Non-Hospice appropriate patients admitted or kept on Hospice

tewdles, RN · Jan 7, 2010

The hospice agency I work for is a for profit agency. My superiors and higher ups in the company are constantly talking about profit and loss and are making the Clinical Directors (my position) and the Community Relations Directors more and more accountable for P&L. I fell like we along with the Admissions murse are being pressured to admit patients that are not hospice appropriate, and to "find" ways to keep pts on service that need to be placed into discharge planning. I am only one person, so how can I keep my ethics in tact follow, the law and keep my company happy? Is it possible to stay in Hospice and not have this issue to deal with? Thanks:confused:

Yes it is possible.

You may well be correct that the root of your discomfort lies in the "for-profit" end of this problem. In order to pursue the goal of the company...which is to be profitable...the management must find avenues to increase revenue. The the most obvious way to accomplish this (without limiting costly but warranted care) would be to admit patients who will provide income for an extended period of time without consuming a lot of resources. SNF dementia patients are often inappropriately admitted by hospices eager to increase their census.

I am in complete agreement with you. I do not want to work for a company that is in any way stretching the rules to line their pockets. I do not agree to admit patients who are clearly not hospice appropriate. I pursue discharge if the patient improves and is no longer appropriate. I am an example that you CAN find an agency that provides hospice care with INTEGRITY and not with greed. Sure, the CEO and other management make an appropriate wage...but the bottom line for this company is pay the bills not make a profit beyond the bills.

I say interview some NFPs in the area and see what is available for you...you gotta be able to sleep at night.

momtotwo · Jan 7, 2010

I work for a "for profit" hospice. We serve more indigent patients than any other hospice in our area, 2 of which are NFP agencies. They refuse the non-pay clients. We are also closely monitered as to the eligibility of our patients and are not pushed to keep someone one or put someone on "for the dollar". We are provide more services than other hospices and we do not charge for services as other hospices in our area do. That being said I don't believe if a FP vs NFP issue. It's a company issue. Don't limit your search for other employment based on that. Sorry you are being pressured!

Mamanurse62 · Jan 8, 2010

Thanks for the advice and insight. I will continue to try and do the best I can for my patients and staff.

LMTRN · Jan 14, 2010

I work for a non-profit, and I would guess one third of the people we admit are not truly appropriate.

alidif · Jan 15, 2010

That is exactly why I stopped working in hospice. I have worked for several different hospice agencies, and in my area, there are no honest agencies. It's sad, really, because hospice is ideally provides an invaluable service. My heart is in hospice, but I refuse to work for agencies who admit patients who do not qualify, and believe me, many of them admit people who are by no stretch of the imagination going to qualify any time in the near future. It is illegal, and it robs those people of the availability of that service when the time comes for them to truly qualify and need that service. (Because many of the agencies admit someone who is inappropriate and then discharge them once they begin losing money on them, and no other agency will take them when they finally become appropriate.) I know that in most parts of the country, the agencies are honest and truly provide quality care, but in my little corner of the country, that just is not the case. Admitting a patient who does not qualify is stealing money from Medicare.

tewdles, RN · Jan 15, 2010

I work for a non-profit, and I would guess one third of the people we admit are not truly appropriate.

Wow. I am guessing that your hospice is engaged in active marketing in the LTC, ALF arena?

Kabin · Jan 17, 2010

Sometimes community pcp's pressure an admission. That becomes difficult since they can recommend other hospices agencies.

Mamanurse62 · Jan 17, 2010

Yes (we) actively market to anyone who might send us a referral

tewdles, RN · Jan 18, 2010

In my experience it is the LTC and sometimes AL facilities where inapprop admissions occur most often. Sometimes it is a mechanism of the person being sick enough to qualify at time of admission but then improving with hospice care to the degree that they can no longer be considered terminal. I think that happens to all hospices. We just discharge them when appropriate, knowing that they will likely be back.

saribeth · Jan 20, 2010

I know that the nurses that work for profit hospices are doing a wonderful job and doing it because they love what they do. In my little corner of the world our VNA is really losing so many referrals to the for profits with their heavy marketing and all of the extras they can provide. We can only offer what medicare gives us and we all know it never covers what we do. There is so much competition in our area that we are barely keeping afloat...we are small but we all put our whole selves in...just like the Hokey Pokey!!!!! :)

mc3, ASN, RN · Jan 20, 2010

I worked for a non-profit hospice, and a for-profit home health agency. This was one of the biggest issues I had with them both, and it's primarily why I left. I won't lie. Period.

mc3:nurse: