Sad sad situation, but not hospice appropriate yet.

[AtlantaRN, RN]

Met the sweetest husband and wife tonight. Husband appears more debilitated than wife. Marketer spoke on phone to husband, but did not meet wife. Wife is declining, but does not yet meet criteria for dementia diagnosis, speaks, eats 100% meals, drank and ensure in one swig......Son was very angry that patient did not meet criteria, i went line by line. he said "marketer said you could do more than home health and you could help us...." yes, if meets criteria. I hate when marketers make promises to patients (btw, marketer is an RN, but is not utilized in that capacity with my company). Yes, patient needs help.....really needs placement, or at least source.

I explained how i could not legally bend any rules to the son (the husband understood), but son did not.

so sad, they need help, but i can't see this wife passing in the next 6 months.

Just so sad.

[curiousauntie]

I think I may be having the same situation on Sunday. I was asked to work a bit of OT by doing an evaluation for a 42 year old with serious pain from a disk problem in her lower back. From what I have been told, she was previously evaluated by one of our on-call nurses and found not eligible, but corp. wants another nurse to evaluate. A 40 pound weight loss and possible depression...sounds like someone who has been falling through all the cracks in every system so her MD decided to see if hospice could do something.

What is so ironic is that we are undergoing an audit by our Medicare consultant to insure we are not keeping patients on service who are not eligible. We have been very closely questioned about a few patients and have discharged a few patients over the past few weeks. One of the corporate nurses wondered if we "know what a terminal patient looks like" as she felt that we were not showing enough decline in our notes.

So, AtlantaRn, I feel your pain. (And if I remember correctly, we work for the same company).

[AtlantaRN, RN]

This wife has been blind her entire life, she has 6 children and only one has really stepped up to the plate to help. He was exhausted, as was husband because wife with sundowners is up all night pacing the floor. Husband said he will take to doc, and she will get 6 weeks of home health (through our company), she comes off service, and they have nothing. Yes, this is like your disc lady....falling through the cracks. really she needs placement............i can't see her passing in 6 months. from what clinical manager said, even the physician was reluctant to give us an order to eval......only hx is hemorrhoids, htn, afib, diabetes, and blindness-----dementia x3 yrs---she is barely at stage 7.....so sad, I would like to really bend the rules on this one, but that would be wrong. and I can't do wrong.

Thank you for empathizing curiousauntie.

[westieluv]

The 42 yo with the disc problem doesn't sound even remotely eligible for hospice. She could live another 40-50 years if low back pain, depression, and weight loss are her main diagnoses!

Why would a physician even consider the idea of hospice for someone in this situation? How about therapy/drug intervention for the depression and a pain management center for the back pain? And weight loss doesn't always indicate an end of life situation, especially if the patient is also depressed. A lot of people with severe clinical depression suffer from anorexia and drop large amounts of weight over a period of time.

Wow.

[curiousauntie]

Westieluv,

That is how I feel. I don't understand why she hasn't been referred to a pain management specialist, a neurologist for possible surgical intervention...someone other than hospice. I feel that we shouldn't touch her until she has had some medical intervention for the "disc problem", and some kind of management for her depression. One thing that I didn't mention was she is a Medicaid patient, no other insurance, so that may be impacting on her ability to find medical interventions or her doctors referrals. I guess I will find out tomorrow when I go to see her.

[AtlantaRN, RN]

Medicaid reimbursement is so low now, that alot of specialists won't even accept medicaid patients...

[tewdles, RN]

Bringing a "disc pain" patient on service sounds like a risk to me...pain control would be the financial responsibility of the hospice. What if the recommended remedy is surgical? Perhaps the pain can be controlled with an outpatient epidural infusion...but that will not be inexpensive for a hospice to initiate either.

I am thinking most hospices would not be eager to take on this type of patient who is likely to be very expensive in the short term.