Need Help...What is the teachable skill?

MrChicagoRN, RN · Jun 10, 2007

I did an admit today. The agency said "go but I doubt we'll go back; there doesn't seem to be a teachable skill". The doctor only ordered a BP check. The medicare pt has end stage Alzheimers. Hasn't been seen by a doctor in 2 years. He/She is being taken excellent care of by a family member. I think He/She could benefit from several weeks of Home Health. BP was 150/90 and pt is not on any BP meds. Pt only on 3 meds which He/She has been on for years. Pt is incontinent of B/B, wears diapers, is changed and turned Q 2/hr. Bedbound, non-verbal, no pressure areas, G-tube continuous feed on pump. Assessment negative other than BP.
If the doctor orders a BP med that would be a teachable skill for the CG. Also I'm thinking that the CG could use end of life education. Perhaps a MSW? Perhaps a HHA briefly?
What do you think? Admit, no admit?

Was there a problem that caused the dr to send you in, or was it just to take a look since she hasn't been seen for 2 years?

If started on a new med, that might be worth one or two visits only. The family knows how to give medications, so what would you teach? And do you really feel this patient would gain anything by lowereing her BP at this point?

If you weren't able to get it all on the first visit, You may be able to justify an additional visit to further assess for any CG needs, need for respite care, or additional services, hospice referral, etc

It's been 3 years since I left HC, but I don't think you can justify more than that.

DutchgirlRN, ASN, RN · Jun 10, 2007

Was there a problem that caused the dr to send you in, or was it just to take a look since she hasn't been seen for 2 years?
If started on a new med, that might be worth one or two visits only. The family knows how to give medications, so what would you teach? And do you really feel this patient would gain anything by lowereing her BP at this point?
If you weren't able to get it all on the first visit, You may be able to justify an additional visit to further assess for any CG needs, need for respite care, or additional services, hospice referral, etc
It's been 3 years since I left HC, but I don't think you can justify more than that.

My personal opinion would be that this pt does not need BP meds because lowering her BP would only prolong her life which has no quality. The problem comes in that the patient made it clear to the CG that no matter what happens in the future regarding his/her medical status that they wanted everything done to prolong their life if they were no longer cognitive to make that decision theirself. The CG feels obligated to keep that promise. That is where I feel MSW could help. A new BP med would get our foot in the door. Teaching SE's etc...could take a visit or two at the most. I do feel like the end of life issue may be the most important next step. Can that stand alone as a reason for admission?

UM Review RN, ASN, RN · Jun 10, 2007

(Remembering that I have never done HH but can fully appreciate the dilemma), how about a Hospice referral? Isn't end-stage Alzheimer's a Dx for Hospice?

CapeCodMermaid, RN · Jun 11, 2007

Yes, end stage dementia is a hospice diagnosis, but if this patient already has a gtube how likely is it that the family will allow hospice? Sounds to me like there really is no teachable skill and you need to dc the patient.