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Smooth transition from home health to hospice
Use team approach to address concerns
On paper, transitioning a patient's care from the home health side of an agency to the hospice service of the same agency should be a smooth, easy to accomplish task. The difficulty is that home health patients form attachments to their nurses and don't want to sever the relationship, says Kim Kranz, RN, MS, vice president of operations for Home Nursing Agency, an Altoona, PA-based agency that offers home health and hospice services.
"Unfortunately, while we can cross-educate staff about the benefits of each service, it is more difficult to cross-train an entire home health staff to care for hospice patients," she says. The main difficulty is that home health staff members chose home health and don't want to work with patients who are dying, Kranz adds.
The transition in her agency is handled by a joint visit from the home health nurse and the hospice nurse, she explains. "The home health nurse introduces the hospice nurse in a way that shows confidence in the hospice nurse's abilities," Kranz says. "We pass the baton carefully so that the patient and family members are comfortable with the transition." Whenever possible, they include the physician in the conversation to increase the patient and family's confidence in their decision, she adds.
"I've found that nine times out of 10, the patient knows that it is time to seek hospice care, so our focus is showing the family how hospice can support them," says Kranz. "Hospice's specialty is symptom and pain management; that is often what convinces family members to support the patient's decision for hospice. They don't want to see the patient in pain."
Because Prairie Haven Hospice in Scottsbluff, NE, is offering palliative care consults to local home health agencies, it makes sense that the staff also offers to make joint visits to conduct the end-of-life discussions that make home health nurses uncomfortable, says Linda Rock, MPH, executive director of Prairie Haven. "We can explain hospice services and give the patient and family information that they can use when making their decision," she explains.
Transition and continuity of staff are not an issue for patients of The Center for Hospice and Palliative Care in South Bend, IN, a hospice that also maintains a home health license to care for palliative care patients with a life expectancy of up to one year. "We discharge easily from home health to hospice when appropriate, and the change is transparent to the patient," explains Mark Murray, president and CEO of the agency. Because the type of care provided to the home health and the hospice patients is similar, there is no difference in the staff's focus, he points out. "The same staff care for home health and hospice patients, so there is usually no change of staff members," Murray says.