EmailMeForm
HOSPICE - PROTOCOLS / Reminder EMF
E
/
P
/
Admin
Please note this is a mandatory refresher quiz and refresher that you need to learn and acknowledge in order to work on the case you are currently assigned to, If you have any questions, call us at 212-614-8057
HOSPICE
*
I understand that my client is on hospice. This means my goals and responsibilities are slightly modified and focused around COMFORT.
It is MY JOB to understand this entire form in it's entirety and ask questions when I am not sure.
Today's Date
*
MM
/
DD
/
YYYY
My Name
*
My Email
My Client's Name (that was placed on hospice)
*
Hospice Agency assigned to my client is
*
Please select
VNS Hospice, 24 hour # is 212-609-1920
Metropolitan Jewish Hospice Calvary Hospice - 24 hour number is 212-649-5555
Calvary Hospice - 24 hour number is (718) 518-2465
Hospice of New York - # -718-472-1999
If you are not sure, call the agency and find out
MASKS/ COVID*************************
Masks
*
When working with the hospice patient, it is mandatory to use your mask at all times.
The mask must be the Home Instead mask provided to you.
The mask must be worn over BOTH (i) nose and (ii) mouth at ALL times (not just when social distancing is not possible).
Please note that any complaint received due to lack of use of mask may result in immediate termination.
911*************************
NEVER CALL 911
*
A hospice patient is under the care of a NYS approved hospice medical team who will care for the patient in any emergency. Accordingly, under NO CIRCUMSTANCES will I ever call 911. I am only to call Home Instead or the hospice agency
MEDICATIONS*************************
Morphine and pain killers
*
There is a hospice medication box containing morphine and other pain medications in the home.
When those medications arrive please let the Home Instead office know immediately
I am not to take instructions from the hospice nurse or family. ONLY thru Home Instead
OBSERVING AND REPORTING*************************
Observing and Reporting
*
I am responsible to report to the agency and to the hospice agency any and all changes in my client's health or comfort level.
I need to also communicate with all my fellow caregivers on these issues
MISCELLANEOUS*************************
CLEAN AND DRY
*
I am responsible to make sure my client is clean and dry at (i) beginning of shift (ii) throughout my shift and (iii) end of my shift
COMFORT
*
I am responsible to make my client comfortable and peaceful. Under no circumstances will I push client to do things or talk about subjects that may make my patient uncomfortable
DEATH, DYING AND PAIN
*
I am aware that hospice means that the patient may be dying or in lots of pain and that I am not to discuss these issues with them or others out of privacy
In my words, I feel that my job on a hospice case is
*
Please use your own words
Signature
*
Clear
Sign your name with mouse or with your finger
Any questions? Call us at 212-614-8057 or email us at
*
