Questions about In-pt Hospice

heron, ASN, RN · Feb 15

Inpatient hospice is basically intensive care for people who are dying. When I worked it (2003-ish to 2011, there were 3 criteria for admission: symptom management, caregiver collapse (respite care) and terminal (as in actively dying) care. It's bedside nursing, with very similar issues.

You are likely going to be doing some, if not all, direct hands-on care. So, knowing how to move and position somebody in bed, clean up incontinence (among other things), do wound care, IV care, respiratory care, etc ... all without putting the dying person through more pain than necessary ... is part of the learning curve.

You will probably be giving meds by all the usual routes, plus a few not commonly used elsewhere. Get familiar with subcutaneous infusions. How much time you spend giving meds depends entirely on patient load and what symptoms you're treating.

And yes, there will be families. And it's your responsibility to deal with them. Basic psych knowledge helps here.

Be very careful, though, about the company you're working for. A good way to get a feel for the company is to shadow a staff nurse on the unit you're applying for.

fworkentin · Feb 15

Greetings heron,

Thank you for replying. This was really helpful information.

You mentioned about being careful about the company I'm working for. This will be a new unit, so I will be unable to shadow other nurses. What kinds of things should I be aware of?

heron, ASN, RN · Feb 15

fworkentin said:

Greetings heron,

Thank you for replying. This was really helpful information.

You mentioned about being careful about the company I'm working for. This will be a new unit, so I will be unable to shadow other nurses. What kinds of things should I be aware of?

Investigate the owner(s). Do they have a record of regulatory issues? If they own LTC facilities or multiple hospice agencies, their inspection violations and medicare scores would be interesting. Does the company have a good reputation among local healthcare workers? Will the unit be freestanding or part of a facility? Ask about planned staffing, including access to social services and chaplains. (Personally, I think a 4:1 ratio is pure fantasy.) How will they be handling orientation and inservice training? Funding sources? Are they a for-profit company?

Inpatient care has the highest reimbursement rate under the Medicare hospice benefit. Private insurance uses pretty much the same model. When I worked hospice, reimbursement was a capitation system: flat rate per patient. The hospice organization has to provide all necessary services, meds and equipment and nursing care out of that flat payment. This makes inpatient care a cash cow if the organization can keep census high and expenses low. Predictably, the industry as a whole is plagued by fraud and poor care: inappropriate admissions, under-staffing, lack of equipment and other physical resources - you get the idea.