Ok, Alex, your rant has motivated me to write! I completely agree with you. I wish hospices would offer more physical therapy for patients that can benefit and that it would be part of the care plan. Maintaining or trying to improve function is important to quality of life. We definitely have patients we send under their skilled benefit who are hospice eligible because of the desire for some physical/ occupational/ speech therapy. If only the payment structure would allow for that. I agree that our system should be structured to accomodate the needs and goals of the patients. Feels good to rant.
Thanks for writing Winnie! Rant away, and let us know if you want to post.
Thank you for ranting about PT for hospice. (I warn on my blog when it s a rant.)PT has become a luxury for anyone of a certain age even if not hospitalized. I m still fighting the battle a year and a half after lumbar fusion (and still weak.)
Fire, flood, whatever – anything anyone can do for himself is vital.
I ve always been able to convince hospices I work for to provide at least 2-3 visits to eval and teach the patient/family/staff what needs to be done for the patient. I do think you would have a hard time convincing the hospices to cover long-term PT/OT except in exceptional circumstances (although one combined home health/hospice near me has done so a couple times with their home health PT/OT s. Have you tried talking to the hospice directly? They are the ones who can decide, since they are the ones who will pay.
I appreciate your rant, maybe I should rant myself.
I say a real hybrid course of care is needed!
I am NP, now work as hospitalist, but have extensive gero, hospice and palliative care background. When a hospitalized patient needs PT or ST, for example, has had an acute stroke with hemiparesis and severe dysphagia but wants to be DNR and/or have a comfort care approach, it sends the care provider team into a confused state and they are unable to blend–it s either hospice or full court press- from neurologist on down. It s like the concept of individualized care is too difficult, and then the actual patient, who already coping with a lot is left with hard choices, and that is ridiculous.
Thanks for letting me vent.
Kathleen Rye, NP
I guess I m in the minority here, but I am very happy c/ pt s choosing either hospice or rehab. I have worked c/ several hospice pt s that were dual certified and did not really make any significant progress. In my experience working c/ geriatrics we are usually more guilty of over-utilizing our services than underutilizing and if we add hospice pt s to the mix we are going to exacerbate this situation. That s just my 2 cents based on my experience, I know every pt is different and unique and shoud be treated c/ optimum care and respect, but I am not a proponent for dual care c/ PT and hospice.
Completely agree. I am a PT who prefers end of life care but is only able to practice this in the ICU, as the great majority of companies decline to hire or pay PTs for hospice care (trust me–I ve been looking). It is the pay structure. There is no reason we cannot increase a person s quality of life just because they are on hospice–fall risk certainly isn t decreasing! PT and hospice are not at odds with one another! For the curious, the philosophy is called rehab in reverse.