HMD opinions vary on the appropriate level of care…

by Julie Bruno, MSW, AAHPM Director of Education

In anticipation of the Hospice Medical Director Course in September, eNews has included some cases related to the content of the course. The last case stimulated some difference of opinion.

Mary Jane was on service with the diagnosis of adult failure to thrive. She fell and was hospitalized with a fractured trochanter. Her pain was poorly controlled but she was scheduled to be discharged to home. Unfortunately, her family was unavailable to receive her till later in the week. You recommend…

1. Respite Care

2. GIP at a local skilled nursing facility

3. Provide continuous care

4. None-of-the-above: it’s the patient/family’s responsibility

While the information we have about “Mary Jane” is limited, the answer listed in eNews was Respite Care. One member says, “I’d admit Mary Jane to GIP as her pain is poorly controlled. I recognize that her hospice diagnosis is adult failure to thrive, but pain could be a contributing factor to her global deterioration. She is too symptomatic for respite.”

Another asked, “Why wouldn’t GIP make more sense, at least for now, when the patient’s pain is reported to be “poorly controlled?”

The rationale for GIP?

The diagnosis of FTT is so broad and vague that many hospices would look at pain as part of the syndrome. Granted – the pain came from the hip fracture BUT now the patient isn’t thriving because of pain. And the hip fracture came from the debility and osteoporosis which contributed to the FTT. It is very messy. So many folks have suggested GIP because there are symptom management issues that must be addressed and cannot be safely and effectively done so in “respite”.

Another option would be skilled care rehabilitation with hospice to follow concurrently given differing diagnoses. This is fraught with problems because most nursing facilities are averse to doing this.”

What do you think?

3 thoughts on “HMD opinions vary on the appropriate level of care…

  1. I think that our first duty is to care for the patient. Here we have a patient who is still in pain, so I wouldn’t consider respite care until the pain is managed. I would opt for gip in an IPU or a nursing home. If no gip bed is available I would next consider a nursing home admission and do continuous care in the facility until I was certain that the pain control had improved.

  2. This case is generating a lot of conversation and raising several interesting questions. Please know that AAHPM is consulting with our experts on the topic and will be offering more information on the blog next week.

  3. Care is the utmost thing to consider for any patient. No respite care when a patient in pain, urgently need all the major actions like admitting in IPU or else to cure them. It’s the only wayout, so no second thought should be there.

Leave a Comment