By Victor Montour
Today I want to talk about choices. Life is all about choices, most of the time we all make good choices. Then we have moments in life we think we are making good choices but in fact are making a bad choice. The choices we make affect you or maybe a loved one in a positive or not so positive way.
In today’s modern world we tend to get caught up in the glamour of things or the newest trends, myself included. It’s hard not to when you have people coming to you offering you the newest and greatest product or enticements to use their services.
Unfortunately, this same model of marketing or sales has penetrated the healthcare industry in an astronomical way. People are being sold on the glamour of a skilled nursing facility, or a weekly delivery of Starbucks or muffins or some other tantalizing goodies given to healthcare professionals to persuade them to refer patients to them. I have to ask, what does this have to do with the care you or your loved one is receiving? More and more people make healthcare choices based off of this type of marketing. I ask you is this a good choice or bad choice?
In my opinion people think they are making a good choice but in fact their choice may not be as good as they thought it would be. Once they are in the middle of care they may be seeing short comings in the care their loved one is getting. Things like, meds not being given on time, equipment is not readily available for use, and staff are not as well trained to provide the care needed and so on.
As healthcare consumers we all must be educated on the things that matter. What matters more than knowing what kind of care can be expected? I’m going to share a case with you today that will demonstrate how excellent care should be the focus and not the colors on the walls in a facility or goodies delivered this week. Patient care should be everyone’s primary focus.
Front Range Hospice and Palliative care received a referral for Palliative care services for a patient who at the time was at a local hospital. Our Community Liaison contacted the discharge planner and began the dialog on what the goals were for this patient and family upon discharging to home. The administrative team at Front Range Hospice and Palliative Care began the clinical review process to determine if this patient met criteria for Palliative Care. It was determined rather quickly Palliative Care would not be the correct level of care, in fact this patient need more care then what Palliative Care would have provided.
This is a 45 year old patient who was diagnosed with cancer in the middle of the year in 2015. This cancer was inoperable and the patient did not tolerate chemotherapy. The patient and the patient’s mother started working on the patients bucket list. The patient had places to see and things to do so they did that for a while. Once back in Colorado the patient had intractable pain that put the patient into the hospital several times. On this last admission in patient Palliative Care was brought in to help manage the patients symptoms. With the help of the inpatient Palliative Care team at the hospital they found a medication regimen that was working. However, it was such a high dose of pain medication that was almost impossible to find in the community on short notice.
Now, I talked earlier about how the care a patient receives is the most important item we all need to be looking at. Well, that is true, with that comes the patient as a whole person and the wishes the patient may have. While the clinical teams in the hospital and at Front Range Hospice and Palliative Care worked on the clinical needs. The Community Liaison at Front Range Hospice and Palliative Care was able to clarify some very important needs and wishes from the patient and family. Don’t forget this patient is very young and has a lot to accomplish in what maybe a short period of time. This patient first and foremost wants to go home to die. No nursing homes, not inpatient unites, just home.
Now most hospice agencies and acute care hospitals would have said this patient is too complex to manage outpatient at home and would have insisted the patient be moved to an inpatient hospice unit. Now don’t let me miss lead you, inpatient care is wonderful when appropriate and it’s the choice you make for yourself or your loved one. This patient was directed to an inpatient hospice unit and was not happy with the plan of care given to them for placement. Plus, it’s just not what the patient wanted. This patient wanted to go home and be present at the birth of the new niece expected any day.
We all have choices; our choices are not taken away because we have a terminal illness or are actively dying. This patient had made their choices clear, it is our responsibility as professionals to help patients achieve their goals, their wishes, and honor their choices.
Knowing the choices and wishes that this patient has expressed the team at Front Range Hospice and Palliative care started working in overdrive. The team had some insurmountable tasks to accomplish in a short period of time. Infusion Company had to be located who could start this patient on a home CADD pump with a large specific cocktail of medications. A discharge plan from the hospital had to be developed that would ensure the safest most effective care at home. The challenges kept coming; it took two tries to find an infusion company that can meet the patient’s needs. The patient lives in the mountains with windy one lane roads leading to the house. This was a major barrier for the nursing team especially with snow fall. The Front Range Hospice and Palliative Care team was able to think outside the box and come up with a solution to ensure nurses can get to the patient safely when needed. The team worked tirelessly with the mother who was the primary caregiver to her son to teach her how to give the medications, how to operate and trouble shoot the IV CADD pump and any other nursing care duties she may need to perform in the nurses absence. Now please know, Mom wanted to carry out this last wish from her child, she was the soul caregiver for the patient and she has others in the home she has to care for as well. But she has somehow found the strength and manages all the medication administration, including caring for the IV and the CADD pump which she was scared to death of. But after hours of teaching and support from the nurse the mom is comfortable providing the care needed for this patient knowing she has support when needed 24 hours a day 7 days a week.
Knowing mom had some anxiety about the volume of care this patient needed. Front Range Hospice and Palliative care worked on a couple of alternative plans. One, if the patient and mom need help and are not able to care for the patient at home we have arranged for placement in a skilled nursing facility not too far from their home. We also had set up, if needed, a non-medical agency to come in and help with cares. Again, these options are available if the patient or family chooses to use them, not required or mandatory.
We are so happy to say this patient passed at home, receiving the needed care to ensure the best days possible while receiving legendary care. This family and patient chose Front Range Hospice and Palliative Care to provide the care needed because we focus on patient care. We pride ourselves on our ability to support the choices people make while respecting their wishes. Muffins, candy and other novelty items are not the foundation of Front Range Hospice and Palliative Care and we will never use the smoke and mirror trick to get you to choose us as your palliative care or hospice provider. Honest conversations and excellent patient care will always be the information you receive when calling or meeting with our admissions team.
So I close this blog with this… Choices; in order to make the best choices for you or your loved one, you have to be informed. You have to look past the goodies, the glamor, and the awe, and really ask the tough questions to get the real answers you need to make the best choices for you or your loved one.
Please reference our blog: What to ask when looking for a hospice.