Bringing hospice into the nursing home

Why your nursing home patients need hospice

When end-stage Alzheimer’s patients become bedbound, families often have little choice but to place them in nursing homes. This places a tremendous financial burden on families, but even more devastating is the tremendous guilt nursing home placement brings. When that stage comes, hospice can be your patient’s best friend.

"Most nursing homes are understaffed. They may have one social worker for 120 beds. When hospice comes into the nursing home, we do everything. We make it clear to nursing home staff that we realize this is your facility, but you have to realize this is our patient, and we will win," says Patricia J. Whitney, MA, MBA, director of hospice for St. Mary’s Hospice in Spring Valley, IL.

Fighting government regulation

The battles are many. "We have one patient in a nursing home and the nursing home is not administering the patient’s pain medication," notes Whitney. "Hospice pain management is not understood in nursing homes. It’s preventive pain management. It’s time-released. Most nursing homes won’t administer pain medications unless the patient appears to be actively in pain. We fight to get our patients their pain medications before they suffer."

In one case, the nursing home staff was not getting Whitney’s hospice patient out of bed because the nursing staff felt the patient was in too much pain to be moved. "We told them, you move the patient, and we’ll take care of his pain. In fact, the patient was in pain because he hadn’t been moved."

Hospice also supplies nursing home patients with equipment to make their last days more comfortable. "We provide extra home health aides. Our own nurse acts as the case manager, and we bring equipment, as needed," says Whitney. "We had one nursing home using electric beds. Many of our patients can’t get out of that type of bed, so we bring in our own beds. We also bring in our own oxygen and meds."

"Our patients get a lot more care than the average nursing home patient. If we don’t like what we see happening to our patient, we will call the state Department of Health," says Whitney, adding that she’s only had to threaten to call the health department twice.

Now, the biggest battle hospice faces is with the federal government. "The nursing home population is the largest population we take care of," she says. "We are dealing with Medicare cutting back on nursing home reimbursement and forcing them out of business. Medicare complains we are duplicating services provided by the nursing homes, but we do so much more," she says. (For more on hospice for end-stage Alzheimer’s, see p. 189. For more on the impact of new Medicare payment systems, see pp. 181-186.)