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In general, hospice nurses are comfortable having “THE TALK.” However, it’s not the type of conversation most nurses expect to have with their patients on a routine basis. At some point though, you will have to cross this bridge. So let’s talk about 3 facts every nurse needs to know about hospice.
Have you ever been told to talk to your patient about hospice? I can’t tell you how many times I have had the “THE TALK” handed over me at the end of a visit.
Before I was a hospice nurse, this was a challenge for me because I didn’t not know a lot about hospice and how it worked.
To be honest, I believed many of the common myths about hospice.
However, when I started working on a oncology unit, I had to get it together pretty quickly. If I was going to make it on my unit, I had to get comfortable talking to my patients about dying. And, I had to know the facts about hospice.
Most importantly, I needed to make sure that patients understood their options. Understanding these three hospice facts helped me. And I am sure they will help you have more effective end-of-life talks with your patients and their families.
Hospice Facts & Figures
Hospice is a great service for patients and families. According to the National Hospice and Palliative Organization (NHPCO), 1.55 million Medicare patients received hospice care for at least one day during 2018. Unfortunately, many patients continue to die without hospice care.
WHY IS THIS??
For one thing, nurses and physicians spend little time learning basic hospice facts . Unfortunately, many nurses simply don’t know these three hospice facts.
So, the next time you are asked to tackle the talk with your patient. Do your self a favor and make sure you understand these three facts that every nurse should know about hospice.
HOSPICE FACT #1
Patients do NOT need to be a DNR to sign up for hospice.
Yes, you read that right! Sounds almost shocking, right. Well, if you didn’t know that patients are not required to be a DNR to sign onto hospice, you are not alone.
This is one of the common hospice myths.
In fact, I worked on a hospital unit that cared for hospice patients for several months before I figured this one out. All of our patients were DNRs so I just assumed that they had to be a DNR when we called hospice in to take over care.
(As I write this, I can’t help but smile thinking of all of my co-workers who have sworn to get their DNR tattoos.) I’m holding off on mine for a couple more years. LOL.
This one catches many nurses, patients, and families off guard. If a patient has a life limiting illness and is no longer seeking curative treatment, then they can be evaluated for hospice. They can sign onto hospice and activate their hospice benefit without signing a DNR.
Sure, the hospice team will appreciate it if the patient has decided to sign a DNR; however, I can reassure you that the hospice team is more than capable of getting this taken care of during their time with the patient and family.
Sidebar: If the patient is close to the end stages of life and/or imminently dying- GET THE DNR!!!
Hospice Eligibility
It is up to the hospice team to determine if the patient meets eligibility requirements. The hospice medical director and the patients physician must sign a certificate of terminal illness stating that if the disease runs its normal course, that the patient’s life expectancy would be six months or less.
When it comes to DNRs, the hospice team consists of social workers that can help the patient talk through advance directives and living wills.
If you still have questions regarding DNR, POLST, and advance directives, you can involve the MSW with this discussion. I have found that they are a wealth of information regarding how these work. There are also classes that you can attend to assist you with learning more about advanced directives.
HOSPICE FACT #2
Patients can come off of hospice at any time if they want to.
In hospice, we call this a revocation. For instance, if your patient has cancer and they suddenly qualify for an experimental treatment. They can inform their hospice provider and sign revocation paperwork to come off of hospice. When this happens, they can return to their traditional insurance and resume active treatment.
It is that simple. No fancy tricks or hoops to jump through.
If the treatment fails and they want to come back onto hospice they can. When I learned this, it made it a lot easier for patients to accept that they had control of their situation.
(Only the patient can revoke the hospice benefit, the hospice company does not revoke the patient!) Nod to my hospice QA folks.
A hospice company can’t just choose to revoke a patients hospice benefit just because they do not want to pay for a procedure. For instance, if the patient goes to the hospital emergency department for a Foley catheter issue, they do not necessarily need to revoke. This is something that the hospice team will discuss. (Make sure you talk to your supervisor or agency if this type of situation should arise.)
Depending on how this information is communicated, it can be the difference between a patient making the decision to start hospice or not.
Most patients and families say that they regret not having hospice sooner!
Hospice Fact #3
Hospice is NOT for the last days of life.
Don’t even get me started on the number of times that I have been called to admit a patient as a general inpatient (GIP) while they are in the hospital. Usually this is because the patient is going to die today or in a couple of hours. Sadly, no one has talked to the patient and family about their situation. At this point my friends, you will really need to prove why the patient needs hospice and can’t be managed by your team.
Lesser understood hospice fact: Medicare has strict guidelines for hospice GIP admissions. You can’t just admit a patient GIP because they are imminently dying. GIP is frustrating for providers and can be a bit tricky to understand.
But I digress.
Back to my point.
It’s helpful to understand hospice facts when having difficult end-of-life conversations. A study published by the American Cancer Society found that cancer patients enrolled in hospice live longer than those without hospice.
Try to wrap your mind around that.
Let me say this again.
Hospice is not just for the last days of life!!! Still yet, hospice is not just here to give morphine to help patients die.
This is one belief that I wish would just go away. The problem is that because patients are often enrolled later in their disease course, this idea just gets further perpetuated.
CONCLUSION
The best thing that you can do as a nurse is educate yourself about hospice care and the many benefits to patient. There are a lot of misconceptions about hospice and the more answers you have, the better equipped you will be to answer your patients, families, and caregiver’s questions.
I’m not oblivious to the fact that no one wants to die! I once heard a chaplain say, we all want to go to heaven but none of us want to die. (I can relate!)
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