Make sure patients, families are informed about hospice
Tell them what services it does and does not provide
When patients choose hospice care, case managers should prepare them and their families for what they are going to receive and what they won’t receive when the patient goes home, says Patrice Sminkey, RN, chief executive officer for the Commission for Case Manager Certification.
“If patients know what to expect, they will be less afraid. Case managers should be very specific and very precise explaining hospice care and make sure that family members understand that hospice care keeps patients comfortable but doesn’t provide treatment,” she says.
Social workers and case managers can play a big part in ensuring that patients have a smooth transition to hospice care by making sure nothing falls through the cracks, says Ellen J. Windham, LVN, AAS, BAAS, a hospice nurse for more than 15 years.
Make sure that everything the patient will need has been delivered or is in the hands of the caregivers before the patient is discharged. Check to see that the needed equipment is in place and that the patient has the comfort medication and other supplies needed. “Nothing is worse for a hospice nurse than starting a case late in the afternoon and when you get to the patient’s home, you find that the patient arrived by ambulance with no comfort medication for pain and nausea. The patient is in pain, the family is stressed, and it’s hard on everyone,” Windham says.
When you talk to the patient and family members about hospice, slow down and take as much time as the family needs, Windham says. “We’re all rushed, but it’s so important that patients be fully informed about what hospice does and doesn’t provide and what the family will be expected to do for the patient,” she says.
The biggest misconception people have about hospice is that someone will be at the home providing care 24 hours a day, Windham says. “Patients and families get upset when they find out that, while hospice providers are on call by telephone 24 hours a day, staff visit the home only periodically,” she says.
In some instances, nurses visit the home for crisis care, Windham says. “We see patients for medication management to deal with symptoms such as uncontrolled pain, nausea, vomiting, and fever. The nurses often stay eight to 24 hours shifts until the symptoms are on control,” she says.
“It has to be stressed that this is for short term only. The most difficult things for families to grasp is that death is not a crisis. It is a natural part of life, especially when patients die peacefully at home on hospice care,” she says.
Make sure that family members talk to a hospice representative before the patient is discharged, Windham suggests. When the hospice admissions nurse is talking, have a family member write down what services the hospice provider offers.
Ask the family how often they would like to have a home health aide to come in to bathe a patient and take care of other needs.
Find out if they want a visit from a chaplain, their pastor, or a priest.
Encourage the family to find out in what room the patient wants to be and have the hospital bed placed there. Perhaps the patient would like to remain in his or her own bed, Windham suggests.
“Some people want to limit visitors during the patient’s last days, but a lot of patients want to be in the living room so they can see their family and friends. This is their last chance to catch up with friends, reminisce, laugh, and get closure and their wishes should be met,” she says.
When patients choose hospice care, case managers should prepare them and their families for what they are going to receive and what they won’t receive when the patient goes home.
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