Hospice services are not usually on the mind of a potential resident or a potential family member when they are looking for assisted living care. Residents and families are looking for the best care, the best activities, and excellent food provided by caring, competent staff. These are things that bring pleasure and fulfill needed support. But as life moves forward, most will be faced with making the decision of whether to receive hospice services in the assisted living community when a terminal diagnosis has been received, or to move to a higher level of care. This is a definite crossroad and is not an easy decision.
Most residents who plan to live out their days in their assisted living community will receive hospice care at some point. These residents have made their assisted living community their home and do not want to move again. This is sometimes out of the resident’s and the facility’s control, but many times hospice fills in the gaps for the higher skills and coordination of care to meet residents’ needs during the process of a terminal diagnosis until the end of life.
So when must a resident make a decision to choose hospice services or move to a higher level of care? This question will be answered when a resident is considered terminally ill and no longer meets the criteria for residency. Review the criteria for residency here. This requires a cooperative agreement between the licensed hospice, the resident or legal representative and the facility to continue residency.
The hospice, in consultation with the facility, develops and implements an interdisciplinary care plan that specifies the services provided by hospice and the facility. Assisted living facility staff may provide any nursing service permitted under the facility’s license and total help with the activities of daily living for residents admitted to hospice; however, staff may not exceed the scope of their professional licensure or training.
To be prepared and ready to assist a resident with hospice services, start with reviewing the policy for coordination of third party services under rule 58A-5.0182(7) FAC. Stated in the rule, “The facility’s policies MUST require the third party to coordinate with the facility regarding the resident’s condition and the services being provided.” How have you communicated with the hospice provider how best to coordinate with the facility? Be clear with the hospice nurses and other disciplinary staff how and with whom you are communicating. It is okay to expect when any hospice staff visits a resident that they give a report to a designated staff member how the resident is doing. The report can be brief, but can be very important in making sure the resident’s needs are met with prompt communication so that coordination of care occurs timely. Be clear about who is going to relay information to the responsible party as needed. Do not assume that because hospice informed the facility staff that the responsible party has been made aware of changes as well. Care should be coordinated among all three parties – the resident/family, the hospice provider and the assisted living facility.
The facility should be responsible for educating staff that more goes into caring for a resident requiring hospice services than just assisting. If a resident is no longer able to reposition herself, then staff would assist her in repositioning at an appropriate frequency. Staff should also be trained to prevent skin break down if the need for incontinent care occurs. Each resident will be different with specific needs that should be coordinated. The hospice staff will be involved, but not onsite frequently enough for assisting with the important care needs that are within the scope of an ALF to perform, such as encouraging hydration (as long as not contraindicated). It is not enough to just have hydration at meal time and expect a resident who is declining to be able to get her own fluids from kitchen water dispenser. It’s not that staff doesn’t have a general understanding of how to provide specific care for the individual resident, but they may need additional guidance.
Does staff have a clear understanding of when to contact hospice? It’s best for staff to call hospice more often than not. If a resident is in pain, short of breath, a dressing is off or has a concern, make sure staff has the numbers and know the importance of not waiting to make the call to hospice.
One concern of many administrators is whether hospice staff and family understand the assisted living regulations related to hospice care. It is not uncommon for hospice to attempt to educate a staff member to complete a certain task so it can be done in the absence of hospice, such as medications for pain as the residents needs it. There is no problem if standard is the same for residents on hospice asking for their pain medication just as any ALF resident would ask, but not for a resident who needs assistance with having her pain medication needs determined. This is just one example of hospice staff and family members needing to understand the ALF regulations versus what can be done in a person’s private home. Best practice is to regularly educate hospice providers and family members about the ALF regulations. Also, teach your staff to notify the administrator if a hospice staff provides instruction to do something outside of the scope of the ALF’s abilities. It is not that the hospice wants to direct staff inappropriately, but it may be a newer hospice staff member or someone who normally works in the nursing centers or private homes. Guard your residents and staff to ensure quality and appropriately coordinated care in their home at the assisted living.
In the resident’s plan of care, any supportive durable medical equipment must be included, such as scoop mattresses, Geri-chairs, and hospital beds. It is possible that a piece of equipment arrives at the facility for a particular resident, and it needs to be verified that it is part of the plan of care and staff are educated on any safety concerns with the equipment.
Hospice care coordinated with the resident, family and facility can provide a wonderful option for many residents, but it is an option that requires more time, education and review for an ALF. Do not assume that if a resident is under hospice services that everything is okay for proceeding. It is a coordinated effort to make it possible for a terminal resident to have her needs meet in her current home. It is a wonderful provision in the regulations to respect the resident’s wishes which requires increased education and coordination of care to make sure the quality of care is maintained. It is an honor to serve a resident with hospice care in an assisted living facility.