82y · female · payer: medicare · election: 2026-01-03 · status: active
Hospice episode · 60_day_unlimited
election 2026-01-03
Currently at: Routine Home Care (RHC)
RHC days
122
$218/day
CHC days
0
$1,626/day
IRC days
5
$525/day
GIP days
0
$1,145/day
Episode revenue
$29,221
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
R63.3
Feeding difficulties
F02.80
Dementia in other diseases classified elsewhere, without behavioral disturbance
M81.0
Age-related osteoporosis without current pathological fracture
I10
Essential (primary) hypertension
E11.9
Type 2 diabetes mellitus without complications
Visit notes
Bereavement-preparatory visit conducted in home. Patient Eula Washington continues to decline with end-stage Alzheimer's disease; family anticipates death may be imminent per RN assessment. Chaplain had visited yesterday and family expressed deep comfort from that encounter. Loretta and Marcus present; two additional family members (grandchildren) also in home. Facilitated family meeting regarding what to expect at time of death and immediate after-death notifications, including calling hospice nurse first before funeral home. Reviewed DNR documentation and its location on refrigerator per state protocol. Marcus expressed he is at peace with mother's journey; Loretta continues to struggle with anticipatory grief and states she fears she will not be present at the moment of death. Normalized this fear and discussed that patients often choose their moment. Provided bereavement brochure and information on hospice grief support services available for 13 months post-death. Family expressed gratitude for hospice team support. Will remain available by phone and plan follow-up as needed.
Follow-up skilled nursing visit. Eula Washington remains bedbound and non-verbal with end-stage Alzheimer's disease. No recurrence of acute respiratory distress since incident on 01/16. Secretion management ongoing with atropine drops PRN; caregiver reports using once daily with adequate effect. Coccyx pressure injury reassessed — Stage I redness slightly improved with consistent repositioning Q2H; foam dressing in place and intact. Oral care completed during visit; lips and mucous membranes moistened with swabs. Patient grimaced with repositioning — morphine 2 mg SL administered with resolution of apparent discomfort within 15 minutes. Urine output decreased per Foley output log maintained by Loretta; approximately 200 mL over 24 hours, tea-colored. Findings consistent with end-stage decline; family educated on signs of active dying including mottling, Cheyne-Stokes breathing, and decreased perfusion. Loretta asked for chaplain to return before patient passes. Chaplain notified. Plan to visit again in 2 days.
Incident note: Caregiver Loretta called hospice nurse line at approximately 0820 reporting that patient had audible gurgling respirations and appeared to be in significant distress, with color change to perioral area. RN responded on-site within 35 minutes. Upon arrival, patient found in semi-recumbent position with secretion accumulation consistent with Alzheimer's-related dysphagia and loss of protective airway reflexes. Repositioned to lateral decubitus; oropharyngeal suctioning avoided per comfort plan. Atropine 1% ophthalmic solution 2 drops SL administered with good effect; respirations quieted within 20 minutes. No emergency transport pursued per patient's DNR/DNH and established goals of care. Family reassured; comfort measures reinforced. Medication supply of atropine drops confirmed adequate. Loretta and Marcus both present; emotional support provided. MD notified of event and current status. Increased visit frequency ordered — RN to return tomorrow.
Face-to-face encounter completed for Eula Washington per hospice certification requirements. Patient has end-stage Alzheimer's disease (G30.9) with severe cognitive and functional decline. Patient is bedbound, non-verbal, dependent for all ADLs. Weight noted at 89 lbs per scale, down 6 lbs from pre-hospice baseline. Swallowing noted to be increasingly effortful; CNA and family instructed to minimize oral intake attempts to reduce aspiration risk. No evidence of acute infectious process on exam. Lung fields clear. Skin on coccyx shows Stage I pressure injury; wound care protocol initiated and dressing supplies ordered. Current comfort medications appropriate. Prognosis consistent with six-month terminal trajectory given functional status, nutritional decline, and severity of dementia. Hospice eligibility recertified. Family updated by phone following visit; questions answered. Follow-up PRN or with symptom changes.
Psychosocial visit conducted at patient's home with primary caregiver and daughter Loretta Washington and son Marcus Washington, who traveled from out of town. Discussed anticipated disease trajectory of end-stage Alzheimer's disease and what active dying may look like in coming weeks. Both family members expressed grief and guilt regarding placement of Ms. Eula in home hospice rather than facility. Validated their decision-making and reframed their presence and attentive care as a profound act of love. Marcus asked about funeral pre-planning; provided community resource list and contact for local funeral home with hospice experience. Loretta tearful but engaged; requested follow-up call mid-week. Spiritual assessment completed — patient was lifelong Baptist; family would welcome chaplain visit. Chaplain referral placed. No safety or financial concerns identified at this time. Will follow up in approximately one week.
Initial hospice nursing visit completed for Eula Washington following hospice election on 01/03/2026. Patient presents with end-stage Alzheimer's disease, unspecified (G30.9). Patient is non-verbal, minimally responsive to voice, opens eyes briefly to touch. Respirations even and unlabored at rest, RR 16. Skin warm, dry; coccyx area intact with mild redness noted — repositioning schedule reviewed with daughter Loretta. Patient on pureed diet per prior SLP eval; no signs of acute distress observed. PRN medications including lorazepam 0.5 mg SL and morphine 2 mg SL reviewed with caregiver for comfort goals. Loretta verbalized understanding and demonstrated correct sublingual administration technique. Plan of care goals discussed; comfort-focused approach confirmed by family. Return visit scheduled in 3 days. Hospice nurse line number left at bedside.