Hospice episode · 60_day_unlimited
election 2025-10-17
Currently at: Routine Home Care (RHC)
RHC days
198
$218/day
CHC days
0
$1,626/day
IRC days
5
$525/day
GIP days
0
$1,145/day
Episode revenue
$45,789
case-mix-adjusted
Audit risk
low
live-discharge classifier
Dx category
neuro_degenerative
Hospice Item Set (HIS)
Pain (F2014)
Dyspnea (F2030) · Opioid (F1010)
Spiritual / clinical context
Diagnoses
G30.9
Alzheimer's disease, unspecified
R13.19
Dysphagia, unspecified
R64
Cachexia / adult failure to thrive
I10
Essential (primary) hypertension
F02.80
Dementia in other diseases classified elsewhere, without behavioral disturbance
E11.9
Type 2 diabetes mellitus without complications
Visit notes
Visited Rosa Mendez and family. Both Maria and Carlos present along with Rosa's sister Elena, who traveled from out of state. Rosa remains unresponsive, breathing pattern irregular, actively dying. MSW provided emotional support to all family members; facilitated a meaningful life-review conversation with Elena and Maria, honoring Rosa's life as a devoted mother, avid gardener, and community volunteer. Carlos, who had previously struggled with acceptance, verbalized peace with the comfort-focused plan of care, stating 'I can see she is not in pain.' Chaplain visited simultaneously at family's request and offered prayer in Spanish per family's cultural and spiritual preferences. Bereavement plan initiated in anticipation of death. Funeral home contact information confirmed with Maria. Reminded family to call hospice line immediately at time of death. Team updated. Plan to follow up with bereavement services post-death.
Follow-up skilled nursing visit for Rosa Mendez. Patient continues on comfort-focused plan of care for end-stage Alzheimer's disease. Compared to incident visit on 10/28, pt appears more settled this morning. Respirations 14/min, irregular with occasional apneic pauses of 8-10 seconds. Extremities cool bilaterally up to knees and elbows. Mottling noted on bilateral lower extremities to mid-calf. Oral secretions managed with repositioning to lateral position; glycopyrrolate discussed with MD and order obtained. No oral intake for approximately 36 hours; family reassured that this is expected and that pt is not suffering from hunger or thirst. Mouth care performed, lips moistened with swab. PAINAD score 1 at rest. Comfort kit reviewed with Maria; she demonstrated correct SL medication administration technique. Death imminent education provided. Family verbalized understanding. All team members notified of change in condition. Continuous care threshold criteria being assessed.
Urgent RN visit completed at 1845 following call from daughter Maria reporting acute change in condition. Upon arrival, patient Rosa Mendez noted with labored respirations, rate 26/min, audible upper airway secretions consistent with end-stage Alzheimer's disease progression. PAINAD score 5, indicating moderate distress. Pt grimacing, brow furrowed, extremities cool to mid-forearm bilaterally. Morphine 2mg SL administered at 1850 with repeat dose at 1920 per comfort protocol; lorazepam 0.5mg SL given for air hunger. Response noted by 1935 — respirations slowed to 18/min, facial musculature relaxed, PAINAD score reduced to 2. Family educated on active dying signs, use of emergency comfort kit, and when to call hospice. Chaplain visit offered; family accepted and chaplain on-call notified. Remained with family 90 minutes. On-call MD notified and aware. RN to return at 0700.
Face-to-face encounter completed for Rosa Mendez per hospice regulatory requirement. Pt is an 82-year-old female with end-stage Alzheimer's disease (G30.9). On examination: non-verbal, no purposeful movement, FAST Stage 7c. Weight estimated at 88 lbs, significant from prior documented 102 lbs six weeks ago. Skin intact with mild bilateral heel blanching; repositioning schedule reinforced with family. Swallowing appears markedly impaired; aspiration risk discussed with family and nursing staff. Lungs clear to auscultation bilaterally. No fever. Current comfort medications reviewed: morphine SL PRN appropriate, adding lorazepam 0.5mg SL PRN for signs of agitation or air hunger. Prognosis consistent with six-month terminal trajectory. Hospice eligibility confirmed. Family updated and expressed understanding. Continue current plan of care with focus on comfort, dignity, and family support.
Visited Rosa Mendez at family home. Present were daughter Maria and son Carlos. Both verbalized understanding of hospice goals and comfort-focused care for their mother's end-stage Alzheimer's disease. Maria expressed significant caregiver fatigue and tearfulness; validated her experience and explored respite options including inpatient respite. Carlos expressed difficulty accepting the prognosis, stating he still hopes for improvement. Provided psychoeducation on the natural progression of Alzheimer's disease at end of life and what to expect in final days and hours. Discussed advance directives — DNR/DNI in place and reviewed with family. Offered chaplain services; Maria expressed interest, Carlos declined at this time. Bereavement resources reviewed. Will follow up next week. Team notified of family dynamics and Carlos's ambivalence regarding goals of care.
Initial skilled nursing visit completed following hospice election on 10/17. Patient Rosa Mendez is an 82-year-old female with primary diagnosis of Alzheimer's disease, unspecified (G30.9), now with end-stage decline. Pt found in hospital bed in living room, unresponsive to verbal stimuli, opens eyes to tactile stimulation only. Respirations unlabored at 16/min, skin warm and dry, no signs of acute distress noted. Oral intake minimal per daughter Maria — sips of thickened liquids only. Foley catheter patent, urine amber and concentrated. Pain assessment via PAINAD scale: score 2, consistent with mild discomfort. Morphine 2mg SL ordered PRN; educated family on proper administration and goals of comfort-focused care. Hospice aide services initiated. Will coordinate with MSW for family support. Return visit scheduled in 48 hours.