Monday, January 6, 2020

Serious illness and end of life - what it's all about

I don't know if "patient experience" is still a buzzword, or if anyone actually finds it helpful to use the roller coaster metaphor to describe serious illness. I think this image conveys a few helpful points about the experience, but it doesn't show the caregiver.

More about the Cresta Run at Sven-Holger funky clothing website.

Very cool YouTube video of a ride from the top.

Sunday, December 22, 2019

Ending the year with a look back at a hospice service failure

It happened on Twitter, so it’s not exactly like it’s a big secret or anything. It was horrible, needless, tragic, and most notable for how quickly it led to circling wagons and how desperately the elephant in the room was avoided.

It was also a normal day in a normal week in the world of corporate hospice, where service failures are a guaranteed feature and not a bug for one simple reason - hospice doesn’t scale.

Some aspects of the service failure are less important, like who specifically it happened to or what exactly happened. You can find the particulars easily enough if you really want to, but my interest is in the larger issue: the greed and ineptitude of for profit corporate hospice chains, and the inevitable results of same.

Here’s what I saw happen, admittedly limited to following it unfold on Twitter.

  • The family member of a physician is admitted to the local branch of a national corporate hospice chain
  • Someone contacts the national corporate hospice chain to report increasing symptoms and suffering
  • Someone at the national corporate hospice chain tells them to call 911
  • Ambulance ride, extended emergency room visit, diagnosis (likely consistent with the patient’s reason for choosing hospice plan of care), some level of discomfort, disruption, frustration, confusion
  • Return to original setting, try to get get back on track with the original hospice plan of care
  • Physician family member cries WTF isn’t this what we were trying to avoid?

What’s the problem?

An effective hospice plan of care leading to the optimal outcome of a peaceful death usually doesn’t just happen on its own. 

It’s most often the result of thoughtful collaboration and support from an interdisciplinary team anchored by proficient (expert) nurses, who themselves are actively supported by a mission-driven organization that values their work. 

It’s a setting where events can build slowly until they explode into avoidable crises, so understanding any potential ‘worst case’ is the first step to preventing it from happening, with developing a plan to address it coming in at number two.

It’s not possible to determine what led to the service failure in question, but there are indications of what may have contributed to it, most notably the name of a large national corporate hospice chain in the physician’s Tweet.

Follow back to the national corporate hospice chain website to learn:

“A VITAS Telecare nurse or other patient care expert answers your call. They have access to patient files and the expertise to answer questions, provide medical advice, contact your physician or dispatch a team member to the bedside—whether it’s 5:45 on a Monday night or midnight on New Year’s Eve.”

Get up to speed

Saturday, December 14, 2019

Let's learn something and have fun at the same time!

Here's a way to fill an hour

I haven't posted in a few weeks, but have still been busy. Here's the title slide for a one hour continuing education program I recently developed and presented to hospice clinical staff as part of their annual dementia training.

My next step is to incorporate the slides and video I used in the live presentation into a format suited for online learning.

Also too: David Bowie is helping me grieve


Monday, November 25, 2019

November is Hospice Month! BREAKING!! Amedisys continues to acquire and disrupt

every picture tells a story

It's a classic case of rolling up the mom 'n pops - industry consolidation with requisite financial engineering, executive bonuses, and related skulduggery

special shout out to my rock-lovin' buddy christian 

Thursday, November 21, 2019

November is Hospice Month! Another hospice story for Info and Edo - How hospice and others made things worse.

I don't think he's going to like this one...

If you need to catch up....
  • New Series! Stories for Info and Edo #WhoseHospice
  • #WhoseHospice Stories for Info and Edo, Part 2
  • So Edo Says No No

  • How hospice and others made things worse

    The new hospice nurse and her preceptor were just getting the day started when a call came in from their clinical manager. The preceptor listened intently for several minutes, then put her phone away.

    "Change of plans," the preceptor said. "We need to get over to Alcott Hospital. We might have to screen a patient for GIP." (pdf) "This will be a good experience for you."

    When they walked onto the unit designated for hospice intensive care, the charge nurse gestured to a small group huddled in a corner. 

    Somewhere down the hall, a man screamed loudly. He was the subject of the small group's conversation.

    The small group consisted of:
    • the unit's nurse manager;
    • an oncologist;
    • the vice president of nursing;
    • a nurse named 'Sheila' who had been at Alcott since anyone could remember, was variously estimated as being somewhere between her late 60's to early 80's, wore a lab coat over expensive clothes, and seemed to just randomly appear in small group discussions or larger meetings, but was never either consulted or challenged.
    The new hospice nurse started walking towards the group, but the preceptor pulled her back.

    "Not our patient yet," the preceptor said.

    "But aren't we supposed to screen somebody for GIP?" the new hospice nurse asked.

    "Not our patient yet," the preceptor repeated.

    The new hospice nurse could still hear the small group's discussion from where she stood with the preceptor's hand on her elbow, holding her back.

    Somewhere down the hall, a man kept screaming.

    "We can't use propofol," the nurse manager said. "He needs to go to ICU if you want to use propofol."

    "We'll do Just in Time Nursing Education," the vice president of nursing replied enthusiastically. "I've been waiting for a chance like this." 

    "I'm not sure if propofol works for pain," the oncologist said. "Shouldn't we ask the pharmacy?"

    "What's going on?" the new hospice nurse asked the preceptor. "What else do you know about this case?"

    The preceptor replied, "The patient you hear screaming is someone who's been on hospice, but not our agency. He was with East Cupcake Home Care and Hospice."

    The new hospice nurse had never heard of East Cupcake.

    "They're a small outfit twenty miles away," the preceptor continued. "They mostly do home care visits - wounds, new babies, teaching people how to inject their insulin, that sort of thing. Every once and a while they admit someone for hospice, and the same nurses do those visits, too. Their census is usually less than five, and anything complicated really throws them for a loop."

    "Yikes," was all the new hospice nurse could say.

    The preceptor went on, "This guy came into the ER this morning. His wife brought him in. He has metastatic cancer and lots of pain. He was on a CADD pump with morphine but it didn't relieve his pain, so the nurses from East Cupcake kept calling the oncologist, who kept increasing the basal rate and the breakthrough dose, and on it went until the wife brought him to the ER. Now here we are."

    "But shouldn't we step forward?" asked the new hospice nurse. "Don't you think we can help?"

    "Not our patient yet," the preceptor replied. "His wife revoked hospice and he's been admitted here. He's an oncology patient, and they haven't asked us to join them, and we'd have to get the wife's consent to admit him back to hospice first, so we just have to wait."

    "Then why are we here?" asked the new hospice nurse.

    Somewhere down the hall, a man kept screaming.

    Why indeed?

    Thanks for reading. See you next time.

    Saturday, November 16, 2019

    November is hospice month! Hospice Fraud Wall of Shame Update

    I think we're going to need a bigger scorecard 

    Yesterday we unveiled the Death Nurse Hospice Fraud Wall of Shame, but somehow missed this $43.8 Million settlement of a shareholder lawsuit filed against Amedisys in 2010. 

    The total paid for 13 settlements on the Death Nurse Hospice Fraud Wall of Shame currently adds up to over $381.34 Million.

    Read the full account of the angry investors at Modern Healthcare. Some snippets:

    "The settlement... is the final chapter of a seven-year legal battle that also saw Amedisys pay $150 million in 2014 to the U.S. Justice Department ...The shareholders said in the class-action that their investment in the Baton Rouge-based company had been damaged by the Medicare fraud scheme."


    "... neither the company nor any individual defendant concedes or admits liability... Amedisys noted in its filing."

    Amedisys reported net income of $37.3 million in 2016 on revenue of $1.44 billion.

    Thanks for reading, see you next time, let's keep 'em honest!