Top 3 admitting terminal dx

Just curious....what are your top 3 admitting hospice terminal diagnoses? I will start. ..

1. CANCER

2. AFTT

3. ES Dementia/Alzheimers or COPD. (both generally run close in numbers)

I can remember, not too long ago, when cancer was a diagnosis we only used a few times a month. Now, we admit 1-3 cancer patients a week ......

Thanks in advance

[Caffeine_IV]

Lots of cancer and respiratory failure.

[cadawasp]

I am surprised to hear that cancer was an uncommon dx. When I started hospice 16 years ago hospice was the most common. Now cancer dx is less then 50% nationwide. For us top three are. Debility unspecified, CHF and COPD.

[NC29mom, ASN, LPN, RN]

We are only allowed to use debility if the patient doesn't fit criteria for any other dx, and has life expectancy of

Our average stay of care is probably 6months. After a year on services, we generally discharge unless seriously declining. One thing I can say, our patients are definitely appropriate for services, not even a few are borderline. ....

Maybe the increase in cancer diagnoses has something to do with our region....dont know.....but huge increase in cancer admits. And, the patients are getting much, much younger. Its not unusual to admit someone in their 30's.

[Daisy_08, BSN, RN]

99% cancer.

the odd aids, CHF, failure to thrive. Once had a young lady who fell...that was sad, sever brain injury, living will that said no tubes so they sent her to us.

[DLS_PMHNP, MSN, RN, NP]

CA, COPD, CHF. Not too many AFTT or Debility dx.

[Kabin]

In 2011 per NHPCO:

Cancer 38%

Debility 14%

Dementia 13%

Heart Dz 11%

Lung Dz 9%

[SuesquatchRN, BSN, RN]

CMS has now disallowed AFTT and debility.

A lot of people admitted to hospice these days, while dying, don't need palliative care. It's become another moneymaker. None of my AFTT people have pain or distress unless they have a wicked decub.

[NC29mom, ASN, LPN, RN]

I find it EXTREMELY interesting to hear you say "CMS has now disallowed AFTT and debility" .

Could you please reference your comment?

Hospice is not just for pain, or pain related diagnosises. A lot of our philosophy of care deals with emotional/ spiritual support, education r/t dz progression, prognosis, and other symptom management (QUALITY of life).

[tewdles, RN]

I have not heard of that dis-allowance...

[tewdles, RN]

CMS has now disallowed AFTT and debility.

A lot of people admitted to hospice these days, while dying, don't need palliative care. It's become another moneymaker. None of my AFTT people have pain or distress unless they have a wicked decub.

I tend to disagree, suesquatch but I am certain that our experiences are quite different in this regard. In those instances our expertise helps to maintain that level of comfort while working hard to promote a good quality of life as well as providing the MUCH needed support to the caregivers.

[KtHospiceRNCM]

FTT and Debility will no longer be acceptable as Terminal Dx beginning in 2014, as I have been notified by my hospice. After very briefly searching online, I found this page

http://www.jdsupra.com/legalnews/cms-issues-proposed-hospice-payment-upda-90381/

You may want to do your own Google search and see what you come up with.

I would say that many of my Debility and FTT Pts are pretty borderline on appropriateness.. While some decline rapidly, it's a stretch for some.. IMO