Hospice Care in Nursing Facilities

Dear Barbara, Can you write about hospice care and the role of the hospice nurse/hospice team in long term care facilities?

The basic premise of hospice is to provide end of life care in the home. Because Assisted Living and/or Nursing Facilities are home for some people, it is appropriate that hospice care be available for residents in these facilities. The issue then becomes is there an overlap of services such as nursing care, bathing, or communication with a physician? Some facilities think there is an overlap and feel they can provide end of life care without the assistance of an outside (hospice) source. Other facilities create their own “hospice” team and provide their own kind of end of life assistance. Still other nursing facilities welcome the expertise of a hospice from outside their facility.

How can Hospice and Nursing Facilities work well together?

I think there are as many ways for a hospice to work with a nursing facility as there are hospices and facilities (all within medicare guidelines of course), but I will tell you what I consider the ideal relationship.

* A hospice team (RN, LPN, SW, HHA, Chaplain, & Volunteers) is assigned to an individual facility. Only that team works in their specific facility. You want everyone in the facility to know, recognize, and understand the hospice team. The entire nursing facility staff (right down to the receptionist) attends an inservice by that hospice team.

* Several educational sessions need to take place in order to clarify not only the role of hospice for the patient, family, attending physician, and facility, but also to provide end of life knowledge (pain management, comfort care, signs of approaching death, and nutritional guidelines) to these same people. Nursing facility regulations are basically in opposition to end of life care. 

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