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.”


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