Last week I came across an article a New York Times article titled “Assisted Living vs. Hospice: Who’s in Charge?” .
The article opens with the story of a man whose parents were in a San Diego assisted living community with the husband on hospice, because of end stage congestive heart failure.
Last week I came across an article a New York Times article titled “Assisted Living vs. Hospice: Who’s in Charge?” . The article opens with the story of a man whose parents were in a San Diego assisted living community with the husband on hospice, because of end stage congestive heart failure.
As the story goes, in the middle of the night the husband wasn’t doing well and the wife responded by calling the hospice who in turn called the assisted living community. After an hour, the wife called hospice again to ask why no one had come, with the hospice worker replying that she didn’t know. The story ends with the son “forcing” the hospice team and the assisted living team to sit together and figure out how to appropriately care for his parents through the last few weeks of his father’s life.
More to the Story
After reading the story a second time, I found myself thinking there must be more to the story. Here are a few of my questions:
- After waiting that long why did the wife not use the emergency call system provided by the assisted living community?
- Why did the hospice worker not follow-up to make sure someone had responded?
- Did the phone call ever really get made?
- Why was there no advance coordination between the assisted living community and the hospice?
Ultimately I am not crazy about this story and the subsequent comments because, the hospice workers who were interviewed for the story, in effect, threw assisted living under the bus as a legitimate venue for providing residents hospice care to the end of life. This does a huge disservice to assisted living communities, the assisted living industry and assisted living residents who in truth receive better, more comfortable, more compassionate care in the last few weeks of life than they would have received in a skilled nursing facility and in many cases at home.
Some Legitimate Questions
That being said, this short article is a long way of asking these questions:
- In your senior communities, given the higher medical needs that require outside resources how do you manage the coordination of all these care resources with your community staff?
- What do you do to eliminate or reduce the possibility of these kinds of breakdowns in communication at night?
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Finally: If you know anyone who is looking at emergency call systems I would appreciate the opportunity to talk with them about Vigil Health Solutions.
I think that a good Assisted Living Manager is the key to being proactive in this situation. My staff always knew to call the manager to communicate change of condition whether it was with a hospice patient or not. By training the staff to reach out to management for the small changes it helps them to feel more comfortable when the big changes happen. As a manager it is your job then to follow up and be sure that hospice was called, what their response was and that it was documented as such. you then be sure staff communicated with the family and call Hospice back as many times as needed to be sure that they have arrived, knowing that depending on how many end stage clients are in the area could impact the reaction time. I have also found that in the middle of the night often times they will rely on the skills and assessment of the Assisted living staff rather than sending a nurse out to the facility if it is not an issue that would be out of the facilities scope of practice. Documentation of these instances is key. Hospice is a fantastic addition to the resources that an assisted living has when caring for a patient that is reaching end of life, BUT the patient is still there to be cared for by the assisted living. A good facility staff will be sure that their residents and family members know that they are there for them and able to help in any situation. The words I Don’t Know are not an acceptable answer at any time to a family question. Let me find out ..will earn the respect and trust of our families. If I were that facility I would be thinking twice about the hospice companies that I partner with. Mutual support is key to any partnership.
Thank you for posting this.
From LinkedIn Groups
Group: Senior Living & Care Professionals
Discussion: Who’s Talking to Who”
Interesting situation Steve. Another question regarding the wife making the phone call, did she have any form of dementia and her health status?? I personally have worked with hospice professionally as a DON and personally. My understanding and how we utilized hospice was that they were the direct responders. Notes were hung in the residents rooms with the hospice company for contact. If the facility had concerns, they also contacted hospice who provided necessary changes and contacted the MD for further orders. The night my dad passed away, the nurse on duty contacted me and hospice. Hospice also called me to see if I wanted them present which I declined since my dad was pain free and semi-conscious. Once he died, hospice came in for support, pronounced his death and contacted the funeral home.
Posted by Barb Przybylowicz
Steve,
When I was a DOW for an assisted living, I brought hospice in. We had meetings and discussed the chain of command. My staff was trained to call me first and hospice second. I would also follow up with the hospice staff. It was clear that if the client was in distress my staff would attend until hospice arrived. It was a matter of working together and taking responsibility for your client.
I think that biggest thing is clear channels of communication with staff, outside providers and family. That is a very said story and not a good reflection on the geriatric care community.
Expectations should be set before a crisis!
I have worked in long term care and now in hospice. So many issues can be prevented with simple communication. Most facilities have processes in place as do the hospice agencies, they both need to make sure to remain in close contact with the family.
If it becomes a matter of course for the facility and the hospice agency to delineate the chain of command for both agencies, to outline fo rfamilies who is responsible for what and when instatnces such as the one described can be rare.
Hospice is a very valuable part of the continuum of care and is underutilized.