Medicare Probe

Sabby_NC · Nov 30, 2007

Also, have any of you had the feeling that the LTC staff would rather we were NOT there?

Yes unfortunately some LTC staff are a bit 'brash' when we arrive but for the most part they have been absolutely awesome.

Just got a new patient in a facility I had not been to and I have to say the staff are VERY accommodating. They are always so happy and have a great raport with each other.

Their management must be nice too as I firmly believe that if the top levels of management are happy and considerate it flows to all levels.

My visits there are so enjoyable.

I pray we pick up more patients with them. :)

tencat · Nov 30, 2007

Sometimes when we get the word that we (nurses) are to do admissions, the patient has already been assessed by another RN and deemed 'appropriate' for our services. I have gone to a couple of admissions where I've thought the patient was NOT appropriate for us. But the decision had already been made. The one time I've been asked to assess a potential patient I saw that the patient really did not qualify for us, and I told the powers that be my opinion. Interestingly, I haven't been asked to assess patients since....which really is ok with me.

req_read · Nov 30, 2007

Personally, I could never figure out why Medicare ever approved hospice in nursing homes in the first place. It is a classic example of double-dipping; i.e. paying 2 different providers for the same client. It must have taken some silver-tongued hospice lobbyists to talk legislators into passing that one. How much better off we would all be if national hospice organizations spent as much time & effort studying dying process as they do lobbying legislators, trying to figure out newer and better scams. There is no reason on God’s green earth why LTC facilities should not be required to train their own nurses in the art of symptom control and teaching dying process to pts/fams. Well, I shouldn’t say “no reason.” Actually there are reasons why (some) LTC facilities don’t provide good care to their clients, but those reasons cannot be described in polite language. I was opposed to hospice getting involved with LTC facilities in the beginning and refused to do it. Medicare is finally figuring out why.

CANRN...

Re: (quote) "Our hospice is non-profit and our marketer is convinced that the future is in nursing homes for hospice."

Your marketer is not exactly a mental giant. The whole concept is flawed... not to mention, on the brink of being shot down by Medicare.

Michael

doodlemom · Dec 1, 2007

From a marketing standpoint it is probably still a good idea to continue to market to LTC facilities since the benefit (probably) will not decrease for several years. I think we can help this population to get better care than they would without us. The problem is that many hospices have abused this benefit - many NF's have opened their own hospices who are giving substandard care because they have no competition. Then there are the agencies that have hired Medical Directors who are NF Medical directors and will only refer to the agency they are working for. It all seems like a conflict of interest. I've seen so much abuse and am proud that I work for an ethical agency that serves the community and not stockholders. I may be naive, but I like to think that the good will over come the bad in the end....

req_read · Dec 1, 2007

I hope you're right doodlemom.

It really does seem like the preponderance of hospice nurses (or at least the ones involved with this forum) function at a pretty high ethical level. That does not surprise me. Hospice nurses have always tended to be an altruistic group. What I wonder about are hospice owners, administrators and managers. Specifically what I am wondering (and hope y’all will comment on) is this: Do any of the administrative types in your hospices read this forum? When you go into work does your manager ever say, “Hey, did you catch that comment in the allnurses form last night?”

When hospice first came into being pretty much everyone involved with it felt strongly about making it work and sticking to its ideals. Now, I don’t know. I see lots of non-hospice nurses posting comments here (students, nurses thinking of switching to hospice, non-hospice nurses asking hospice-specific questions etc.) but I do not recall ever seeing a post by an agency owner or administrator (nurse managers are sort of in-between.)

Do any of you nurses ever mention this forum to administrative types? Or do you prefer they not see what goes on here? (Which would be understandable.) It's just something I wonder about occasionally.

Michael

doodlemom · Dec 1, 2007

I know that my director reads this forum but I don't know if she posts here.

Allow Mystery · Dec 2, 2007

Michael, I don't believe any of owners or administrators I've worked for in Hospice read this forum. I've mentioned comments/discussions from this forum numerous times, especially when trying to stand ground and stick to my values, to the various powers-to-be, but I've never been able to elicit an intelligible response, most choose to keep their head in the sand. I've read posts on this forum that I've assoicated with a Hospice administrator/manager (one or more of the moderators maybe?), but I don't remember seeing them weighing in on these topics of contention, or if so, not to further the discussion.

Doodlemon, I hope you are right, but I'm not so naive, and I have my doubts that the good will overcome the bad (in our world). I've worked for both, non-profit and profit Hospices, and I can't say that I noticed much difference in philosophy, and actually, the non-profit was more concerned with the bottom-line than the profit, but, this may have been just an isolated experience, the administrator for the non-profit

was inept and shallow. You are right-on about the NH situation. I worked for a Hospice that was started by a large, corporate organization that owned/managed numerous NH in a two-state area.

In two years time, one of their Hospices became the largest Hospice

in the second largest city of our state; their philosophy was to require their NH administrators have their staff actively seek Hospice patients (weight loss, decreased LOC, increased confusion, family members that complained about NH care), admit all referrals, and always recert. But,

if the NH patient was in a Medicare bed, even though may be imminently dying and in distress, would not be referred to Hospice, and

as one NH DON told her staff, "we can do what Hospice does".

Take Care!

CANRN, MSN, RN · Dec 2, 2007

I have also mentioned this messageboard to my co-workers as well as managers and our director. Since I have never gotten any feedback, I am assuming they have never come here. Their loss!

doodlemom · Dec 3, 2007

I think that many non profits are very concerned about their bottom line because they don't have as much to begin with as the for-profits. Because you see the top to the bottom in one place, the concern for the bottom line is much more apparent. I do believe (and know) that there are really good agencies with good values and there are good and bad management staff in both for-profit and not for profit. A bad manager can ruin your experience no matter what the mission is. Again, I feel very fortunate that I work for a very ethical agency in which the majority of the staff and administration have a strong belief in our mission.

req_read · Dec 3, 2007

doodlemom,

Are they (your ethical agency) hiring?

Michael

doodlemom · Dec 3, 2007

Every once in a while we have an opening but not now!

aimeee, BSN, RN · Dec 4, 2007

Here I am....one of those administrative types. :) I've been out of town attending the NHPCO conference in New Orleans.

Its amazing to me to hear all the press about the cap. The only way I can imagine any hospice coming close to the cap is if they are admitting an awful lot of people who do not meet criteria or who are very borderline. I would also suspect that they are heavily marketing to nursing homes and assisted living facilities. Our hospice is in no danger of getting anywhere near cap. We regularly discharge patients who have stabilized and have extended prognosis. We would never dream of not admitting a patient who is close to death because we wouldn't get enough return out of it. Our first priority is to the patient and family. Our mission is to serve.

As for blaming the nurses....sorry, the buck stops with the Medical Director. The Medical Director is the one who must sign the recertifications and who must approve all initial admissions. In fact, the subpart regs that went into effect at the beginning of the year, the Medical Director is supposed to review the history of the patient WITH the referring physician before approving their admission into hospice. Of course, this is totally unrealistic because physicians will not take the time to do this so it is done through an indirect passage of information.....IF the hospice is ethical enough to even follow this.

At the conference I heard that it is the practice of some hospices to recruit multiple associate Medical Directors...that way the Medical Director of the facility also becomes one of their hospice Medical Directors and then there aren't any of those pesky differences of opinion between facility and hospice regarding appropriateness. Of course, they have no expertise in hospice care and can't really serve to be a resource for hospice as they are intended to be.

Every time I learn about things like this it makes me really angry. :angryfire