When I started in hospice 13 years ago, we had certain diagnosis we could use: ALS, dementia, renal, cardiac, et al. There was specific criteria which had to be met. They could see their attending but could not see any specialists for the diagnosis we admitted them for. If they were still wanting to get treatment or voiced they would go to hospital, they were not ready for hospice. We used Roxanol, Ativan, scope patches, phenergan, bisacodyl, Tylenol and ABH in our comfort kits which were sent to every pt admitted and these meds worked great at controlling symptoms.
when families called after hours, it was because the pt was sob, in pain and/or scared and their loved one was dying. I would do a lot of teaching about signs and symptoms, calm the pt and assure the families they were doing a great job. It was a hard job time wise and emotionally, but very rewarding and I thought I would never do anything else but hospice.
They got rid of adult failure to thrive, but now the diagnosis of protein calorie malnutrition is used. Many other diagnosis which in years past, the medical examiner would question and has no disease specific criteria, is used all the time. The criteria seems to be recommended but if the doctor thinks they qualify, they get admitted.
Pts who would never qualify before, are being admitted. The medications we usedto use are no longer allowed because they'd are compounded and cost more, but trying to find something that works ends up costing more. And not everyone gets comfort kits on admission.
i get called out for itching, dressing changes, constipation, all on pt's that are not dying anytime soon, and more than likely not within 6 months. They can come on for "palliative care" and basically see and do anything they want and still receive the benefits of hospice.
we are managing diabetes, Coumadin, doing PT/INRs and other labs, IV antibiotics.
i feel this is not hospice anymore but level of care above hospice, but below home health. It takes an act of congress to get our c 2 meds, when before I would call up the local pharmacy, give them the order and the medication would be delivered. Now, we have to call an intermediary company enclara and they mail the medication after they receive the c2. If I need it now, I still have to call them so they can enter it into the computer, then wait before I can call a local pharmacy. They have to get in touch with doctor to get C 2 and then the pt will get their meds. It ends up taking up to 45 min to just make all of these phone calls.
i don't know if I'm just getting burned out, or just getting old but I don't like this "new" hospice. It's been the same with the last 3 hospices I worked at. I thought it was the company itself but it continues wherever I go.
I also wonder why do I care so much that people who don't really qualify, are getting on service, I should be thankful I have a job in this economy, but I do care.
anyone else having issues with the changes or is this localized? Or am I over reacting and just need to accept the changes or do I get out.
i would like to hear about some of the changes you are experiencing and how do you deal with it?
sorry so long, but thanks for reading!!