Why wasn't Mr. Daly referred to hospice care? Hospice provides an extra layer of care for terminally ill patients and eases a nursing home's heavy burden of patient care. Hospice nurses and physicians are experts in end-of-life care, including pain and symptom management as well as wound care consultation.

A hospice nurse could have created a pain management routine that met this patient's needs and advocated on his behalf when medications weren't given on time or when the plan of care wasn't followed. Home health aides could have provided assistance with bathing and feeding, and their plans of care could have been tailored in ways that would have best assisted Mr. Daly, his family, and the staff. Social workers, chaplains, and volunteers could have visited with and provided additional emotional support for the patient and his family.

Michelle Sabree, MSN, RN, CNAA, CHPN

Newnan, GA