Hospice episode · 90_day_2
election 2026-02-18
Currently at: Routine Home Care (RHC)
RHC days
76
$218/day
CHC days
0
$1,626/day
IRC days
5
$525/day
GIP days
0
$1,145/day
Episode revenue
$19,193
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
N39.0
Urinary tract infection, site not specified
M62.50
Muscle wasting and atrophy, not elsewhere classified, unspecified site
R63.3
Feeding difficulties
F02.80
Dementia in other diseases classified elsewhere, without behavioral disturbance
I10
Essential (primary) hypertension
Visit notes
Urgent psychosocial visit at family request. Mr. Vernon Castle is actively transitioning with end-stage Alzheimer's disease. Met with daughter, son-in-law, and patient's sister who traveled from out of state. Provided emotional support and psychoeducation on the active dying process, normalizing the changes family is witnessing. Sister expressed distress at seeing Mr. Castle's Cheyne-Stokes respirations, fearing he was 'suffocating.' Explained that altered breathing is a natural part of the dying process and that current comfort medications are addressing any potential air hunger. Family gathered around bedside; encouraged them to speak softly and offer presence. Discussed funeral home contact information already on file per prior conversation. Chaplain had visited earlier today; family reported finding it meaningful. Bereavement follow-up plan confirmed. Hospice team on standby; RN to visit again this evening. Family feels supported and wishes to keep Mr. Castle at home through the end.
Routine nursing visit. Mr. Vernon Castle's condition continues to decline consistent with advanced Alzheimer's disease. Patient remains bedbound and non-verbal. Oral intake now minimal — family offering ice chips; no distress noted with oral care. Mottling observed bilateral knees and lower extremities. Extremities cool to touch. Respirations irregular, 10-14/min, with occasional Cheyne-Stokes pattern. No audible secretions at this time. Heel protectors in place; no further skin breakdown. Current comfort medications being administered on schedule per daughter's report; she demonstrated correct SL technique — technique appropriate. Daughter aware patient is likely transitioning. Emotional support provided; chaplain notified and visit arranged for this afternoon. MSW contacted to coordinate bereavement support. Family instructed on signs of imminent death and encouraged to call hospice line at any hour. Continuous care level discussed and offered; family declined at this time, wishing to maintain current schedule.
Incident documentation: Daughter called hospice line at 1510 reporting acute agitation and moaning in Mr. Castle, consistent with pain or discomfort crisis. RN on-call provided telephonic guidance; PRN lorazepam 0.5 mg SL administered by daughter at 1520. RN arrived at bedside at 1615. On assessment: patient grimacing, limbs rigid, HR 102, RR 22. No signs of fall or injury. Repositioned patient; morphine 2 mg SL administered per new MD order. Within 30 minutes, patient visibly relaxed, HR 88, RR 16. Assessed for potential underlying cause — possible urinary retention; bladder scan deferred given comfort-only goals. MD notified; standing morphine q6h ordered in addition to PRN dosing given escalating Alzheimer's-related end-stage symptoms. Daughter educated on revised medication schedule and comfort positioning. Will increase visit frequency to daily x 3 days.
Face-to-face encounter completed at patient's residence per hospice recertification requirements. Mr. Vernon Castle presents with end-stage Alzheimer's disease, unspecified (G30.9). Patient is bedbound, non-verbal, and does not consistently follow commands. Weight noted at 108 lbs, down 4 lbs since election. Dysphagia worsening; patient accepting minimal thickened liquids only. No signs of acute distress; respirations unlabored. Skin: stage I redness noted bilateral heels — offloading measures ordered, heel protectors to be placed. Morphine 2 mg SL q4h PRN dyspnea added to comfort medication profile given increased apneic episodes observed by family. Patient continues to meet hospice eligibility criteria. Updated plan of care discussed with daughter. Prognosis consistent with six months or less if disease continues expected course. Will coordinate with RN for increased visit frequency.
Social work visit conducted in patient's home. Mr. Vernon Castle continues on hospice for end-stage Alzheimer's disease. Met with daughter and son-in-law for approximately 45 minutes. Family expressed anticipatory grief; daughter tearful, stating she feels guilty she 'cannot do more.' Validated her feelings and reinforced the significance of her presence and familiar touch to Mr. Castle's comfort. Discussed disease trajectory, including expected decline in swallowing and responsiveness. Provided bereavement resources and local caregiver support group information. Son-in-law asked questions regarding funeral pre-planning; offered to connect family with funeral home liaison. Advance directive and POLST reviewed and on file. Plan to return in one week; will assess need for chaplain referral per family's expressed spiritual needs.
Initial post-election nursing visit. Patient Vernon Castle is a male with advanced Alzheimer's disease, unspecified (G30.9), residing at home with daughter as primary caregiver. Patient is non-verbal, responsive to touch and familiar voices. Vital signs: BP 98/62, HR 78, RR 16, SpO2 96% on RA, afebrile. Skin intact; no pressure injuries noted. Oral mucosa moist. Patient accepting pureed diet and thickened liquids per SLP recommendations. Goals of care reviewed with daughter; she verbalized understanding of hospice philosophy and comfort-focused plan. Medications reconciled: lorazepam 0.5 mg SL PRN agitation, acetaminophen 650 mg q6h scheduled for pain management. Daughter instructed on PRN medication administration and when to call hospice line. Follow-up visit scheduled in 3 days.