LTCF

In my area, most of the LTC's are closed tight. A couple of the chain-type hospices have exclusive contracts. A couple of years ago, we were able to get a one-time contract into one of the nicer LTC's who was not happy w/ the care their residents were getting from the hospice they were using. We did a good job...family, staff, and doc were all happy. We were finally able to get into the facility on a permanent basis. It's the only LTC we go to. The medical director has been impressed w/ the care we provide. He now refers to us about 90% of the time.

This is a 200 bed facility and we currently have 15 pts there. One thing we did, was to have several inservices w/ the 4 ADON's and the DON explaining the hospice program and the benefits of working together as a team. I also re-enforce to the floor nurses that we aren't there to take over, but to compliment the care they are already giving. I love to take hand-outs to the nurses on subjects such as EOL care, feeding, pain, and if someone has an unusual disease process, I take anything I can find for them.

We also don't switch nurses and CNA's around. The pts see the same nurse and same CNA on the same days each week. I stay on top of routine refills for meds, so I'm not always asking if the pt needs anything. It's taken a while, but now when it is suggested that Mrs. Smith really needs to stay in bed and not up in her gerichair all day, they listen. PRN pain meds are still a problem w/ a couple of nurses, but they are all slowly getting it. It's taken a while, but slowly things have turned around.

I think one of the most important things to remember in LTC is that sometimes the nurses and CNA's feel like hospice is trying to take over. They have cared for some of these pts for years and remember when they were up and talking and walking around. It's hard, sometimes, for them to accept the decline. Our job is to work WITH them. Eventually, they will come around.

I work in a LTCF, and really appreciate all that hospice has to offer, and all that the nurses do for our patients. We have three different companies in our facility, and there is a huge difference between them. One of them accepts absolutely NO input from the floor nurses, and that is very frustrating to us - we know our patients! He gets irked when you suggest something that might help, but god forbid that you call the doc yourself to get an order...

Some things that might help to foster a good relationship:

1. Acknowledge that the floor nurses probably know what they are talking about re: the patient

2. Acknowledge the floor nurses' grief - these patients are part of our family

3. ASK us what we see as unmet needs for the patient and family

4. Understand that LTC has all sorts of silly rules that we gotta follow, even if they sometime get in the way of what is helpful for an individual, and then write an order for that. Ex: if a patient is better eating in their room, but facility policy says that everyone has to eat in the dining room, get an order for the exception if the facility can reasonably accomodate.

5. If you can, visit your patients on different shifts; our 7-3 nurse isn't very inspired (and it pains me to say that more than I can express) and won't pass on what happens on 3-11 and 11-7 shifts, but you know how patients change throughout the day. Come to see it for yourself.

6. We have the same goal: to help our patient to move to their next existence as comfortably as possible. Let's work together to accomplish this.