(This is part seven of a series on how to choose a hospice. To start from the beginning go here.)
In part 5, I talked about how many patients each nurse has. This time I want to talk about how much attention you should expect and who you should expect to get it from.
First, frequency of visits. Your nurse should visit at least twice a week. Any nurse that thinks they can keep up on a hospice patient’s condition by visiting once a week is delusional. Find a hospice that promises two nursing visits a week. It shouldn’t be too hard.
Second, find out who makes the visits. The question you should ask is if the same nurse will visit every time. There are two different theories on how to use nurses. As with everything in hospice one is best for the patient and one is best for the pocketbook.
The theory you want your hospice to have is the theory that believes that having the same nurse seeing you every time generates better care. There are things that only an RN is allowed to do, and most of those things are only done once every two weeks. A good hospice has the RN make every nursing visit. That keeps them as up to date as possible. A bad hospice has the RN make one visit a week and an LPN make the other. While this is better than those that offer only one visit a week, it is still not good enough. The biggest thing a nurse needs to know about a patient is what is normal. Some have high blood pressure, some low, some are 98.6 temp every day, some are a little lower, some are short of breath at all time, some are not. For a nurse to know when something is wrong, they have to know what it looks like when it is right. The only way to find that out is for the same nurse to see the patient every time. Now, a RN make about $5 an hour more than a LPN so there is great pressure from the bean counters (especially in large corporate hospices) to use LPNs as much as possible. In those situations Case Managers may take care of 20-30 patients instead of the 12-15 I suggested earlier. I have nothing at all against LPNs, but for the sake of consistency, you should choose a hospice that doesn’t use many LPNs. You want the same nurse to come every time. The only way that will happen is if RNs make all the visits. The routine use of LPNs is an indication that the hospice is taking care of the bottom line at the expense of the patient.
There are two more parts to this series. Next, find out why staff recomendations matter.