Some questions about Hospice Case Mananagement

Mazzi · Mar 29, 2008

I would recommend being a field nurse first in order to grasp the whole realm of issues dealt with by patient and family. There is also the area of payment that you would need to understand. Example if pt was Medicare, Medicaid, Private Insurance. Then you need to understand DME's, the different types of any supply. There would also be the underdstanding of all the different interdisiplinary support staff, Chaplin, MSW, HHA, and voluteer. If your background is Home Health, this would make it a little easier to understand the pt/family needs. Hope this helps.

kayla123 · Mar 31, 2008

I am a Hospice CM in SW Florida. I have a caseload of 12 patients. I work out of assisted living facilities, several different ones, so I do quite a bit of driving. I do get half descent mileage compensation. My typical day begins with voice mail, e-mail and messages, if no immediate problems, I start my day. I am required to do a full assessment on each pt every week, and a follow up visit. If pt's are stable I need only call the facility to make surethere are no new needs or concerns. I break my week up and usually do 4 or 5 assessments a day. I make the beginning of the week busier so I am not stuck doing assesments Fri. afternoon. I take care of the medical side, the SW does the financial side (Thank heavens) We all work as a team, the RN, LPN, SW, CNA, volunteers, Management, and our Hospice Docs. If one person is behind, someone else jumps in to help. Our LPN's can do everything except an assessment, they are worth their weight in gold. I work till 5 pm. If my visits are done early, I go home and do my charting (on computer) as long as I can be reached until 5, it is OK. After 5 triage picks up and I turn my phone off. If I need a visit, or a pt seen later on, I call triage to visit. We have an interdisciplinary team meeting weekly and discuss select pts with all disciplines present. (Works great if you needs new orders) I do not work weekends, nights or holidays. I make my own schedule and am very autonomous. Some days very obviously are more difficult then others, We have an awesome psych support system not only for pts and families, but employees as well. We also have aroma therapy, massage therapy, pet therapy, music therapy, art therapy, and probably some more for our pts. My pay is less then the hospital, but I do not pay for full benefits, and I do not have hospital baloney to put up. I would scrub toilets before I ever step foot back in a hospital. Is this stressful? Yes, it very well can be, but coming from an open heart and PACU background I can honestly say this is so much better. It can be very emotional for you, being with a dying pt makes you re-assess your own feelings on dying and death, but the fact of the matter is we have no say on when we will die, but we can definitely say how. I consider it a privledge to be a part of peoples lives during such a difficult and emotional time. The main difference is that these people WANT you there and appreciate everything. This what nursing is supposed to be. It is also not for everyone. We have a pediatric division, which to me I would rather die myself then work it. If you call your local hospice and ask to shadow a nurse for a day to see what is truly involved, I can explain until I am blue in the face, in won't substitute for your experiences. Good Luck, please let me know how it goes.:nuke:

shewalke · Apr 9, 2008

I really thank you all for you comments. I really found them helpful. I have an interview tomarrow for a position as a RN Case manager for hospice patients, so I'm hoping all goes well. I would be happy if I would be able to give the appropiate time and focus on one patient at a time without having those constraints that occur in the hospital. Thanks again for your help!

kayla123 · Apr 9, 2008

Best of Luck to you! :yeah:

Please let me know how it goes.

shewalke · Apr 12, 2008

Well, I got the job!!! :rollI'm a little nervous but excited. They are telling me the caseload is 14 patients. I will receive 2-3 weeks training. Unfortunately they have on-call. It would be every third weekend. I believe she stated from Fri after 5p to Mon 7:30a. They also don't have LPN's so that's kind of a downside too. She stated mileage compensations is on the low side $0.40. MDT meeting is every other Wed. The pay is salaried so that's another bonus. I have benefits, PTO, etc. So I hope this will work out for me. Kayla123 if you have any opinions, I would really love to know what you think. Thanks again for you help!

kayla123 · Apr 13, 2008

Congrats!!!!! :yeah:

It is a whole different way of nursing. My philosophy is to take each day by itself. Once I realized I could not solve ALL a pt's problems and started focusing on the ones I could help with, life was easier. We have a natural tendency to solve all things. Family dynamics were a big one for me. Give yourself time to get settled into a 'routine', you wil love it.

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Passion for the Job · May 23, 2008

Congrats, sounds good. Keep in mind, ti takes about a year to get the hang of it so don't quit or get overly frustrated @ first. It will be overwhelming.