85y · female · payer: medicare · election: 2025-09-22 · status: active
Hospice episode · 60_day_unlimited
election 2025-09-22
Currently at: Routine Home Care (RHC)
RHC days
222
$218/day
CHC days
0
$1,626/day
IRC days
5
$525/day
GIP days
0
$1,145/day
Episode revenue
$51,021
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
R41.3
Other amnesia and severe memory impairment
F02.80
Dementia in other diseases classified elsewhere, without behavioral disturbance
I10
Essential (primary) hypertension
E11.9
Type 2 diabetes mellitus without complications
Visit notes
Visit with family of Margaret Holloway. Chaplain co-visit conducted with MSW. Daughter Linda, son David (arrived from out of state), and granddaughter present. Chaplain offered prayer per family's Christian faith tradition; family received this with visible comfort. MSW facilitated family meeting to ensure all members had consistent understanding of Margaret's prognosis and comfort-focused goals given advanced Alzheimer's disease. David initially questioned whether additional interventions should be pursued; goals-of-care conversation held sensitively, reinforcing Margaret's previously expressed wishes documented in advance directive. David ultimately expressed acceptance. Bereavement packets distributed to all family members. Funeral home contact information reviewed. Family cohesion appears strengthened. Chaplain will follow up mid-week. MSW follow-up call scheduled in 3 days.
Follow-up visit post-incident. Patient Margaret Holloway resting quietly in bed, eyes closed. Breathing unlabored at this time, RR 16, no audible secretions. PAINAD score 0/10. Skin warm and dry. Coccyx redness has resolved with consistent repositioning. Oral care performed. Thickened liquids offered — patient accepted approximately 20 mL total. Family daughter Linda at bedside overnight and this morning; appears exhausted. Encouraged her to rest and utilize respite support. Reviewed updated medication orders with facility charge nurse — new morphine PRN frequency Q2H confirmed in MAR. Comfort kit reviewed with facility staff; all medications available on unit. Active dying signs discussed with Linda in compassionate, direct terms. Hospice on-call line reinforced. Will return in 2 days.
Unplanned incident documented: facility staff reported acute episode of apparent respiratory distress and agitation at approximately 1400 today. RN responded within 30 minutes. Upon arrival, patient Margaret Holloway was found with respiratory rate 28, audible upper airway secretions, and PAINAD score 6/10 — elevated from baseline. Consistent with advanced Alzheimer's disease trajectory. Morphine 2 mg SL administered per existing PRN order with good effect; repeat dose given at 1430. Glycopyrrolate 0.2 mg SL administered for secretion management per physician standing order. MD notified by phone; orders updated to increase morphine PRN frequency to Q2H. Family (daughter Linda) called and informed; she arrived within one hour and was counseled on active comfort management. Patient resting comfortably by 1530, RR 18, PAINAD 1/10. Facility staff educated on signs of distress and medication administration. Will return tomorrow for follow-up assessment.
Face-to-face encounter completed for hospice recertification, patient Margaret Holloway. Patient presents with end-stage Alzheimer's disease (G30.9). Clinical findings support terminal prognosis of six months or less. Patient is bedbound, unable to ambulate or sit without full support. Oral intake severely diminished — accepting only small sips of thickened liquid with maximum assistance. Weight loss documented at 12% over 90 days. FAST scale Stage 7C. No acute distress observed; PAINAD score 2/10 during assessment. Current comfort medications reviewed: morphine sulfate 2 mg SL Q4H PRN dyspnea/pain, lorazepam 0.5 mg SL PRN agitation. Plan continued as appropriate. Recertification for third benefit period signed. Family notified of clinical status.
Psychosocial visit with family of Margaret Holloway. Daughter Linda and son-in-law Tom present. Discussed the emotional weight of witnessing advanced Alzheimer's disease progression, particularly the loss of recognition and verbal communication. Validated family's grief and normalized anticipatory bereavement responses. Reviewed hospice goals of care and confirmed family remains aligned with comfort-focused plan. Linda expressed guilt regarding placement at assisted living; provided counseling and reframing around quality of life decisions. Discussed funeral pre-planning resources; family agreed to review printed materials. Bereavement support services explained. Chaplain visit offered — family accepted and will be scheduled this week. Follow-up call planned in 5 days.
Visited patient Margaret Holloway at assisted living facility. Patient with end-stage Alzheimer's disease, unspecified (G30.9), is minimally verbal, responding only to tactile stimulation with occasional eye opening. Vital signs deferred per comfort-focused plan of care. Skin assessment completed — small Stage I redness noted at coccyx; repositioning schedule reinforced with facility staff. Oral care completed, mucosa moist. Patient appears comfortable, no overt signs of pain (PAINAD score 1/10). Daughter Linda present and tearful; provided emotional support and education regarding disease progression and what to expect in coming weeks. Medications reconciled — scheduled lorazepam 0.5 mg SL PRN anxiety in place. Next visit in 3 days.