Nursing Home and Hospice abuse

[noctanol]

long story but i try to cut it short. Have you experienced or do you have a patient in your facility that you think or believe that hospice is just in for the money, i mean they don't need hospice. Take this two examples from where i work. 1) a pt has been on hospice for 2.5 yrs now, i politely asked my unit manager why she really requires hospice and she stated that that is what the daughter wants, my manager doesn't think that she requires hospice and neither do i, the daughter is getting all the necessities of hospice like air mattress, personal aide for showers, weekly assessments by hospice for decline etc and that seems to be what made her put her mother in hospice care. 2) another pt has lost 18 lbs and the doc wrote a review for hospice, well the hospice nurse came assessed the pt and was looking, i mean literally fishing for a reason to admit this lady to hospice, in the end she ended up admitting the lady for end stage dementia, something that I totally don't agree with but don't know how to raise my point in a manner that does not appear to be rude or interfering with well being of the pt. In the past i have seen hospice orders and actually spoke to hospice nurses who would not admit a pt to hospice if they didn't have legitimate reasons/diagnoses. I hate it when i see family and staff doing this, i have seen people in dire need of hospice and how hospice care is really important especially for end of life care and compassion. ANY EXPERIENCES OUT THERE

[misschiatia]

Yeah, how do they manage to keep pt #1 on hospice? Where i work, they have to come off of hospice after so long if no decline. I know they review it every 6 months and things like weight gain and increased appetite can cause a pt to no longer be eligible. We had one lady , 100 y.o.,deaf, blind, has cancer, big growth /scab growing on her scalp, and they dropped her from hospice after like 1 1/2 years because she gained a few pounds and was just too stable. Broke the hospice nurse and my heart because you know she's not any better, but she didn't get worse quick enough. But I might add that she still eats a regular diet, walks with a walker(she sees shapes) and is sharp as a whip/confused intermittently. She's also still here 2 years later, so it shows they were right, she wasn't ready for hospice yet

[DizzyLizzyNurse]

We also have people who come off of Hospice after 6 months if they are stable. We've had people in and out of Hospice. Being accepted into Hospice seems like life prolonging medicine for some! :lol2:

[merlee]

Although 2 years is extreme, there are some patients who stabilize just because they have the service. They are not getting better, just living longer than originally expected.

Whoever the payor source is will be keeping track of this, and if they (the payor) are suspicious, they will investigate.

Sadder is the ones who could use these services, but due to denial (of the pt or family) will not have the opportunity.

[Hospice Nurse LPN, BSN, RN]

Yeah, how do they manage to keep pt #1 on hospice? Where i work, they have to come off of hospice after so long if no decline. I know they review it every 6 months and things like weight gain and increased appetite can cause a pt to no longer be eligible.

Actually the pt must be recertified more often than that! 90 days for the inital cert and Q 60 days after that. Medicare/Medicaid have guidelines in place that must be met for a pt to be eligible for hospice care. The hospice cannot admit pts willy-nilly. First, the doc has to give an order for hospice consult, then the pt can be admitted, if they are appropriate. The MD and RN both sign the initial admit and all recerts. We've actually had pts on service for > 1 yr, but they continue to met the guidelines. I've also had to discharge pts because of wt gain or other improvements. Some pts do actually improve for a short while after admission to hospice. It doesn't matter if they are home or in a facility. Think about it. A nurse is visiting 2-3 times/week, CNA 3-5 times/week, MSW visits, Chaplain visits. Usually after the initial improvement, you will usually start to see decline. It may be rapid or slow. Believe me, you don't want to keep pts on service who do not meet guidelines.

[heron, ASN, RN]

Without getting an inappropriate amount of information, it's impossible to say whether the specific situations cited in the OP constitute abuse of the hospice benefit.

As others have pointed out, it's not unusual for a person to at least appear to improve after hospice admission. It's also not unusual for some patients to meet criteria for hospice and still survive for a long time.

But the OP has a legitimate concern. The financial realities of hospice are that the company makes more money on longer-term admissions. Most organizations go through all kinds of contortions to make sure their admissions meet criteria, otherwise the company has to pay the money back to Medicare and could be charged with fraudulent billing. Still, the temptation is always there and historically it's been a real problem in the system.

The OP needs to get a bit more familiar with Medicare criteria for access to the hospice benefit ... ie is the patient admitted for dementia still eating, walking, talking? Is the patient whose daughter wants hospice still getting life-prolonging treatment for the hospice diagnosis? (Most folks in LTC have multiple medical issues and the hospice evaluator has to "pick one" that meets criteria unless the case can be made for adult failure to thrive or non-specific terminal illness = the hospice diagnosis.)

I wouldn't assume that the daughter mentioned in the OP is just being greedy or "getting something for nothing". The hospice benefit is intended to provide care and comfort to people in their homes - and LTC is home for many people. It's a shame that all residents of LTC don't get the same attention ... but staff can only work with what they have and LTC owners will only give so much.

If it's really clear that a patient is not hospice-appropriate and the hospice keeps re-certifying her, then someone needs to "drop a dime". Healthcare fraud is not only theft, it also imperils the existence of the program and makes it harder to care for the people who need it.

ETA: if the Op honestly concludes that a resident is on hospice inappropriately, the state Medicare program probably has a hotline to report possible fraud. If it works the way it's supposed to, it would trigger an investigation, so hopefully it's anonymous.

[CapeCodMermaid, RN]

Just curious...did the OP not think the woman had end stage dementia or did she not think that was a valid reason to be admitted to Hospice? We have several different hospice organizations in my building. They are not all the same....good and bad as in every sector of work.