LTC Hospice

nutella, MSN, RN · Oct 8, 2016

Home hospice:

Family provides 24/7 care and hospice nurse comes in for assessment/teaching, usually a couple of times a week or at least once a week depending on how the patient /family is doing.

Case management more challenging due to care situations.

Requires to call and schedule a time for visit.

Results in more calls due to questions, "emergencies".

May result in nurse also providing basic care when visiting.

Can end up long if situation requires long visit,

Often leads to nurses not being able to finish documentation in time though less documentation than SNF.

Pro - can be great for pat and families if it works out and pat has enough support.

SNF:

Patient basics are covered through staff.

More potential for conflict between SNF staff and hospice nurse - who is a guest in the facility.

Visits can be shorter and if several patients in one facility not so much driving.

Not many calls for emergencies or such.

No need to call for a time unless need to meet with family as well.

Requires more paperwork and documentation.

Medication orders have to go through facility MD - thinking ahead and have prn orders are essential.

May requires scheduling medication as opposed to prn to avoid patient being undermedicated.

Did I mention potential for conflict????

SNF often want hospice because of the "free" CNA and equipment - they do not always really want the nurse , spiritual coordinator or SW and can resent the hospice RN because they often feel the hospice RN "has the better job" or "tries to tell me what to do" and so on. Often there is also conflict with the CNA provided from hospice. SNF hospice can be a minefield and you have to have the right personality and be successful in that setting. Collaboration and communication are key. Admissions are usually long because you need to review much more paperwork and medications, write long medication recs, make sure the care plan is in the chart and so on and forth.

I found that a mix of home hospice and SNF / assisted living worked very well for me. I liked SNF hospice visits a lot and had no problem with nurses or aids in the SNF.

HisjuleRN · Oct 10, 2016

Thank you so much for that information. I recently accepted a position with a Hospice LTC team and my specific assignment is 12-15 patients at 3 ALFs, I start orientation soon and I am very excited for this opportunity. I have been on a very busy med-surg floor for almost 3 years and am so ready for this change. Any other information about ALF hospice nursing would be greatly appreciated.

nutella, MSN, RN · Oct 10, 2016

Here are some important resources for you:

http://geriatrics.uthscsa.edu/tools/Hospice_elegibility_card__Ross_and_Sanchez_Reilly_2008.pdf

http://hpna.advancingexpertcare.org/

this is our professional organization - if you become a member you get discounts on books, certification and conferences. I value my membership a lot, you also get access to journals online with it. I use their tip sheets and handouts from the member section for families and patients as well.

HPNA

this is the best book to get up to date solid knowledge, it also has some grids for quick review

National Hospice and Palliative Care Organization

always a lot of info - your organization may have a membership for all of you and you may be able to use member only content.

The important part about hospice in AL facilities is to know what the policies are in those facilities. Usually the family or hospice is responsible to give patient medication for symptom control, which can be also at night or on the weekend. It is not uncommon to get a call from AL that a patient is not comfortable and you have to scoot by - it is not a nursing home level of care. Families have to be more involved ! Usually patients have a lock box in their room or apartment for the medication.

Often enough, the family will hire additional help if needed but the AL and families often rely on hospice to provide the HHA. Not all patients can stay in AL, some have to transfer to a nursing home. But AL views hospice more as a means to get equipment and "extra help" for patients who are work intense or have problems that would usually require nursing home level of care. For them it is less about the prevention of suffering and more about "we need a hoyer lifter, a broda reclining chair, and air mattress, and the HHA".....

Criteria for admission to hospice are the same as for other patients but AL facilities favor hospice companies who are more lenient when it comes to admission to hospice and staying on hospice. Some adminis can get abrasive when hospice determines that a patient is "not eligible" because guess what --- hospice means that the patient is declining somewhat and life expectancy is less than 6 months... it is not enough to be off a high age or just custodial.

You will work in an area that is very difficult to navigate for most hospice nurses. Your company will require you to have "excellent customer skills", be collaborative, listen to requests and demands from AL and families and talk with a lot of diplomacy. Your company is most likely specialist in services for AL and will expect a certain type of nursing there. They will clue you in, I am sure. Just remember - you are a guest in those facilities......

The expectations are often unrealistic in those facilities from staff and from family but if you are able to deal with that you might enjoy it!