Stay Until The Job Is Done - Hospice and Home Health

Dear Barbara, How do you get people, mainly management, to understand that hospice work is not an in and out job, it’s a team commitment to serve the patient and family and, honestly, each other. It's a heavy calling, and one that I have been blessed to be part of for 8 years as a hospice nurse. But the push to get in and get out and head to the next one is super stressful. It feels that productivity is valued more than anything. We went under the same director as Home Care a year ago when our founding director retired, and this has been a struggle within my department ever since. We are constantly being compared to what Home Care is doing. No matter how many times I have voiced that we can not be compared to Home Care, my voice is not heard.

I ran a home health care agency and a hospice agency at the same time, as separate entities (different staff, different expectations, different care, even different billing mechanisms). A home health care visit is, yes, in and out whereas hospice visits are in as long as it takes to address the current situation and then out.

With hospice you never know what you will find once you enter the home. Service can’t be time based. Visits have to be stay until the job is done and that should be an expected 60 minutes but can easily turn into three hours.

The way hospice visits used to be were that we stayed as long as we needed to to address the particular situation BUT, over the years, because of medicare regulations, wage and hour, and profit motives, hospice has lost its focus on the time it takes to provide good care.

I think part of this loss of focus is because hospice administration (the management) now comes from a hospital/home health/business base and not from the philosophy of idealism, heart centered, end of life care that is the root of hospice care.

I think this is why you are frustrated (it is certainly my frustration as well). What to do about it is another matter. Defend your choices. Find like minded co-workers. Be the Light in the darkness.

Something More... about Stay Until The Job Is Done

In my book, The Final Act of Living, Reflections of a Long Time Hospice Nurse, I share insights and experiences gathered over decades of working with people during their final act of living. For both professionals and lay people, this book weaves personal stories with practical care guidelines, including: living with a life threatening illness, signs of the dying process, the stages of grief, living wills, and other end of life issues. 

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barbara karnes

Hi Sandee, Yes, it is hard returning to the space where our loved one died. You made your return a special, healing time, that was the beginning of your grief journey. My blessings are with you. Barbara


Oh my! That is so very true! After my mom passed, it was i who put fresh bedding on her bed….immediately! Then before the day was to end i walked into her room….laid right next to her side of the bed, and talked ALOT! Cried ALOT (crying right now too!)! And actually i threw myself on her bed, not laid! I recall asking the people who came to remove the body, to please take all the bedding with them, they did and i was very grateful for that!…


Hi Anthony, I am so pleased to hear you had a supportive hospice experience. That is what hospice is supposed to be. Thank you for sharing. Blessings! Barbara

Anthony Buss

I’m a lay person who ended up here by way of “Gone From My Sight” about a year ago. The book provided an amazing comfort to my family as we said goodbye to a loved one.

Since then the e-mail newsletter and practical advice on the site have blessed me repeatedly. My heart is full to see this information being shared and I only wish everyone involved in end of life care could read it and have it drop from their minds to their hearts.

That brings me to the post above. I have very little experience with these matters but the hospice providers I met were an amazing gift to my loved one and our family. They “got it” and it sounds like we were fortunate to be involved with an organization that also “got it” and supported them. As someone who loved one of your patients dearly, just know that when you care for them you’re caring for me too. I will never forget the names, faces, and conversations we had and how they helped us turn unspeakable grief into a beautiful celebration. Fight the good fight. We need you and are rooting for you!

Thank you for your commitment to doing what’s right for your patients. And thank you for making end of life care your life’s work.

Kristine Sachara MSN, RN

Despite the edicts of Medicare, I don’t care how much time I spend with a patient or family… I stay until I feel comfortable leaving… the situation is handled, my patient is comfortable, clean, etc. One thing I do which I gleamed from “The Final Acts of Living” that I wish more hospice practiced is not only staying with the patient and family until removal but making the bed after the patient is in the care of the funeral home. I find something in the room (a cap, stuffed animal, flower) placing it on the pillow. As Ms Karnes points out it would be difficult to walk into a room and see a disheveled bed that held your loved one.

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