When I started my last job I went through all my pts histories, talked to their families and did thorough assessments and name to the conclusion that well over half of those pts were not appropriate. In some places I’ve worked I would even say 80% not appropriate to 20% qualifying. I also like everyone else see the writing on the wall and do fear that the death panels could very well start in Hospice. I can see where this new health care law could end up with forced Hospice because socialist are evil, murdering people. And I refuse to have a part in it if it ever comes about.
Of those who were inappropriate admissions (as much as 80%?) how many of them subsequently died while under hospice care?
They don’t die under Hospice care. For example, when you admit a pt with Alzheimers , guidelines state that they must be unable to communicate in a meaningful way, can’t perform any ADL’s for themselves, etc. I would argue that is a little too late to get the full benefit of Hospice. Hospice is focused on the pt, but also on the family. And to me if you wait too late the family doesn’t bet the benefit of Chaplain services, social services such as help planning a funeral if necessary, getting help with food, transportation to Dr. visits, etc. However, most companies want you to admit them when they are first diagnosed and sometimes these individuals are still able to drive, etc. But the longer they are on service the longer you can bill Medicare. And see that is what I will not do. In Hospice, the nurse is also a case manager. That makes he/she responsible for who is admitted/discharged. So with my last job, as I said before, I came in and inherited 15 pts from the previous nurse. I could have discharged probably 11 of those pts if I had gone strictly by the book. However, I’m not ashamed to say I had a married couple who had dementia, one being worse off than the other, but they desperately needed the aide services of bathing and dressing and fixing meals everyday so I made the decision to leave the one on service even though that particular pt could have been discharged. So you see, it wasn’t about bringing about anyone’s death, it was about helping with quality of life and things we take for granted such as being clean.
But I would say the majority who are not in the field and are strictly looking at the bottom line want to keep pts as long as possible and have as many as possible even when not appropriate.