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CAPC Palliative Care Discussion Forum
Hospital and Hospice Partnerships

Next Reply: Re:Changing hospice inpatients to "Routine Level"
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Post Changing hospice inpatients to "Routine Level"
Author: yaegerj
Date: May 20, 2010 3:39 pm
I am concerned with what to do with a patient who initially meets criteria to be admitted from the field as a hospice inpatient but then stabilizes but now needs a nursing home bed. Do any programs change to a routine level of care while "waiting for disposition". Obviously this is a financial loss to the hospital but less of a loss than many of the other inpatients on whom the hospital has already spent the DRG and is getting nothing.
I would like to avoid doing this except very occasionally when the patient does not fit any of the criteria for inpatient hospice.
I have heard of programs that use "respite" while waiting for a nursing home bed. I don't think Medicare allows this use of respite.
Replies: order by [Date] [Author] [Subject]
+ Re:Changing hospice inpatients to "Routine Level" (by SharolHerr on 05/20/2010)
If the patient has stabilized and is ready for discharge it isn't likely that they would meet the inpatient, acute care criteria for continued stay. Therefore, it is difficult to see a supporting rationale for the transition to acute care. Being less of a loss is not compelling when you see that the patient doesn't meet acute inpatient criteria. Sounds to me like you would want to begin discharge discussion on day of admission to the inpatient hospice setting and then be prepared to pursue disposition and placement when hospitalization criteria is no longer met. Of course that is easier said than done. After over 13 years disposition and discharge planning and management continue to be one of our greatest challenges. Sharol Herr, RN, BSN, MSEd, CHPN; Nurse Clinician/Education Coordinator; Mount Carmel Health Palliative Care Leadership Center; Columbus, Ohio.
+ Re:Changing hospice inpatients to "Routine Level" (by DOVENM on 11/11/2010)
our hospice-hospital partnership is exploring this same question, after learning more details about GIP criteria from Medicare University online. Have you had any other responses, or learned more about your question?
does your hospice also use GIP for pt's already hospitalized, as their entry point for hospice, if they are not safe to go home?
if a patient is already in the hospital, has never been on hospice, and does NOT meet GIP criteria, have any of you used the routine level of hospice care (stay in same bed, technically "discharge" from hospital,admit to hospice medicare benefit, "routine" as opposed to GIP level) while the pt. remains hospitalized?

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