Long-Term Care Survey Alert

These quality indicators/measures provide a major clue.

Identifying residents who may be ready for hospice can open the door to better care and head off complaints that lead to survey disasters.

How so? For one, the hospice works with hospice residents' families to help them expect and adjust to the resident's inevitable downward decline. That way they are less likely to misconstrue the resident's downward spiral as being due to poor care  or to take their grief out on the facility by complaining to state agencies.

For example, when a patient has a change in condition that signals the end may be near, usually someone from hospice comes to the facility to check on the patient to make sure he's comfortable, noted Harold Bob, MD, a medical director for hospice and nursing homes in a presentation at the annual 2008 American Medical Directors Association meeting. The hospice staff person will also help the family begin the bereavement process before the person passes away. By contrast, nursing home staff even on a well-staffed unit on the evening shift might have trouble providing that kind of hand holding, he pointed out. And "if our caring causes us to call 911 for an ambulance" to take the dying patient to the emergency department where he waits four hours on a gurney, the family may not be so happy, Bob cautioned. Not only that, but a lot of complaints against nursing homes are coming from the ED when staff doesn't get the transfer information and are alarmed by the dying resident's poor condition.

Another benefit: Hospice also provides bereavement counseling for patients' families, Bob noted.

Staff can be "family," too: Hospice nurse Cherry Meier has encountered nursing homes that say they can provide care to a dying resident and don't need hospice. But once residents have been in a facility for a period of time, the staff becomes like their family, says Meier, with VITAS Innovative Hospice Care in Flat Rock, N.C.

"And it can be hard for the staff to let the dying resident go sometimes. That's not a sign of inadequate care --" it's a sign of compassionate care," she emphasizes. And as a more objective third party, the hospice can come in "and help staff cope and let go."