Education paves way for hospice support

Nursing home staff receptive to clinical info

Establishing a relationship with a nursing home is not an easy task, especially because the staff members of both organizations don't necessarily understand how the other works.

Staff education is a critical component of a successful relationship between a hospice and a nursing home, says Martha Barton, RN, CEO of Pikes Peak Hospice and Palliative Care in Boulder, CO. "We take every opportunity to educate nursing home staff members about issues that help everyone provide better care for the patient," Barton says. "Because a nursing home is so busy, we make ourselves available to slip into planned meetings and present short information sessions."

Team meetings, regular inservice meetings for certified nursing assistants, or any other planned meeting provide opportunities for education, she says. "We also have one-page information sheets that can be distributed to nursing home staff members," Barton says. The one-page sheets address simple topics, such as explanations of what the hospice medical director, pharmacist, or nurse practitioner can do. "These sheets explain the additional resources the nursing home staff can access in a quick, easy-to-read format," she adds.

Clinical topics that are well received by nursing home staff members include a discussion of which services are included in the hospice benefit as compared to the nursing home coverage, how to have the tough conversations with families and patients about end-of-life options, bereavement care, and how to recognize a patient who might be appropriate for hospice care, says Barton. "We also bring our medical director or a nurse practitioner in for presentations on when to ask for help for control of symptoms such as nausea, constipation, poor appetite, and agitation," she says.

Because nursing home patients frequently have these symptoms, a nursing home employee might not realize that a hospice nurse often can prescribe more effective treatments for those symptoms in a hospice patient, Barton adds. "These are symptoms we are accustomed tomanaging with our patients, but we need to know that they are a concern, so we rely on the nursing home staff to let us know early in the symptom's appearance so the patient doesn't suffer longer than necessary," she explains.

Tough decisions to make

The strong relationship that nursing assistants form with patients in a nursing home make some of the decisions that patients and family members make at the end of life difficult to accept, says Linda Todd, RN, executive director of Hospice of Siouxland in Sioux City, IA. One of the educational sessions her hospice offers to nursing homes focuses on these tough decisions.

"We talk about ethical decisions and dilemmas that are faced when working with a hospice patient," Todd explains. "Our medical director walks them through situations that address withholding nutritional support or therapeutic treatment and explains how families and patients come to these decisions. If nursing home staff members have a chance to hear about these tough decisions before they witness their patient making them, they are easier to accept."