The Difficulties of Being Discharged From Hospice Care
Barbara Karnes, RN
Author of GONE FROM MY SIGHT aka: "the hospice blue book", NHPCO Hospice Innovator Award, End of Life Educator
“I just wonder how individuals deal with getting discharged from Hospice because the patient didn't decline quickly enough for Medicare?” is a question I received recently– and it’s not the first one of its kind I’ve received.
Why is the patient being discharged, you ask? Is it because the patient just didn’t decline as rapidly as expected? Yes, that can be the situation.
Is it because hospice took the patient on to service too soon to keep admissions up? Sometimes that happens too.
Is it because dementia was the main diagnosis for admission? Dementia doesn't play by the rules for determining approaching death. Way too frequently, the person has to be dismissed from the hospice program for no longer meeting Medicare requirements.
No matter the reason for discharge, that discharge leaves the family literally stranded without support. No more nursing visits, no more CNA visits, no more social worker or chaplain visits, no more volunteers. No more access to the “I’m scared and don’t know what to do” on-call service. Added to all that, they now have to figure out a different way to pay for expensive equipment and medications.
One of the things I see missing when patients and families are discharged from the hospice benefit is a lack of information and assistance in getting the services they are losing, which can be (partially) found elsewhere.
When at a team meeting, the discussion is often limited to "this person needs to come off of service."?A plan of how to get them different community support needs to become the plan of care.?
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Social workers need to increase their visits and outline community support services.?Not only to suggest and inform, but also to help them get services established. Address the?replacement of equipment, medication delivery, and costs. Discuss the option of palliative care until it is time to return back to hospice. Palliative care doesn't offer financial resources but it does give guidance and support.
Suggest an End of Life Doula. They don’t have the time limitations that hospice services do. End of Life Doulas do charge for their service.??
The point is: PLEASE DON’T LEAVE THE PATIENT AND FAMILY ADRIFT!
Something More... about?The Difficulties of Being Discharged From Hospice Care
I have another blog article,?Hospice Services Pulled for Dementia Patient,?that may be helpful to those whose person?with dementia has been discharged from hospice. My resource,?How Do I Know You? Dementia at the End of Life??will help with understanding the dying process with dementia.? Here is a recent review of this booklet:
One of the BEST dementia supports available!!
"Working as a Dementia trainer and practitioner for 25 years, I can honestly say this is one of the best dementia resources available on the market! Worded in a way that caregivers and families really get it, it affects positive change for all parties involved. Here, here!" -Kim F.
Certified End of Life Doula , Grief Doula, Life Planning Specialist, Massage Therapist, Reflexologist, Reiki Master, Certified Manual Lymphatic Drainage Therapist
11 个月We End of Life Doulas are trying to help in this area but with our services not covered by insurance, most people can’t pay for the services. We need to change our system. Insurance should not be dictating care.
Transforming the denial of death into a celebration of life.
11 个月We might have to discharge our first resident from hospice, and I'm not ready for it ??
President/CEO LifePointe Hospice Dallas Metroplex
11 个月The Hospice CAP is a real part of the issue. Initially there was probably good intentions in creating the hospice CAP, but things and circumstances have changed drastically since the Hospice benifit was approved by Medicare. In reality no one can really predict death until imminence has approached. I am not sure that Medicare realizes the impact that the hospice CAP has on patient’s access to care. Often patients have a difficult time finding a hospice because they have been discharged after being on a previous hospice for more than 6 months. Sometimes patients live longer because of the care, interventions and attention that most hospices provide. Individuals should have the choice not to be forced back into the vicious cycle of hospital, rehab and home health. Especially patients with Dementia. We need to do something to make end of life care better.
Certified End of Life Doula | RN
11 个月Thank You for your suggestion of an End of Life Doula. We can be helpful in situations like this.
LCSW-R, CCM, Geriatric Practice Fellow
11 个月I always share with patients and families that people potentially can outlive Hospice. I attribute this to the good care that they receive from hospice. Depending on the diagnosis, exploring other resources and preparation for discharge is appropriate.