Mentally Ill Patients and Hospice

[SCgirl1962]

We admitted a patient to hospice for end stage COPD. Unfortunately, he also has schizophrenia. Currently, his COPD is fairly well controlled. Unfortunately, his schizophrenia is not. The family calls us all the time stating that they want him in a nursing home or to have him committed. We are working very hard on this, but psych beds are not easy to come by. He has been in a psych unit recently, but was discharged after just a few days. His MD states that we can do more to get him placed than she can. My thought is that we should have never admitted him to begin with, considering that his schizophrenia is far more out of control than his COPD. When his schizo is well controlled, so is his COPD. I guess he is more willing to take his meds then. Personally, I think we are asking for trouble with this one. Any ideas or comments?

[doodlemom]

Does he meet criteria for COPD?

[rn/writer, RN]

If he's in hospice, does that mean he's end-stage? If he hasn't signed a DNR and doesn't openly say that he wants to die, could the interference of his mental health issues be construed as behavior that is harmful to self? Does he in any way present a danger to others?

The other route you might investigate is to have him declared incompetent and see if someone can be appointed his healthcare POA.

The difficulty I see with this kind of patient is that he has two distinct, and in many ways conflicting, problems. Any facility that will be equipped to handle one aspect will probably balk at being asked to deal with the other.

If he could be admitted to an inpatient psych facility, perhaps visiting hospice nurses could care for him there.

What does the patient say he wants?

What a tough situation all 'round.

[river1951]

This is a really hard place to be in for both the family and the patient. Sickness and stress increase the mental illness problem, these poor folks cannot deal with much stress. Getting the patient in somewhere where both diseases will be treated will be your major problem. The faamily may have their fill and be worn out. I would be sure the schizophrenia is being optimally managed as the basis for anything I did. (my expertise here comes from both my hospice experience and my younger sister having schizophrenia) Will be keeping you in my prayers.