Help! Navigating through hospice providers.

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Help! Navigating through hospice providers.

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I'm beyond frustrated through this process.

Background. Mom has pulmonary fibrosis and she in end stages of disease. Earlier this month hospitalized with UTI. Plan was discharge w hospice. I thought I did my due diligence, asked my friends who been through this for recommendations and then followed with questions. One of my must haves are Spanish speaking Nurses for my mom. I specifically stated Spanish speaking Rn, Lvn and bath nurse. Surprisingly many hospices didn't have Spanish speaking RN. Ok.

1st hospice I chose ended up being very pushy, even though I already told them they have our business. I fired them after they continued to be pushy after warning them. 2nd hospice said they had Spanish RN. Came time to set up admissions to hospice, no Spanish RN, so I fired them. My moms UTI came back and week later return trip to hospital. Hospital helped me with few more hospices, again vetted them and decided on company who said they had Spanish RN. I was very transparent with why I fired last 2 hospices. It's Thursday 4pm. Dr said my mom ready for discharge tomorrow morning, great! Hospice now tells me no Spanish RN available as she has full case load!!! Wtf?!?! I feel like these companies tell you what you want to hear so you sign up , put you between a rock n hard place.

In the meantime, I've had several people from social workers to doctors saying that I am not ready to face hospice and end of life care. Ok. Maybe that's why I fired 1st two. But again from the start, one of my must haves are Spanish speakers, so it is wrong of me to fire 3rd hospice who reassured me they had Spanish speaker and not able to deliver?! It's not whether I want hospice or not, but my mom definitely needs it. It scares me I have a hard time identifying another level of decline. A nurse who visits regularly could spot this better than I. But at the same time I refuse to be manipulated into something I don't want. Hospice and nursing homes seem to be predatory and thirsty for Medicare dollars.

Am am I the one who is being difficult and in denial?

How do I choose a hospice that I can trust that meets my needs? I'm in Southern California and surprised it's been hard to filled skilled RN that speak Spanish. My mom scheduled to discharge tomorrow morning.

End of Life Home Care Hospice

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To tell you the truth you will not see the RN a whole lot. That is the fact. You will more see the workers who come to care for your Mom. As they are with hospice they should be good at filling in the RN and case workers about Mom's condition. There are quite honestly not as many Spanish Speaking RNs as there are other aid workers, but I agree it is surprising in So. Cal.
Now one more thing. I am concerned that some have said you are not ready to accept hospice care. You do understand hospice care being end of life care? Am I correct in assuming that. And you are read for that?
You are also correct in assuming that Hospice is not what it once was. Very few are, in fact. During my career I saw Hospice's beginning in our country.So many so dedicated and such comprehensive full care of patient and family. My friend still works in hospice. What it was is gone and it is now fully a part of the Military Industrial Complex. That is to say, follow the money. It is business more than once it was for certain. There are still some marvelous ones. I suspect they are few and far between.
They WILL discharge you mother when she is ready to be home, whether hospice is in place or not. I would go for as many Spanish Speaking people as you are able. I am assuming you will be there to interpret much of the time? Would that be a correct assumption.
Wishing you the very best. This is a hard time.

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I am so sorry you are going thru this. It also happened to me when my daughter was dying. I wanted the care that was appropriate and had questions to which I was told I was your 'typical grieving parent'. Now that I am trying to get some assistance - that is not even end of life care - for my 91 year old Dad, even our MDVIP doctor appears to be treating me the same way!!!! I, like you, just want the best for our parent. PLEASE DO NOT GIVE UP UNTIL YOU GET WHAT YOU NEED!! I can tell you from my experience with my Daughter....at the end you will know, and feel peace, that you did the very best for your loved one. God Bless You.

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I have also heard about people HAVEING BAD EXPERIENCES with Vitas and Yes I know they are for profit ...so are doctors ,and hospitals ,everyone who works are for profit so whats wrong with profit hospice I always wondered? They are doing Right by my Aunt and even prescribed antibiotics 3x for celluitis, UTI ,upper respitory infection ..she recovered from all 3 ailments and shes got a cna 2x per week RN 1X dr when needed hospice is for comfort at the end of their life if you need more help then a home health care agency may be better because they give you help about 12 hours a week or maybe even more but the home health is for profit too .

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I dont have time to read all these responses, but if your mom is staying at home, then you may need hospice (try to find a non profit one) and you will also need home care service provided under medicare. And possible some added care to cover other times. Sounds like you are a candidate for assisted living.

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Did you read the post? Not trying to be rude but your reply has nothing to do with the post. The OP does not need AL. Her mother is the person in need and her mother is on hospice. They having trouble getting a Spanish speaking RN through a hospice provider.

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I find in this day and age that nothing goes as planned. You think you have everything set up, only to have it fall through. Happened to my mother - the Nursing Home killed her.

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I find it hard to believe that hospices in SoCal have never had to accommodate people who spoke only Spanish. Maybe a hospice might be able to use a phone translation service. I’ve seen it used on TV but don’t know much about it. I hope you find what you want for your mother.

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I was shocked too. They have LVN nurses but not RN . Apparently the ones that are , are in high demand

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We are not in California, and did not need Spanish speaking. However I must say that when we needed Hospice for my step dad we found a not-for-profit one that was MUCH better than the one that was affiliated with the NH. It also seemed to keep the staff "on their toes" better with his care since they were all used to the hospice people affiliated with the NH, and here was someone from the outside seeing what goes on.

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What part of the country are in? I live in Seattle I bet it would be tough to easily find Spanish speaking staff. I am on the tail end of 7 children so I have dealt with these issues more than I expected. It can be difficult finding people that meet the entire wish list. These people do not make a lot of money and lets face it they are doing work few of us can or want to do. I found on going clear communication, patience and putting my time into it always got me thru this. THE mixed blessing is you do not have to deal with this for a very long period of time

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I'm in Southern California. I assumed there wouldn't be a "shortage" here . There were plenty of lvn nurses but not RN. THe RN would be the Main nurse checking on her, so it was important to me, as well as my mom build a relationship with her

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I'm very surprised Spanish speaking providers are so hard to come by too, I hope that means agencies are trying to hire more. Sound's like they must be in high demand, it may very well be that the person you ask (the one selling the services) has no idea of the case load for a given nurse they just know that they do ave Spanish speaking providers and when it get's to the scheduler is when the system realizes while they have them on staff they don't have any with space available in their case load. That said you are not wrong or out of line, in denial by wanting to assure your mom get's a Spanish speaker, it is a caring and reasonable demand. You may find that you will need to give a little in other areas perhaps to accomplish this by the sounds of it but shooting for everything that's important to you is not wrong, you just might need to be willing to prioritize here and deal with not getting it all right off the bat. So for instance the first agency you fired, now knowing what you do about the other options would it be worth having to push back on there pushy sales tactics in order to get the Spanish speaking providers? I don't know the details of what pushy things they were doing and it may be systemic in which case good riddance but it might be just that initial sales department who is that way maybe once you get too or have been processed through intake the people are more service less push?

You might ask the discharge person at the hospital for help in finding a service with an assured available Spanish speaking team, they must run into this problem somewhat regularly if you keep running into it.

Then my final thought is asking the coordinator for the companies you like the best if there is any way a Spanish speaking nurse can be made available, maybe there is a patient who doesn't need a Spanish speaker and wouldn't mind switching nurses or for the other aids coming in to be Spanish speakers until a nurse becomes available or how long it is likely to be before a Spanish speaking nurse is available. Perhaps a Spanish speaker could come for the set up or come with the non Spanish speaker for the set up to help facilitate both mom's and your comfort. Remember a good Hospice provider/agency is there to support you and the family as well as your mom, they take and provide a wholistic family service for this difficult time and recognize the differing needs of everyone affected.

Good luck and remember taking care of yourself at this time is also taking care of Mom, keep up the loving work.

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in retrospect, you're right. That 1 st one I fired may have been better choice in the end. I ended up choosing one that " said all the right things". . They did provide us with the Spanish speaking RN. but in the end, I clearly over thought it, and ended up with worst possible choice. I get tooo angry to talk about all of it, as my mom has since passed. but let's just say the RN Stole a ring from my mom I had placed in her jewelry box. Her nice jewelry was stored in the safe, but this was a piece she wore every day, and had recently taken it off. Anyways, that the least of the issues I have with that RN. 😢

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If this is home hospice, I think someone has to be with Mom 24/7. Like said, home hospice the family does most of the care. RNs only show up once or twice a week to do vitals and evaluate. CNAs 2 or 3 times to bathe. You can ask for more time so u can do shopping or just get out of the house.

So like said, someone who speaks Spanish can be there for Mom. And I agree, that the CNA would be the one who needs to speak it.

I am from NJ. I too am surprised that they are short on Spanish speaking RNs. But then I was at Moms LTC and a woman was hollering in Spanish. One staff member came up to her speaking Spanish. She told me she was the only one on that shift that spoke it. Really?

There was an Italian lady who only spoke Italian. My RN daughter says when people have Dementia, they tend to go back to the language of their birth and forget their second language.

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Hey, JoAnn, you just taught me something about elderly with dementia reverting back to their “home” language. That makes perfect sense, however, I had never heard that.

So as your daughter has seen, we definitely need more nurses with the ability to speak various foreign languages. One would think that in California where “Mama2drama” has her mother, there would be multiple agencies filled with Spanish-speaking staff, but what we might think seems logical, may not be a reality.

I enjoy reading your answers on this site. You can tell that you’ve learned a few things in life.

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Make sure your mother is not being denied care due to inability to find Spanish speaking nurse, ok.
Let's face it. There are a number of factors here.
1. This is the United States where English is the primary language. 2. Spanish speaking workers are needed in every line of work in the country.
3. There is a major shortage of caregivers, nurses, CNA's, etc.

I would let the next company know you will fire them if they claim to have yet cant provide a Spanish speaking nurse. In all reality, you need to realize it just might not be possible.
Hire an Interpreter.
Best of luck and keep up the good work.

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When my Husband was on Hospice the Nurse came 1 time a week but the CNA was here 2 to 3 times a week.
Since both the Nurse and the CNA schedule visits and the CNA will be the one that will work more closely with your Mom it might be better to "push" for a CNA that is fluent in Spanish. I am guessing you would be there for the visits with the Nurse so you could translate if necessary.
You are right about being surprised that there are few nurses that speak Spanish in your area. Unless they are finding employment in Hospitals if more lucrative for them.
Dealing with your Mom, her hospitalizations, decline as well as your health problems my guess is you are overwhelmed.
Ask again about getting a CNA that is fluent I think that will be more of a benefit than the Nurse simply due to the type of contact the CNA has and how much time she/he will spend.
By the way the term you used "Lvn" not sure what that is. I had a Nurse, the CNA that did personal care, bath, dressing him, ordering supplies, weight or measurements etc, then there was a Social Worker and a Chaplain.

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LVN - Licensed Vocational Nurse - same a LPN ( I think).

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I hesitate to say this to someone who's as understandably stressed out and frustrated as you must be, but.

The Spanish language skills ARE proving a problem. I'm surprised, too. But since they are, and since the main reason you yourself state for needing hospice on board is the nursing skills, and specifically the ability to spot key clinical signs, then surely it would be better to prioritise those nursing skills and relegate the language skills to "nice to have" rather than "must have."

Experienced hospice nurses are practised in communicating with people who can't speak, can't hear, or even can't understand at all. It isn't that I think you're being intentionally difficult, or in denial, but I think perhaps you're not giving enough credit to skilled nurses' ability to care very well for patients they can't necessarily have a proper conversation with.

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My mom is on hospice, and the majority of care will fall on the family. I assume your mom will not be living alone, because if they are on hospice this would be highly inappropriate. So the issue of Spanish-speaking only should not be such a problem because family is around the patient anyway (unless the family also cannot speak English which would pose a problem). My mom has end-stage Alzheimer's so everything that is said and done falls on the caregiver (I am also her DPOA). If there is a language barrier they are supposed to provide interpreter services, which can be delivered via telephone.

They can send a home-care aide, but they are only there less than an hour a few times a week at most. I wish I could take mom off of hospice, but I can't since she is 100% homebound and I just can't take her to the doctor. Getting your loved one on hospice initially requires a doctor's order. Afterward you can revoke and get them back on hospice without an order. More on this later.

Hospice nurse practitioners and doctors don't like treating problems like frequent urinary tract infections and you get the usual speech just let them die and keep them comfortable, which means drug them up with narcotics and let them die of dehydration which can take weeks. If the treatment is inadequate, and the hospice doctor/nurse practitioner does not want to work with you, then tell them you are taking them to the Emergency Room. I've done this to mom lots of times due to the stubbornness of hospice. AS LONG AS YOU NOTIFY THEM--which you MUST--because the ambulance and emergency room visit bill will entirely fall on hospice. MEDICARE PAYS HOSPICE $4,000 a MONTH for care, and you get hospital equipment like bed, oxygen, and so on, and a nurse to visit you once a week for a few minutes and they help with supplies like diapers, wipes, gloves, thick-it, but there are times you have to buy your own. Hospice and Medicare are apparently separate accounts.

Hospice will NOT authorize a feeding tube should that need arise. You have to revoke hospice--then get them hospitalized--get the feeding tube inserted which is a surgical procedure and probably overnight stay--then get them BACK on hospice afterward. Revoking hospice is very simple. Just sign a paper and it's done. Getting them BACK on hospice is equally easy. Just call a hospice and since they were on hospice already you do NOT need a doctor's order. Talk to a hospice social worker before doing all of this. If they support and work with you, you may want to get back on the same hospice. If not screw them and get them on another hospice.

I already fired VITAS.. for your information they are FOR PROFIT hospice.

I cannot stress enough IF you got your loved on on hospice, and you intend to do Emergency Room visit--you MUST notify your hospice first. They cannot deny you this visit. And yes if hospitalized, hospice will also pay for that.

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A full case load? This is hospice. Did you ask when Spanish speaking nurse would have opening for another Spanish speaking patient? RN will be coming once a week for about a half hour? Would it be possible for you to be with her during that weekly visit? Or maybe a volunteer organization that could provide translation services? Perhaps a church would have members that look for a chance to volunteer in this way? Maybe you are not ready?

I googled Spanish speaking hospice southern California there were a number of hits. Have you talked with Bella Vida? Exclusive servicing Spanish speaking.

http://www.bellavidahospice.org/english/home.html

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Mama to drama; Not surprised about Hospices I worked in health care for 11 years and we dealt with lots of hospice care I felt most comfortable with Vitas they are nation wide I would not know any others in California thats a bit out of my woods lol ....No you are not overreacting this is your loved one ! You have to look out for them .My Aunt is on Vitas hospice right now in my area they are really complaint ,with all my wishes and what ever I turn down , our nurse is bilingual , we have CNA that comes 2xs per week for showers ect.. a Nurse 1x per week,We turned down the Chaplin not my aunts type ,and every 60 days you can get a Respite where your loved one stays at a nursing home 5 days there were a couple NH to pick from THAT COST IS COVERED FROM MEDICARE And when the time comes they offer continuous care in your home or at their own continuous care unit RN or LPN nurse sits by the bedside at night and CNA during the day so that your loved one is not alone..that's how it has worked for us in my area .I have not used CCfor my relative but we often did at my job.its a good service HUGS TO YOU AND LUCK

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I had horrible experiences with VITAS..although Medicare approved, they are for profit and there were times I had to buy my own supplies because VITAS does restrictions how many diapers and wipes you get a week..and sometimes they don't even deliver. Long story which I will not get into, but I fired them for good reasons and filed a State complaint against them. VITAS really sucks.

Help! Navigating through hospice providers.

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