OneThunder

In the U.S today, more than 20 states with more than 20 percent of the population have statutes which recognize the legal therapeutic use of herbal cannabis or cannabinoid-based medicinal preparations. Another dozen or so have CBD-only laws which authorize the use of low-THC, high-CBD content cannabis.

Totally burned out DON, I'm thinking about working in MDS. Can anyone recommend online classes to bring me up to snuff? I used to do MDSs when they were pencil and paper. (LOL!)

I am looking towards that certification. I worked in hospice for 5 years. You would think that physicians and nurses in the hospice field would be able to distinguish pain from addiction. I recently moved over to an inner city SNF. I see the same attitudes there-even from the pain docs! Instead of addressing the problem of addiction, they limit their pain meds, wonder why they go AMA and soon, we see them again. That is not caring for the patient. I'm hoping we can expand services and I am in the process of educating my nurses. I hope there comes a day I don't hear from a nurse "oh he's just drug seeking". Addicts have real pain,too.

just recently had a tour of our local funeral home and he explained the very same things you did. one thing he also said that if the dentures are lost, they do have a prosthesis that can be used to make the mouth look as though the teeth are in.

Sometimes it's not the family that requests an autopsy. Sometimes it's the law. A fall that precedes death is one example. Regardless of whether they are on hospice or not.

Yes, I agree. I had not heard of "leaving marks, tearing skin" and the like. I have done 100's of post mortem care and never experienced that, but I suppose it is possible.

That is an interesting perspective. Food for thought.

if indeed, my perspective is 'hopelessly biased", then your perspective is punative.

Cigarrettes....FDA approved. Yeah, they do a good job...zelnorm, bextra,vioxx,aprotinin..... tattoos a "bad" habit? OMG....

AMEN! I taught first and second semester RN students. MY clinical group started IVs, inserted foleys, walked rounds with the physician....wrote workable care plans and they loved it! You should have seen their faces when the blood in the canual "back flashed" or when the yellow gold (urine) started flowing in the tubing... they would just look at me and smile from ear to ear. The kids knew my clinical was no slouch... to do a head to toe assessment, they needed to see the patient naked. As long as they were naked, they might as well give them a bath...LOL. At first I could see they didn't expect to be doing all this "manual" labor, but quickly realized that it was to their benefit. And talk about proud. Last summer when I visited the medsurg floor of a hospital, a nurse came up to me and said, "do you remember me? I was in your class"

the big difference between how you and i see things is two fold. i want to see the health care system we have improved one bite at a time. you would like to throw out the whole meal and start over. i want to see our healthcare funded by limited gov't programs and more personal responsiblity. you want comprehensive healthcare to be an entitlement. we both agree that the insurance companies have some pretty shady practices, if not down right illegal and immoral. hhhmm perhaps we should join forces and elicit change on the thing we agree on?

I'm not so sure about that. The media will "jump" on a negative story much faster than a positive one. And remember, just because a patient chooses one hospice, doesn't mean they have to stay with them. They can transfer to another. Hospice patients, like any other patient, must be a informed consumer. I understand that patients facing death (and their families) are in an emotional upheaval. Doctors, social workers, nurses need to be informed on the availability of hospice providers and their reputations, not just refer to the "non profit" hospice because it seems to them it is somehow "better" than a "for profit" hospice.

payment for medical treatment is a complex system of qualifications, whether you rely on government assistance or private insurance. hospice care is a treatment option, just like chemo, physical therapy, respiratory therapy. you must qualify for those treatment options. taking away a treatment option from someone that qualifies makes the government play god, as does restricting access to treatment. all other factors being equal, i don't want to support a healthcare system that does.

payment for medical treatment is a complex system of qualifications, whether you rely on government assistance or private insurance. hospice care is a treatment option, just like chemo, physical therapy, respiratory therapy. you must qualify for those treatment options. taking away a treatment option from someone that qualifies makes the government play god, as does restricting access to treatment. all other factors being equal, i don't want to support a healthcare system that does.

I agree. But shouldn't the marketplace dictate the standards? No business, no hospital, no hospice can stay in business with a bad rep for bad service. And there is the matter of Medicare survey and Joint Commission for monetary punishment.

what you seem to think is obscene, i see as a "continuum of care". what the resident needs, therapies, wound care, respiratory care, is almost always provided by outside services that come into the nursing home to give the resident the specialized care that they require. why is it, that hospice is looked upon differently? there are processes or procedures, if you will, in place by medicare. violations/infractions are delt with.should they be stronger? should the system be changed? are there more nursing homes doing things right than those that make the media who do things wrong? all in all, i maintain the nursing home resident has the same right as anyone else to end of life care. this "specialized" care is hospice.

Originally when there weren't such things as "nursing homes" (back in England, back in the day). And no, I don't think most nursing homes (or corporations for that matter) consider hospice as a way to "limit staffing". Regardless of hospice assistance or not, federal guidelines demand the same forumula including all the residents whether or not they are on hospice to calculate their staffing levels. What hospice really does, it lets the hospice aide spend a decent amount of time doing ADLs,(not rushing through to get to the next resident),do the little "extras" (paint female residents fingernails, perhaps a bit of makeup) and the Case Manager time to actually talk to the resident and/or family, do a more complete assessment without having to worry about all the call lights going off, the phone ringing, and supervising 7 or 8 nursing assistants. Hospice lets the social worker counsel patients/families in grief and loss, or guide them through the maze of financial woes. It lets the Chaplain spend time with the dying resident/family and help them make peace. I really hope you are kidding about taxpayers taking over the nursing homes. The average Joe has no idea how nursing homes are under-reimbursed for the care they give. They just see the sensational headlines about nursing homes that the "ambulance chaser" lawyers pursue. I don't think hospice should try to address all the problems in nursing homes. Only one. The dying resident who wishes to have hospice care at the end of their lives. Just because they happen to live in a facility, shouldn't prevent them from the benefit of hospice care.

Be that as it may, it is reality. LTC facilities budgets are limited by their corporations. They hire and train as they are budgeted for. We can point fingers all day to whose fault it is, but that is NOT assisting the dying patient in the nursing home. And that what hospice was intended to do. Help the dying patient.

Absolutely, like I said, huge case load.

Commenting on the settlement, CEO and President Robert Lefton stated, "We are pleased to have permanently resolved these matters with the federal government and to have avoided protracted and expensive federal litigation. While we continue to believe that our programs and caregivers are compliant with Medicare guidelines, we welcome the opportunity to work with the OIG to further enhance our already extensive compliance program." http://www.thefreelibrary.com/Odyssey+HealthCare+Finalizes+Settlement+with+the+U.S.+Department+of...-a0148061976

Obviously, you have never worked in a LTC facility. The staff can hardly take care of the residents that they have, never mind a dying patient that needs extra assessments and care. Not to mention if the family is at the bedside.

I personally think no one should die without hospice care, and if it takes a marketing team to find them, so be that.

and don't forget union contracts that forbid nursing management to work the floor. Don't laugh- I worked as a manager where this was in effect. You want to talk about frustration! during a particularly nasty flu epidemic, I threw caution to the wind and assisted the nurses on the floor. Believe it or not,my administrator got an official complaint, I was written up and had my hands slapped. We need to develop a vaccine against stupidity or innoculations of common sense.

TRUE - I used to make it a point to use ONE family member as a contact point. All other family members should get their information from this person. Made my life simpler- I could actually spend time on my PATIENTs instead of the telephone. NO>>>>>>> nursing management dictated that we are "sympathetic, concerned, had time to answer questions to all 15 family members>>>>>>' I seriously considered give them her HOME phone number....

I have always said, on admission, families have to sign (or they don't get in) permission for administration of psychotropic medications. Usually the patients are not the problem, it's the families. Prozac in the air filtration system should be of some benefit......(no really, you think I am jaded???)