Friday, November 4, 2011

Starbucks, Hospice and Visiting Nurses

I'm writing this with my new laptop, back on the screened-in porch, a few weeks after my previous laptop crashed. OK, I spilled water on it and THEN it crashed. It's raining now on a  cool, fall evening.  Coffee about ready for brand new Soin Medical Center Cup.    Starbucks never tasted so good.  I’m tired.

I received three calls from visiting nurses at lunch time today.  I always take calls from visiting nurses and hospice nurses immediately.  These situations are fairly complex and involve multiple persons beyond the patient.  I like to hear the nurse’s professional opinion after I give an overview of the patient, their life and family situation.  I want to get their perspective and give mine, then we clarify and make decisions.
One visiting nurse just met my patient today and told their family that Hospice could help them, before I ever spoke with the nurse.  Then the family member who is POA for healthcare called me to express their shock that their mother might be needing hospice.  It took a while to reassure them that their mother was not in a hospice mode, but recovering from the illness that lead to her hospitalization.  Very interesting.

Two days ago another  visiting nurse called about another patient and wanted to get an order to send out a social worker to review end of life advanced directives.  This patient has been in the hospital twice recently and already reviewed the information, to the extent she wished- not at all.  Her son with the Healthcare Power of Attorney takes care of that since she is mildly demented.
Two end of life pushes in one week from a hospital owned visiting home health company gets me curious.  It’s never happened before.  I wonder if they had a presentation from hospice about how they now take care of all sorts of patients.  (I wonder if they got excited about transfers of their company’s patients to hospice.)  I wonder if they know the extent to which end of life conversations have been started and how far they have progressed with each patient and their family already with their family physician (me).  I wonder if I should advise these patients to get a different home health organization.
OK, I will advise them to change home health organizations.  I'll call the company and express my surprise at the aggressive, premature and inappropriate Hospice suggestion their employee made to my patient, just out of an acute care hospital.  Then, I’ll inquire about the patient with mild dementia and why they suddenly are pushing these decisions onto patients and families, sometimes before knowing the patient situation and before discussing the patient with their personal physician.  I’m skeptical about the origin of these situations.

What might be next?

Another cup of Starbucks coffee in my special Soin MC cup.


  1. My Dad works in hospice and we are in the same state as you. There are too many hospices and not enough patients. There are huge marketing/management pushes to get patients. It is very competitive.

    I can't imagine how nurses would be overtly pressured into pushing hospice, but they probably see the lack of patients and the people losing their jobs as no patients means no money.


  2. P O P,
    Thanks for the comment, it adds perspective to the broader issues affecting hospices.
    Hospice people have a great Tweetchat on Wednesdays from 9-10 PM on Twitter on hashtag #hpm that discusses current hospice issues. Pallimed is a daily hospice and paliative care newsletter available to all on the www.
    I think we will see some helpful initiatives about End of Life Care, along with some inappropriate pressures.

    The home health agency was sensitive to the misinformation and apologetic to me when I called. The supervisor is clarifying the situations (some parts of the "cases" are changed in my blog-e.g. genders and similar info that covers up the identity of patients involved, by the way).

  3. Thanks for the info on the hospice chat, I will pass it on.