers. When I have to make more suggestions to the MD than the hospice nurse (after discussing it with her) I am not pleased. We need to work as a team to do what's best for the resident.