Hospice protocols?
My mom has been under home hospice since February 2020. It was a tough decision to make but I'm glad I did. For the most part things have been okay, weekly nurse check-ins, bed and supplies. And, mom seems to be doing much better under hospice.
With that said, I have a few questions/concerns: (1) What are the protocols for hospice recerifications in these Covid times? Just before the 1st 90 day recert, nurse commented that mom may be kicked out of hospice. I did not appreciate this and have since reached out to mom's PCP and oncologist who stated that mom would continue to be hospice eligible since she has terminal cancer. (2) Nurse deficiencies? Since we've switched to virtual visits, I've had to reach out more than once to inquire if we are having a weekly check-in. Also, as it relates to supplies, I've had to request briefs several times before they actually arrived. The excuses have been: I forgot, needs manager approval and brushed off. I recently expressed my displeasure with the nurse and haven't heard from her since.
I thought hospice was supposed to relieve frustration not add to it. Any suggestions/recommendations?
Were you not trained to flush the picc? Ask her to teach you. With hubby on hospice for 18 months I am surprised at this. It’s easy to do. I had one inserted while in the hospital for a post arthroscopic shoulder repair infection. I was taught how to flush it myself as well as administer my own antibiotics via PICC, flush it and then was discharged home. I had to wait 3 days in the hospital because there was no PICC certified RN available until then to insert the line which was done at bedside. That was the extent of my training. Same with my neighbor who is receiving chemo through the picc. The staff flush the picc after chemo then the family does the flushes every day.
As far as supplies, do you have a CNA that is visiting mom to bathe her, dress her and check on supplies? If so that is the person you should talk to about reordering.
If you are get the brush off from the nurse I would call their office and talk to a manager.
It is odd that she is not getting nurse visits if she is at home. The Hospice I volunteer at, the nurses and CNA's are doing home visits they are doing fewer facility visits and the facilities are using their own nurses for the weekly required visit notes.
Does the Hospice you have have an APP that will allow you to relay information to the team? Ours uses TapCloud it is a secure way to communicate with the Hospice Team.
It will be hard right now, but you can get another hospice in. And telling you Mom maybe discharged...these places will do anything they can within Medicare rules, to keep a client. This is how they make their money. The one who determines Moms discharge is Medicare.
You can always ask for a different nurse. She can't be the only one.
There is no reason that they should be causing more stress.
They usually find something to keep them on hospice. If not, ask for palliative care.
If supplies are not being supplied as often, then step in, and order them and have them delivered, or take them over yourself. No reason not to. If mom wasn't on hospice you would be buying Abri-forms /diapers yourself. Better to have more supplies than not enough.
She has terminal cancer.. That is the main reason for them to keep her on Hospice. Make time for her, play music, dance. be joyful when you see her.
Hospice is not perfect.
take care.
I think the best thing for you is to go over the nurses head and request a new nurse to be assigned to your mom's care.
I'm not a Hospice genius, but someone with terminal cancer should be a no-brainer for continuing Hospice. That was an insensitive remark on her part--and probably caused you stress.
The NURSE does not hold the keys to continuing care, the Drs. do, so don't worry that her recommendation is the last word.
I wish you luck and peace in finding the answers. These days, everybody is so on edge--healthy or not, we're all feeling the stress of trying to get care that's appropriate for us and our LO's.
Nothing more, nothing less.
Not that your mother will lose hospice, of course, but the nurse needs to disclose all those possibilities to you. This is a difficult time for you and maybe you latched onto that specific phrase and assumed incorrectly the nurse meant hospice would be stopped. Maybe she is a new hospice nurse. Maybe she had 6 patients to see that day. Maybe she is the only nurse!
Hospice will not be stopped for your mother. It will not.
I’ve said it before- these are extraordinary times. Healthcare professionals are doing the best they can. The healthcare environment is forever changed now. Telehealth will be the norm. There will be more remote medicine going forward because this pandemic has proven it can be done and done *WELL & SAFELY*. More onus will be placed on you, the consumer, to call your insurance company to see if your test is covered, etc. In healthcare all are being made to multitask (as in other non healthcare companies as well). The “good old days” are gone and never to return.
MD’s to RN’s to CNA’s are scared of getting this virus. It’s an occupational hazard now. Many nurses have just quit and may not ever go back to direct patient care. Some PCP offices are not even open yet and doing telehealth exclusively to avoid Covid exposure. With those PCP’s those patients are sent to the ER if it cannot be handled via telehealth. The ER is not where you want to be. Many older PCP’s are retiring now as this pandemic stretched their resources and they’ve decided it’s just not worth it for the Medicare/Medicaid reimbursement rates (which keep getting lower). Not to mention the new hoops many doctors are required to jump through for authorization from insurance for reimbursement on procedures that were commonly done without extra auth.
I subscribe to Indeed.com for RN’s. Every week there are several open positions for Hospice nurses. Every week. They are *always* short staffed. I have always wanted to work in hospice but when I see those open positions so frequently I hesitate because although I would love to work there as a RN, I am not going to put myself in a position of being the only nurse having to cover RN turnover and have to take care of too many grieving families that I will not have the time to take care of properly and have those families complain when I am doing the best I can. I don’t roll that way. If I can’t care for you the way you deserve to be cared for I am out of there. So no hospice position for me unless it’s as a volunteer when I retire.
I am sorry you have to cope with this while your mother is dying. I wish the best for you.
As stated bring your concerns to the director of nursing and give them a chance to fix it.
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