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What hospice docs need to know for a home visit
It's a major change for some
Making a home care visit is one of the biggest challenges for physicians and other health care practitioners trained in the medical model because they're not in control of the interview.
While hospices train their nurses and nursing assistants to work in a home care setting, they may be overlooking the needs of hospice physicians and nurse practitioners, experts suggest.
"When you see patients at an office you decide when they come in, decide when to see them, and you walk away when you're finished," says Deidra R. Woods, MD, FACP, CMD, hospice medical director of LifePath Hospice & Palliative Care Inc. in Ruskin, FL.
"You're really controlling that interaction," Woods adds.
It's an entirely different scenario during a home visit.
"When you enter someone's living space, they are the king of the castle, and you're no longer in your own environment," Woods says.
Physicians and nurse practitioners sometimes find themselves surprised and uncomfortable in a home care situation.
For instance, Woods once was visiting a man who was sitting on his screened-in porch, where it was very hot. As the man talked with Woods, the man's daughter held a hand-held video camera and was videotaping the interaction.
"It was quite a surprise," Woods says. "I said, 'Oh, how unusual,' and the daughter was very clear that she didn't care who her daddy was talking to; she was taping her daddy in his dying days."
Woods had been uncomfortable, thinking the camera was connected to the care she was providing, but to the patient's daughter it was all about recording his last moments, even when he was talking with his hospice doctor.
As LifePath Hospice's business has grown, the hospice has hired additional nurse practitioners and physicians who previously had not done home visits, says Terri Massaro, MS, ARNP, AOCN, APRN, BC-PCM, a nurse practitioner with LifePath Hospice & Palliative Care in Tampa, FL.
"So we were talking in our medical staff meetings about what makes a good hospice visit and what were some of the trials and tribulations of them," Massaro says.
As a result of these conversations, Woods and Massaro have spoken at national hospice conferences about how practitioners can achieve successful home visits.
"It's difficult because you are on the patient's turf, and you are a guest in their home and that kind of shifts the power," Massaro says. "It's still a clinical visit, but you're a guest in their home, and it's easy to lose boundaries when you're looking at pictures of their grandchildren and petting their animals."
Woods and Massaro offer these ideas of the challenges to successful practitioner home visits: