Stay Until The Job Is Done - Hospice and Home Health

Dear Barbara, How do you get people, mainly management, to understand that hospice work is not an in and out job, it’s a team commitment to serve the patient and family and, honestly, each other. It's a heavy calling, and one that I have been blessed to be part of for 8 years as a hospice nurse. But the push to get in and get out and head to the next one is super stressful. It feels that productivity is valued more than anything. We went under the same director as Home Care a year ago when our founding director retired, and this has been a struggle within my department ever since. We are constantly being compared to what Home Care is doing. No matter how many times I have voiced that we can not be compared to Home Care, my voice is not heard.

I ran a home health care agency and a hospice agency at the same time, as separate entities (different staff, different expectations, different care, even different billing mechanisms). A home health care visit is, yes, in and out whereas hospice visits are in as long as it takes to address the current situation and then out.

With hospice you never know what you will find once you enter the home. Service can’t be time based. Visits have to be stay until the job is done and that should be an expected 60 minutes but can easily turn into three hours.

The way hospice visits used to be were that we stayed as long as we needed to to address the particular situation BUT, over the years, because of medicare regulations, wage and hour, and profit motives, hospice has lost its focus on the time it takes to provide good care.

I think part of this loss of focus is because hospice administration (the management) now comes from a hospital/home health/business base and not from the philosophy of idealism, heart centered, end of life care that is the root of hospice care.

I think this is why you are frustrated (it is certainly my frustration as well). What to do about it is another matter. Defend your choices. Find like minded co-workers. Be the Light in the darkness.

Something More... about Stay Until The Job Is Done

In my book, The Final Act of Living, Reflections of a Long Time Hospice Nurse, I share insights and experiences gathered over decades of working with people during their final act of living. For both professionals and lay people, this book weaves personal stories with practical care guidelines, including: living with a life threatening illness, signs of the dying process, the stages of grief, living wills, and other end of life issues.