Hello all, no bells, whistles or sites for you to visit today. I would like to share an experience I recently had while working in the ER of a small (critical access) hospital. A little background first: the hospital is closely affiliated with a rural health center that has 4 doctors. This hospital is in a small town where pretty much everyone knows everyone else and the doctors have seen the same patients or their families forever. Please keep this in mind while reading on.
One of the employees of the hospital has been caring for a parent at home for some time. The parent is very elderly and has recently suffered at least 2-3 strokes and just began having seizures over the past couple days. Previously, the parent was able to get out of bed with assistance and would interact with the employee; however, in the past week that has all changed. The parent now is unable to get out of bed at all and is basically non-verbal except for saying help and the employee's name. Therefore, the employee wished to have a hospice referral/consult because they have become exhausted caring for the parent. Now, hospice will not accept or consider a patient without a physician referral/order so the employee called the rural health center, where the parent had previously been seen (albeit over several months ago). The doctor who was familiar with the parent from prior contacts was not willing to order the hospice consult, nor was the doctor willing to go out to the house in order to see the patient (again keep in mind that we are talking about a small community and the physician was already familiar with the parent).
My first question to you all is what are your feelings about this? Next, consider what constraints are on both the hospice company and the physician that result in their apparent unwillingness to help out this family. With all the healthcare rules and regulations combined with our letigious society, do you believe the care provided to patients has benefitted or suffered as a result? When confronted with a situation like the one I have described, what would you suggest? Do you agree or disagree with the physician's decision in this situation? Does the situation as described seem to be the provision of ideal end of life care? Remember, I am just asking for your opinions.
As an update to this post, the parent ended up having to be brought to the hospital by ambulance, was admitted for the mandatory 3 days in order to qualify for nursing home admission per Medicare, and was transferred to the nursing home on Friday afternoon. The parent ended up passing away on Saturday evening. No hospice consult was ever ordered to my knowledge. Again, what are your thoughts on this? Do you believe we did our best by this family?
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