igloorn93: E/S Cardiac does stand for end stage cardiac. As far as psychotherapy goes, the pt won't typically leave his home...he gets very anxious when he has too...so I doubt he will go to psycho therapy, but I will encourage it. Maybe there is a psychotherapist around that will do home visits. At least he did consent to let a counselor come in one time a week. I am going to the pts home 3x/week at this time for emotional support. I will ask the MD about Klonopin...I don't think the pt has tried that one yet. Thanks for the reply!
maureeno: This poor man is frantic. He also insists that no one can help him. Most doctors, even his most recent psych MD, just give him meds and never even talk to him. I asked his wife about his behavior at the doctor's office...the pt is withdrawn and quiet so I guess I can see how the MDs miss the anxiety factor. I can also understand why this pt would feel as though there is no one there for him...many doctors in the past have dumped him, his current doctor doesn't think he can help him, his family doesn't come to see him, and most of his friends are dead (pt is 86).
The hospice social worker visits the family also. She also stated that the pt had more of a problem with anxiety than depression. I know the pt still has some depression. The pt is very effected by loss. The depression started with retirement 20 years ago and seems to worsen with each loss (loss of his mother, loss of a son, loss of a son-in-law, loss of friends, etc). His anxiety runs very deep too. He worries about everything...his kids, medication, impeding war, his health, etc.
I don't think the pt will be recertified under his dx of end stage cardiac because he won't fit medicare's criteria, but there may be a different dx he will fit into. We have actually had some hospice pts with us for 3 years. Usually, as long is there is some type of change like weight loss, decreased functioning ability, etc..., the pt can be recertified under our program. We just have to be cautious of medicare fraud. I will just have to document well so my man will be recertified when the time comes. I would hate for him to get dropped by us too.
I am going to suggest Klonopin to the MD. I'll probably try to get the order through my hospice MD, as he is more willing to work with me and the pt than the psych MD.
I will continue to be there for the pt and his wife, even if he does remain anxious. The wife is very relieved to have someone in the home a few times a week to share the burden. I will remember to be predictable like you said...that is very important right now. Thank you so much for your help and advice!