by Lisa Pahl, LCSW
Recently, the spouse of a new hospice patient shared with me that she felt a bit overwhelmed by all of the calls she was receiving from the hospice team. While we can all probably agree that too much support is better than too little, it was causing extra stress for this wife, who didn't understand why we were all calling.
When a person is admitted to hospice, Medicare guidelines require that the IDG (Interdisciplinary group) complete an assessment within five days. This means that the nurse, social worker, and chaplain are typically arranging a visit to assess for the medical, emotional, and spiritual needs of the patient and family.
While it may feel overwhelming to receive so many phone calls, there are some reasons why things move so quickly.
• Many people die within the first two weeks of admission, so we must move quickly in order for families to receive support during the dying process.
• Often times there has been a recent hospitalization or crisis which prompted the admission to hospice. If a person’s functioning has recently declined, the family may not have the resources in place to care for the patient.
• Coming on to hospice is often an emotional and difficult decision. Each discipline has specific tools and support that they can offer to help with the feelings that may arise related to this decision.
What can hospices do to ease the burden of multiple assessments?
•Upon admission, inform the family of the five- day Medicare guideline and that they should expect a call from all disciplines. If the family appears overwhelmed by this, the admission team should inform the visiting staff so that they can come up with a plan that better meets the needs of the family.
•Explain clearly the intention of the visit and your role so that family members understand what you can offer, rather than it feel like just another thing they have to do.
• Consider joint visits to reduce the number of visits to the home and family members needing to repeat themselves. This can be nurse and social worker, social worker and chaplain, or all three at once, depending on the comfort and preference of the family.
• If the family reports feeling overwhelmed by calls and the patient does not have a prognosis of weeks, consider a phone call assessment initially with a plan to visit in person the following week.
•Inform the family that while it’s very busy initially when starting hospice services, each discipline will develop their routine visits with you based on your preferences. It will slow down after the first week.
Again, in most situations it's a positive to have hospice staff be attentive and willing to offer immediate support. It's also important to keep in mind how this may feel to the patient and family member who are not used to having many different professionals in their home or residence.
Comment (1)
This was very informative and it will be helpful to families just coming on service. I work as the Volunteer Coordinator in Hospice and I often try to avoiding being “another phone call.” Although it is rare that information for Volunteer Services is requested during the first week, I came up with an alternative for our team to easily and unobtrusively deliver the requested information in a QR code. It is provided on the front of our Hospice Handbook that every family receives and the code is attached to our discipline’s work bags. I still try to avoid phone calls to our patient’s and families during their time on services. Alternatively I will ask a team member who is going to see them to relay my question or information, rather then me being “another phone call” for them to deal with. Thank you for writing this and reassuring me that less phone calls is probably better for our families. I love your Death Deck and all you do for end of life, please keep up the good work.