RKMARK

As a Hospice/Home Health RN for many years, I have witnessed the trend to send a patient home who requires increasingly technologically advanced equipment. For example, a vent-dependent patient was rare ten years ago in my area (south). Now complete TPN and PICC lines (etc.) are the norm, along with patients who require more skilled care than many caregivers are prepared to provide. However, it appears to me that the Home Health industry is guilty of simply "dropping" our patients off in the home setting with little regard to proper.....even basic.....instruction for the caregiver. In almost every instance I inquire about, the caregiver states that they felt overwhelmed and unprepared for the task they now faced. Even the most basic safety rules we all learned our first week in nursing school (i.e. proper lifting and transfer techniques/turning q 2 hr/skin and bed care) are never demonstrated. Think of how lost in K-Mart these caregivers feel when faced with complex machinery and the inevitable functional problems that will occur. I know it is, as always, a matter of reimbursement and lack of funds. Yet I can't help but feel that we, as professional nurses, should spend at least one full day in the home of a new client to assess the environment, available resources, and the capacity of the caregivers. How many backs would be spared and unnecessary visits saved if we could simply spend more time in the initial orientation period rather than leave our clients to their own devices? I sincerely feel this is a point that must be addressed, esp. given the tremendous growth in the elder population depending on their children as caregivers. Any opinions or input would be greatly appreciated. Thanks to all of my hard-working, hard-driving coworkers.

Thank you for your response, and your points are well taken. I suppose that the reimbursement structure has changed greatly in the past two years........and no hospice can keep their doors open if they go broke. Thanks for your prespective.

Hello to those of us who are called into Hospice Nursing. I have been an RN for so long, my first job was keeping Flo's candles lit. In those years, I have practiced in Med-Surg, ICU,CCU, ER and community nursing before finding my real love........Hospice Care. Having began my Hospice career seven years ago by working "continuous care" cases in the client's home, I recognized the extraordinary journey that began by entering a home of individuals usually unknown to me previously, and being honored with the trust they bestowed in me to walk beside them in such a difficult time. The opportunity to apply the skills I acquired in providing comfort, pain management and emotional support has always been my view of the essence of nursing. It has always been my philosophy that it is ones ultimate dignity to die in ones own bed, surrounded by the familar faces and possessions that completed their life. However, after a two year hiatus from Hospice practice, my personal observation is that this basic aspect of historical Hospice care has been lost. It seems that the two Hospice organizations I have been associated with here in Arkansas have all but abandoned respecting the patients wish to remain at home with professional care to ease the death process. Instead, the overiding practice of filling up the beds in the in-patient unit appears paramount. If one's wishes are to die at home, the current practice seems to be providing (at best) sporadic care from a CNA (who, for the record, I have the utmost respect for) or leaving the patient and family to their own devices with no resources other than a list of telephone numbers to be called after the event. I am curious if this is isolated to my particular area, or if other Hospice professionals have encountered similar practices? I fear we may be abandoning a very basic tenent of our promised commitment to our patients in exchange for more lucrative (and selfish) motives. Any comparisions or opinions from my colleagues around the country would be greatly appreciated. All my best to each of you. Robert

Hello Amy: I just picked up your message and wanted to respond. Actually, I was not in Arkansas 15 years ago.....ironically I was living in Arizona at that time. Yes.....Hospice HomeCare is now a for profit organization. They do have a beautiful in-patient unit off of Bowman Road in west Little Rock (an area which has grown tremendously since you were last here). I began working for Arkansas Hospice (a non-profit) around six years ago. I loved the organization their true emphasis on the individual patient. Unfortunately, the woman who hired me suddenly passed away (between visits, for Gods sake), and she was replaced by a guy who had previously worked in the payroll department. As time went on, the situation became a bit awkward as he wanted to cross my personal boundries and became harassing. I then went to Hospice HomeCare......and it has been different, yet still satisfing. Their emphasis is definitely on the bottom line. I used to do continious care (which I loved) but HHC does not do such duty. They had rather fill up their inpatient unit. They are also in some flux as they are facing a multimillion $$ fine for Medicaid fraud (cutting deals with local nursing homes). Things are changing slowly, as they have some new investors. We will see. They usually have openings for RN's (as does Arkansas Hospice)......and with your experience, you should have no trouble at all. Also, the big VA hospital next to UAMS is opening a pallative care center soon (next few months). They have great benefits and pay. Arkansas Hospice does pay better.....at HHC, I make $21.66/hr as a PRN nurse. You are probably used to a higher rate of pay, but again, your experience could easily warrant a higher rate. Let me know if I can answer any questions for you. Come on back......the property values here are still holding steady, and the cost of living still very reasonable. Hope this helps, and will give you any assistance I can. Sincerely, Robert Morgan

Thank you so much. I had a instinctive feeling that there is an emerging market for this servce. Your information is most helpful, and I will begin to send letters to the elder care lawyers in the Little Rock area. Can you offer any more resources I could explore. For the past five years, I bave been a case manager in hospice practice, yet wish to start a business with an attorney friend of mine who would be excellent in the area of elder care. We both love geriatric medicine, and would like to be an advocate for this growing population. I was diagnosed with metastatic prostate cancer at age 42 (seven years ago) which had moved to the bone when it was found. I love hospice work and would like to take my service further. Again, thank you for taking the time to respond to my post.....your kindness and thoughts are much appreciated. Robb

Hello. I have an idea for a nurse who seeks more independence and autonomy, esp. one who is interested in the aging population. So many of my friends (in their 40's-50's) either relocated for career reasons, or have a parent who is now experiencing medical/physical problems their children are finding difficult to manage. How about a service in which a nurse is contracted to perform an assessment of both the parent, the family unit, and the current living situation. We have been doing assessments throughout our career. Then, the nurse could provide a "care plan" of sorts dealing with potential options in which to address with the entire family. If the parent is currently being treated for some disease, we could provide input in the expected progression and treatment options. We could make suggestions on how to create a safer home environment should the parent wish and is able to remain in their home. Screen and hire in-home assistants. Help navigate the complex world of insurance and treatment regimens. Act as a liason between the physician, patient and family. The possibilities are endless. Also, with the practice of elder care law expanding at a tremendous rate, think of how a nurse could provide our unique insight into the needs of an aging client and their caregivers......create a framework in which to work to provide for the much needed security of eventual long term care. I realize that Geriatric Care Managers provide much of these services, yet there is no requirement that they be nurses, or actually have any medical background. Has anyone else pondered such an opportunity for nurses who want to expand into their own businesses? Does anyone currently provide such services now? Please share your thoughts with this forum. Sincerely, Robb from Arkansas

Hello Everyone. I hope all of you are doing as well as thopossible in these very different times we find ourselves in. Any information on Oydssey HealthCare, a national company......would be greatly appreciated. I have five years of hospice experience......and it is definitely my niche. The company I contract out with presently is undergoing a change in ownership......and many of us are not comfortable with the new managements priorities. Therefore, like many of us, I am looking for employment as an RN elsewhere. I was offered a position that paid "per-visit".......and the math did not justify the move. Oydssey pays a salary for PRN nurses (which I am interested in) and does have openings in my area. Does anyone currently work for Oydssey.......has in the past....or even know anyone who has been employed as an RN there? Any bit of information would be very welcome.. Good thoughts to you all....

You are quite welcome. I apologize for potentially slipping up and quoting the PRN rate. I think the Case Managers and the In-Patient staff pay around $19-20 per hour with benefits. If you are moving to Hot Springs (I lived there for a few years and loved it), Arkansas Hospice operates an in-patient unit in the new St. Joseph Hospital.....which is a beautiful facility. I do see postings frequently for RN's there.....and the staff is great. The Bentonville/Springdale area has really grown, and there are some hospice organizations there. I think their pay would be comparable or perhaps better. I would suggest a Google search for "Hospice in Fayetville/Bentonville AR" to see. By the way, I am thinking about moving myself, and am curious about the employment climate for Hospice RN's there.....Phoenix or Scottsdale.....and what they pay for regular and PRN RN's is currently, if you might know. I would appreciate the information, and good luck in your move.

Thank you so much for your information and attention. I feel better about making a change, thanks to you. Robb

Hello. I live in Little Rock, and there are two primary Hospice organizations here. Arkansas Hospice is a non-profit agency with offices in Hot Springs, Cabot and Russellville. They have small inpatient units in LR, Hot Springs and a larger one in Russellville. From what I have experienced, they are the preferred one to work for because of their belief in their mission and the community support they receive. The other one is Hospice Home Care, which is a For-Profit organization. They have a large in-patient unit in LR, and also cover much of the mid-state area. However, they are undergoing some ownership changes, and it remains to be seen how this will affect them. Having experience with both, I would probably steer you towards Arkansas Hospice. They have frequent openings for RN case managers and PRN positions. If you do a search for either on Google, they will have their current openings posted. Arkansass Hospice pays their PRN RN's at a rate of $30.00/hr......and HHC pays $22.00. Good Luck and welcome to the Natural State.

Hello. I am an RN of over 20 years.....the last 6 of which I have worked in Hospice. I am thinking of relocating to the Dallas/Ft. Worth area, and am curious about the employment opportunities there. My main interest is working in the field, and doing continuous care. I carry my own benefits, and prefer working on a PRN or contract basis. Can someone shed some light on the hourly pay/job climate/etc. Also, can anyone recommend any company they have had positive experiences with? Any input would be greatly appreciated. Thanks.....Robert