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Complex case: How do we educate patients and families about hospice programs?

Case Management Weekly, April 2, 2008

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Case managers in inpatient hospital settings that also include inpatient hospice programs have to accept a great deal of responsibility for educating patients and families so that they can make the right care choices.

Martha is an 83-year-old resident of a skilled nursing facility (SNF). She is admitted to a local community acute care hospital for symptoms of fever, tachycardia, and shortness of breath.

Martha had completed an advance directive at the SNF (including instructions to not resuscitate or intubate, and had nominated and completed a healthcare proxy). In the hospital, Martha is diagnosed with pneumonia and dehydration. She also has an extensive medical history with comorbidities of diabetes, hypertension, Parkinson's disease, and intracranial hemorrhage.

The dehydration and pneumonia are immediately treated, but Martha remains lethargic and unable to swallow, continuing to require naso-gastric feedings. Martha's daughter is her healthcare proxy, and because of Martha's continued failure, her daughter is asked to make a decision to allow surgeons to place a permanent feeding tube. The daughter instead decides to allow her mother to be made as comfortable as possible by being placed in the inpatient hospice program.

To read more about how this complex case was resolved, click here to access the March 2008 issue of Case Management Monthly. Not a subscriber? Click here to find out about the benefits of subscribing to Case Management Monthly.

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