Stella1688

Hi SuesquatchRN...just to put this out there, there is a bill in congress requesting increased funding for hospice and palliative education to be mandatory in all accredited medical and nursing schools. It has a poor chance of passing but sometimes it helps to write your state rep in support of the bill. Here's the link of you are interested Text of H.R. 1339: Palliative Care and Hospice Education and Training Act (Introduced version) - GovTrack.us

I would be leery too! That is still quite functional and inappropriate for a dementia primary dx

Thanks PamRNinTX, I have often used 294.21 or 331.0 if their chart specifically says Alzheimers. It seems like Senile Degeneration of Brain is a safe bet though.

I'm more curious on everyone's views on dementia as a terminal diagnosis. I think most of us agree that debility is way overused. What about the patient with advanced dementia that can no longer swallow and continues to aspirate, has had a >10% weight loss, needs pain and/or resp distress med management and FAST scale worse than 7A? Are you all still admitting these patients under a primary of dementia if they have no other qualifying conditions?

Just curious, who decided on coding "senile degenerative brain" for dementia? Is there any documentation that this is a better coding choice than just regular dementia, or was it just a company decision? I appreciate your input

NC29mom I am referring to the most recent updates from CMS and looking for help from those who have read them. I understand that comorbs should be listed, my question is a matter of the primary dx. I also do not work for a company that fraudently admits dementia patients, I just want to be up to date with the regulations. Thanks

Hi All, I have read and reread the Federal Register from CMS that was released 8/7/13 with the final rule on these diagnoses...and it is very vague for Dementia. On one hand it looks like they don't want us to use Dementia as a primary dx at all, and on the other hand it seems like it is okay as long as there is not a more appropriate (ie. cancer) dx that should have been listed primary. The report states that many hospices have listed dementia as a primary dx without listing ANY secondaries, and I think that is their issue. Has anyone else reviewed it? If so how have you or your organization interpreted it? Last week I admitted a patient with a primary dx of anorexia and a secondary of dementia and dysphagia to be safe, per the recommendation of the MD. This goes against what I have always done...listed the underlying cause of the anorexia and dysphagia as primary...DEMENTIA! Just wondering what everyone else is doing?

Join HPNA, they have a member's only educational section and try to attend a conference in the future. Purchase the core curriculum book from HPNA (it is what is used to study for the certification test). Your employer should have hospice education available to use as well. ELNEC is also a great resource and NHPCO websites. Good luck!

YES! It has taken a long time to learn not to take it personally. Like the others said we are entering someone's life at the most vulnerable time, but also the families most overwhelming time. It is a lot harder to be the caregiver watching your loved one die than to be the person dying. This person will probably end up apologizing to you. In a way we are sometimes the only punching bag for the caregiver...which is okay as long as it doesn't get out of control. Keep your chin up :)

I agree Tewdles and Nurse_Diane! In a way I am not surprised about AFTT and debility since they have been talking about that for years (and I believe some agencies do overuse these dx and put people on hospice that aren't quite appropriate), but dementia?! It is often clearly a terminal dx, without any other secondaries/comorbids that are enough to qualify for hospice. I really hope this is not going to happen...for now I am really trying not to use AFTT and debility, but with dementia and I am just documenting to the extreme.

Hi All, I got the following message from NAHC regarding proposed CMS changes: NAHC is reporting that in the CMS Open Door Forum held on May 8, CMS indicated thatin the future they will be returning claims to Hospice providers for certain diagnosis codes. It appears CMS is explicitly stating that it does not consider debility, failure to thrive, dementia and other similar diagnosisc odes to be appropriate as a principal diagnosis code for hospice claims. NAHC is recommending that that all hospices review each case where these diagnosis codes are listed as the principle diagnosis. Agencies should also be reporting all related co-morbidity diagnosis codes on their claims." Has anyone heard anything further? This is concerning since there are patients who truly only qualify under one of these 3 diagnoses.

Oops I forgot to say I am an RN and mileage is 0.55, but we do have a high cost of living and gas prices

I work full time in CT $35/hour, don't usually have to take on call but anything over 40 hours is time and a half

I work for a small hospice agency that is only 1 year old and the majority of my patients have been in facilities or home with appropriate care so I have not yet needed to implement continuous care, however if there was truly a need we would implement it after reviewing with the team and MD. Even as a small agency that has not even started making a profit yet, we would never be told that we simply do not offer it.

Try to educate the nurses at the facility as much as you can and empower them to get involved in end of life care. For the most part I have found LTC nurses to be caring and receptive to education, but they are usually stressed and over worked. A few times I have met a nurse who does not understand why you would give morphine for respirations...that is scary, but takes those situations as opportunities for education. Try your best to build a rapport with these nurses, because they can make your job much more difficult if they don't like you. Of course you will never be able to please everyone, but the worst thing you can do is have an attitude that you are better than them. I have been a LTC nurse in the past and felt that some hospice nurses have had that attitude so I try my best not to come off that way.