It never occurred to me until today that enrolling my patients in hospice could cause them harm and distress. What unfolded is what happens all the time but which I hadn't recognized could have such a negative effect. My patient had been receiving home health through one agency for chronic ulcers and short term home rehabilitation. She has been largely bed and chair-bound and I have seen her frequently on housecalls. Her condition had plateaued and with her strong desire not to ever return to the hospital and to live as comfortably as she could in her home until she died, we agreed it was time to transition to hospice. The previous home health agency did not have a 'sister'-hospice as part of their organization. So I enrolled her with one of the agencies I work closely with.
The intake by the hospice case manager was uneventful. All seemed well until I heard from her family that yesterday several men from several different DME (durable medical equipment) companies came in and out of her home to change ALL of her equipment: hospital bed, pressure pad, wheelchair, shower bench, oxygen and humidifier, etc. She was overwhelmed, distraught and felt she had lost all control of her life and her home. Hearing this I felt immense remorse and guilt. I already knew that many agencies have contracts with different DME companies. But I had never recognized that, of course, when hospice uses different companies from pre-hospice days, the equipment is changed over--necessitating a tremendous upheaval (physically and emotionally) for the client.
I wish I'd had the foresight to discuss the DME issues with the hospice case manager before this had occurred. Might we have been able to spread the visits so they didn't coalesce in a torrential downpour in one day? Or would there still have been an urgency by the DME companies and hospice to have everything set up promptly per their contracts? I don't know. I intend to discuss the case with the hospice. While patients in closed systems such as the VA or HMOs may not experience this, it's worth discussing for those of us who practice in the community and partner with different home health and hospice agencies. Who would have thought that something as 'mundane' as DME contracts could so significantly influence a patient's quality of life? Well, now I know better.
The intake by the hospice case manager was uneventful. All seemed well until I heard from her family that yesterday several men from several different DME (durable medical equipment) companies came in and out of her home to change ALL of her equipment: hospital bed, pressure pad, wheelchair, shower bench, oxygen and humidifier, etc. She was overwhelmed, distraught and felt she had lost all control of her life and her home. Hearing this I felt immense remorse and guilt. I already knew that many agencies have contracts with different DME companies. But I had never recognized that, of course, when hospice uses different companies from pre-hospice days, the equipment is changed over--necessitating a tremendous upheaval (physically and emotionally) for the client.
I wish I'd had the foresight to discuss the DME issues with the hospice case manager before this had occurred. Might we have been able to spread the visits so they didn't coalesce in a torrential downpour in one day? Or would there still have been an urgency by the DME companies and hospice to have everything set up promptly per their contracts? I don't know. I intend to discuss the case with the hospice. While patients in closed systems such as the VA or HMOs may not experience this, it's worth discussing for those of us who practice in the community and partner with different home health and hospice agencies. Who would have thought that something as 'mundane' as DME contracts could so significantly influence a patient's quality of life? Well, now I know better.
Comments
I was thinking that sometimes we reduce patients to a series of check boxes of steps we have to go through. It gets the job done by audit standards but one may miss information on quality of life choices.
I have had a similar expereince and I too felt badly for not taking the DME upheaval into consideration. I think it's a learning opportunity for all of us.
Heather Shaw
Loved your comments, and agree with you that Hospice Services and Home Health Services need to consider this disruption. I forwarded your thoughts to the Hospice where I work as a Medical Director, and will see what our policy is....If it's causing this much disruption, we need to change it!
Carol Jessop, M.D.
Can be.
I've found the best way to handle this is for the acquiring DME to perform the breakdown and removal of equipment and placement of theirs. Arrangements should be made ahead of time between the DME's for exchange of their equipment. Good communication is a must. The switch out is not the patients or facilities deal and must be done in a polite, friendly, un-obtrusive way. Without exception, the transition is supposed to be smooth with no adverse affects. No more than two people should handle the job and those individuals need to be experienced and trained DME technicians.