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Palliative Care in Long Term Care Settings

Next Reply: Re:How often should I see my nursing home patients?
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Post How often should I see my nursing home patients?
Author: jdescher
Date: Oct 28, 2009 12:48 pm
I am a NP, and started a nursing home based palliative care program( not hospice). Things are going very well, but a physician approached me and expressed concern that I was seeing my more stable patients too often. He stated that if they aren't showing any active symptoms, that I shouldn't see them more than the PCP( I see tham about twice monthly). My patients are very frail, and the families want them seen by me. They, as well as the nursing home staff are extremely pleased with the program, especially the communication that I keep with the families. Many of my patients are not far from hospice, the families want them on hospice, and I want to refer them at an appropriate time instead of the usual when they are comatose. How often should I see my patients who are not having active symptoms?
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Re:How often should I see my nursing home patients? (by mrabow on 10/29/2009)
Great question and it sounds like you are doing great work.

I'm looking forward to responses from other NP's about their practices.

From my perspective, it is appropriate to think about symptoms broadly, including physical symptoms like pain, fatigue, but also psychological symptoms (anxiety, depression) and existential symptoms (spiritual distress, end-of-life crises, growth). In addition,advance care planning is key.

With a focus on symptoms broadly-defined and comprehensive in nature, the frequency of your visits, based on patient need, might very well be a matter of weeks, rather than months.

Best,
mike
Michael W. Rabow, MD, Associate Director, UCSF PCLC

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