Some hospices are very good. Some are indeed to be feared, like the one that killed Terri Schiavo.
The hospice we are working with just had a woman come to her in the past month who had been refused by two other hospices. She has esophageal cancer and has had a feeding tube for years without difficulties. She is starting to go downhill, not on death's door, but in need of hospice care. She cannot swallow on her own due to the prior treatment for the esophageal cancer.
She was told by TWO hospice providers that they would not take her unless she agreed to stop the feeding by feeding tube. She has months to live. Agreeing to their terms, which violate federal guidelines, would be a premature death sentence.
Not all hospices are trustworthy. Some are deadly.
>She was told by TWO hospice providers that they would not take her unless she agreed to stop the feeding by feeding tube. She has months to live. Agreeing to their terms, which violate federal guidelines, would be a premature death sentence.<
These Hospice agencies need to be reported ASAP!
I have read through this entire post and now I want to share my experience as a Hospice nurse of 5 yrs and as a layman who has had family on Hospice.
First of all I have to address this post. If what you say is true, then I want you to report these two hospices immediately to the states A.G. office for investigation. I have had many pts on feeding tubes and they keep the tubes until they pass. Hospice Medicare benefits cover a person to get a feeding tube placed when they can no longer swallow or if its too painful to swallow.
Hospice is not a death sentence. A pt chooses to seek or refuse treatment as they see fit. If the person has been on hospice and decides they want to seek treatment not covered under Hospice, then you simply discharge them. It takes 2 signatures on two forms.
I have NEVER, nor have I ever seen anyone else, withhold food or water or anything else for that matter, from ANY pt at anytime. Now, when a pts body enters the dying process, they’re entire body begins to shut down. Blood flow decreases to extremities, it is concentrated to the heart and lungs, which is the natural dying process. If you force fluids, via orally or intravenously at this point, the cells will not process this fluid and it will fill up the interstitial spaces usually starting in the face and then the rest of the body and then the lungs, so essentially the pt can in fact die from drowning, which I watched my father in law do for days and it still haunts me. Also there isn’t adequate blood flow to the kidneys in order for them to properly filter fluid and that is why you begin to see very little urine, if any. If you try to feed a pt at this time, their digestive system will not digest it or digest it fully because there is not enough blood flow to the digestive tract and it began to slow down or stop all together, so it just sits in the stomach or one of the intestines and is very painful to the pt. Even putting tube feeding into a tube it just sits in the stomach and when you check residual all of the feeding will still be there, unless of course it backed into the lungs, which will most likely cause bacterial pneumonia. I have seen a pt who was continually fed when they were unable to digest it literally throw up there stool. I have also had to digitally remove stool from pts for the same reason, and is quite painful.
I can also tell you from my experience as a nurse, that having family members who won’t give mama morphine because they don’t want her sleeping all the time and they also want to be able to talk to mama, absolutely can make me lose my religion. They will watch their love one suffer in agony so they can “talk” to them. It is so incredibly selfish! Having said all this, I left Hospice nursing this Jan. and may not go back to nursing at all because of the stress. Nurses, who are worth 2cents, will get attached to their pts and families and that is what I did, probably too attached. I internalized the suffering the family was going through. If I had a pt in the slightest bit of pain I took it personally. Sometimes no matter what you do, or what you give a pt., because you cannot OD them, they still have pain. I began to blame myself for it and I would feel like I was failing my pt somehow. With the deaths of my inlaws within a yr of each other and I lost 4 pts in December of last yr within 48 hrs, I reached my limit. I definitely have reached burnout.
As far as some of these articles dealing with private Hospice companies and enrollment under debility and failure to thrive, when I got out a few months ago Medicare was getting rid of the debility dx because of rampant abuse due to its vague guidelines. And I would argue that failure to thrive shouldn’t be a dx either but Medicare doesn’t care what I think. However, whenever I have had a pt with adult failure to thrive, its because their bmi is very low and I would order periactin or megace, or even steroids to increase their appetite, which usually works. I would monitor their wt and bmi and when it came up above Hospice guidelines, I would discharge them.
I do however, have a HUGE problem with Hospice companies needing marketers. Them and the DON’s in charge of making that money will try to get you to admit livestock if they think they can get away with it. But if you are a nurse who takes your license seriously, then you don’t do it. Because when Medicare comes knocking and they will, they are not going after that Doc who signed those order to admit, they are not going after that DON or marketer either, cause they gonna hang you out to dry. The nurse is the one who admitted, we just went with what she said. Good, smart nurses won’t admit a pt who isn’t appropriate. That’s why my last boss didn’t like me too much. She would try and bully me into admitting pts that weren’t appropriate and I wouldn’t do it. I worked hard for that license and that’s my reputation on the line. Not all nurses are very bright, though. Some only care about kissing the bosses ass.
Also the statistic above that states 20% probably don’t qualify I disagree with. 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.
I would just like to end my lengthy post by saying that nothing I have said is intended to discredit anything anyone has said here, or any of their experiences. There are very good caring people in this world and vary a moral people who only care about earning a paycheck. And I would never deny anyone’s experiences because I know how people can be.