Your are reading Part 7 of my series, “What to expect from your hospice nurse.” To gain full perspective, I encourage you to start from the beginning by visiting the series landing page HERE.
Hospice care can happen wherever you call home. This means that your hospice nurse can take care of you anywhere you have residence. This can be a senior living center, an assisted living facility or even a nursing home.
Why have hospice in a nursing home?
It may seem redundant to have hospice care in a facility that already has 24/7/365 nursing services.
If you consider all of the articles I have written up to this point, I have shown how robust hospice care actually is. This series should also show how complicated it can be to care for a dying person. Then if you consider the fact that 15%-20% of nursing home patients either qualify or are on hospice, this means that a large portion of nursing home patients need the increased care that a shortened life expectancy represents.
As a hospice patient starts to decline, their needs increase. While the nursing home does have RNs, LPNs and CNAs, they don’t generally have a chaplain to address spiritual needs, and they (generally) only have one social worker.
Simply put, hospice patients can have a lot of needs that are (somewhat) outside the normal flow of nursing home activity. You might think that nursing homes are just full of dying people, so nursing home nurses should be just fine. This is not true. Only some of them are dying. Most of them call it “home” because their medical needs are just too complicated to remain in the community.
So, what do hospice patients need that is so special? Hospice patients get a lot more visitors than regular residents. This means even more questions for facility staff. Often times, funeral arrangements have not been made. Sometimes there isn’t a DPOA who can make decisions once the patient is incapacitated. Hospice patients have a lot of increased psychosocial needs because, well, they’re dying and most of the time they’re scared.
From the nursing side of things, the nurses in the nursing home can have 20, 30 or even 40 patients they are responsible for every day. At night the ratio can get even higher. This means that most nursing home nurses just don’t have the time in their day to address every need that a hospice patient may experience. Having the ability to pick up the phone and request a visit from the hospice nurse can be a huge benefit.
A hospice nurse can rearrange her day to make a special visit to address a significant change in condition. The nursing home nurse still has many residents to care for, and she can’t spend the kind of time a hospice nurse can spend at the bedside.
Your nurse does not own the nursing facility where you live
I’m sure this sounds pretty obvious, but I can tell you from experience that, sometimes, hospice nurses get treated like they own the nursing home and can just wave a magic wand to change how the nursing home does things.
Please understand something. I’m not saying that nursing homes don’t know what they are doing. Nursing homes have certain state mandated regulations they must follow. This means that your hospice nurse cannot just do whatever she wants. The hospice must follow the same guidelines that the facility has to follow. What may be allowed at your home may not be allowed in a nursing home.
Hospice is not in the nursing home to take over your care. Hospice is an extra layer of care on top of what you are already receiving from the nursing home.
This means that your nurse cannot (and should not) do anything without first consulting facility staff. This is because your hospice nurse, and the facility nurses should work together to provide your care.
You may be tempted, at times, to try to put your hospice nurse in the middle of any problems you may be experiencing with the nursing home. You may think, incorrectly, that your hospice nurse has enough authority to correct or fix facility related problems.
Your hospice nurse has no authority over how the nursing home works. Your best solution when problems arise is to ask for a Care Plan Meeting.
A care plan meeting in a nursing home will have facility and hospice staff involved. Generally, the facility will send someone from nursing leadership, the social worker and any specialty services such as dietary or rehab. The hospice will usually send the RN case manager and the social worker. Other members of the IDT/IDG may attend depending on any concerns that will need to be addressed.
The meeting should be pretty straight forward Hospice staff will answer any hospice related questions, and facility staff will answer any facility related questions. Hospice should not try to “fix” what the nursing home is doing, and the nursing home should not try to “fix” what hospice is doing. They should both work together to address your needs.
In some ways hospice in a nursing home can become more complicated than it is at home in the community. It can be especially complicated if you are receiving hospice care at home and have to be moved to a nursing home due to increased care needs.
The key is strong communication from all three entities. The more everyone communicates with each other, the less likely they are to experience problems.
It is my STRONG opinion that the majority of the communication and understanding needs to be the responsibility of the hospice. Nursing homes have a certain way of doing things. It is up to the hospice to conform to the style of the nursing home. Not the other way around.
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