How can I increase the time that hospice stays at the house?
My Grandfather is receiving hospice care, he is 93 y/o, my grandmother is 90 y/o, they live alone and hospice is there only 3 hours per day. Their children are trying to fill in the gaps but they either work or love 2 hours away. What are the criteria used to determine the amount of time hospice is there each day? Who determines the amount of time? How would I request a re-evaluation of the services he is receiving? They live in Union county, NJ.
Expert Answer
Thank you for asking this question. Many families do not fully understand the services that hospice provides.
Hospice is a philosophy of care that strives to keep people in their own homes, and as such is an alternative to an institutionalized death. But, in order to accomplish this, the family or caregiver must be trained to give the care, and the medications, to the patient. Generally, the hospice nurse makes two visits per week"”rarely, some patients only require one visit per week. This number (2 per week) can increase as the patient's condition changes, or as death nears.
You state your grandfather is receiving services for 3 hours per day. I'm imagining you probably have a home health aide visiting, in additional to the nurses visits, 2-3 times during the week to account for the three hours daily. The number of visits by the nurse or the home health aide is determined by the RN case manager at the time of the initial assessment and becomes part of the Plan of Care. But, because hospice cannot be there around the clock (like a hospital or a nursing home) every patient needs a "caregiver." It sounds like your grandparents could benefit from hiring a caregiver to assist the family members with the care giving duties.
Another option would be placing him in a Hospice House if you have one in the area. These are lovely domiciles where your grandfather could receive 24-hour comfort care and the family could visit as often (and as long) as they wish. If this isn't possible, another course would be a nursing home where he could still receive hospice services. However, I think your grandfather may want to spend his last months in his own home.
Discuss your concerns with your case manager or your social worker. Together, they can help with options. Remember that hospice care is supportive care"”for your grandparents, and for all of you. This is truly what the "team concept of patient care" is all about. And, most importantly, the desires of the patient and the family (their goals) is what an individualized plan of care is all about.