Thursday, May 27, 2010

Respite Admission Process

Medicare covers respite stays through the hospice benefit.  Generally, a patient is eligible to one 5 day stay per benefit period.  This is a helpful resource for primary caregivers, whether they're burned out and need a break or are simply going on vacation.  The patient will go to a Medicare-approved facility, such as a long-term care facility or hospice home, during the respite stay.  The hospice social worker sets up the respite stay.  I've been able to set up an emergency respite stay as quickly as 3 or 4 hours.  For a preplanned respite stay, a day or two's notice for the facility is generally enough, so long as they have a bed available.

There are tons of phone calls, faxes, and legwork going in to every respite stay.  There's a lot of waiting to hear back from various facilities.  A place may have a bed but they still need to review the patient's medical information before they will decide whether to accept them for respite admission.  Here is a behind the scenes glimpse of what goes on when respite is requested.

1. Review LTC facilities with respite contracts, check for bed availability, inform RN that family is requesting respite care.

2. Call family and discuss contracted LTC facilities, ask verbal permission to fax information to LTC facilities.
  • At this time, decide on mode of transportation.  Will the family transport the patient or will a Medicar or ambulance be necessary?  
  • If using Medicar or ambulance, explain that a specific time will be arranged with the facility and mode of transportation.
  • Check on specific equipment needs, such as oxygen, catheter, hospital bed, wheelchair, etc.
  • Explain to family that hospice pays for room and board for 5 days, medications related to the terminal illness, and transportation. 
3. Call Admissions Director of chosen LTC facility(ies) and ask availability.  Inform if patient is on oxygen or has a Foley catheter. If there is availability, then:
  • Ask if patient's MD is on their staff or if family needs to choose a physician on their staff.
  • Ask if the patient can bring their own medications
  • Get a range of possible admission times
  • Call family and have them choose a time, taking travel time in to account.  The facility may need the family to fill out some paperwork so they should factor this time in as well.
4. Fax the patient's record.  The following documents should be included: initial assessment, H & P, initial plan of treatment, care plan, face sheet, medication list, hospice consents, DNR (if signed), psychosocial assessment, last RN note, last MSW note, last ICC summary.

5. Call family and report above arrangements and:
  • Explain the time that patient is expected at LTC facility
  • Inform them that DNR needs to accompany patient, especially if they are not providing transportation
  • If they can take their own medications, they must be in original containers, clearly marked
6. Call the RN (or triage nurse if on the weekend) and request they call the patient's physician to inform that patient is going to respite care for 5 days and also to see if physician will see patient at the nursing home.

7. If needed, call the ambulance or Medicar.
  • Request specific time
  • Inform them about how many steps into the house and whether the patient is on the first or second floor
  • inform them if there is a need for oxygen
  • If using Medicar, order a wheelchair, if needed.
8. Call the family and confirm the time and destination.
9. Call facility Admissions Director and confirm time that patient will arrive.
10. Inform other hospice team members by voicemail.
11. Inform triage/communication line/hospice office.
12. Arrange return transportation after 5 days, if needed.

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