SNF/ALF challenges with Hospice providers?

[HazelnutCream]

Hello all! I am a Hospice Director of Nursing, working to improve our collaboration and coordination of services with both local skilled nursing facilities and assisted living facilities.

I have two questions/requests:

1. What are your current biggest specific challenges that you face with local hospices?

2. What strategies have you used that have been most effective in improving these relationships?

I'll include examples of some of our challenges in the comments.

Full disclosure: I imagine at some point in the future, I will put together a presentation or article on this topic. I have cross posted this to the hospice area to get their input as well. No specific details, challenges, or strategies will be included without prior approval.

Thanks!

[HazelnutCream]

Some of our challenges (from the perspective of a hospice provider):

-ALFs that refuse to allow any PRN medications

-ALFs that do not allow hospital beds or oxygen

-SNFs that expect hospice to perform all treatments (e.g. daily wound care)

-SNFs (and some ALFs) that contact their attending MD for orders without notifying or updating hospice of the concern or the new orders.

Not one I've personally faced, but have heard from other providers:

-ALFs requesting continuous care any time a patient has ANY symptoms

I'm sure there are more that will come to mind but these are the biggest ones that I can think of. Interested to hear what others are facing and what is working for you. If you have suggestions for what works great for you, I would love to hear that, too!

Thanks!

[ktwlpn, LPN]

I have two questions/requests:

1. What are your current biggest specific challenges that you face with local hospices?

Communication,not receiving necessary documentation on a timely manner,delay of care.

2. What strategies have you used that have been most effective in improving these relationships?

Palliative care nurse now co-ordinates the care to make sure we are a cohesive team.Protocols are written as needed,each agency has a clear understanding of our expectations.We don't hesitate to call our physicians ourselves when a resident is symptomatic and the agency is not responding.We can make one call much faster!

The staff of all of our hospice agencies work WITH the unit nurses.They also will come in an give in services.The culture in the facility has really embraced the hospice model but it took a long time.The more visible they are in th he facility the better they are acceptedn

[CoffeeRTC, BSN, RN]

We seem to have good relationships with all of the hospices that we use.

We are a SNF and may only have 1-2 residents at a time. Any isses we've had seem to be resolved by communication.

A few things that we had to work out dealt with communication. When we get a respite admit, we rearely get a good listing of the medications or basic chart copy from the home.

[RNBearColumbus, BSN]

As a LTC/SNF nurse, I think the biggest challenge we face when dealing with hospice providers is that not all of the nurses that work the floor understand the role of hospice for patients in a LTC/SNF setting.

They also do not understand when or why continuous care is needed or appropriate.

Maybe partnering with the facilities you work with to provide inservice or educational materials about hospice care, and the partnership between the facility staff and the hospice staff would be a good idea.

At the facility I work at, we view hospice as a supplement to the care we provide.

[VivaLasViejas, ASN, RN]

I think a big challenge in LTC facilities is educating floor nurses to be less afraid of giving adequate amounts of comfort medications. I've seen (and followed) many nurses who were so nervous about the high doses and frequency of morphine and other drugs that patients were actually undermedicated, much to their detriment. I'd come on duty and find my end-stage cancer patient had had only 10 mg of morphine all shift, when he clearly needed it every hour. That meant spending much of my shift trying to get ahead of his pain and air hunger, and of course this only added to his distress. In one facility I actually went over the administrator's head and asked one of the hospice nurses to give an inservice to our nurses on caring for EOL patients. They were only happy to do so, and our patients got better care once the staff understood that the goal was NOT to keep the patients alive, but comfortable.