Focus on attentive older patient listening to young female doctor.

PHYSICIAN REFERRALS

As a medical professional, we realize that you have a choice when it comes to referring your patients — and you want the highest quality care for them. At Visiting Nurse Service & Hospice of Suffolk, our skilled nurses and professional staff will create a plan to provide the best in home health and hospice care.

HOME CARE REFERRAL FORM

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HOSPICE REFERRAL FORM

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Please fax completed forms to 631.912.1114. We will be in touch with you shortly.          For questions, contact 631.930.9375 or refer to the below guidelines.

Clinical guidelines for home health care

COULD YOUR PATIENT BENEFIT FROM HOME HEALTH CARE?

YES, if they could benefit from assessment or instruction regarding:

 

CARDIOVASCULAR SYSTEM

•Patients with new medications

•Patients needing further teaching regarding cardiovascular condition

•Patients needing further instruction on a special diet

•Reoccurring hospitalizations

•Unstable Hypertension

 

ENDOCRINE SYSTEM

•Diabetes recently diagnosed

•Patients having problems with hyperglycemia or hypoglycemia

•Recent change from oral to insulin therapy

•Reoccurring hospitalizations

•Change in insulin orders

•Patients with poor manual dexterity or vision problems

 

RESPIRATORY SYSTEM

•New medications

•Lack of understanding regarding activity, breathing techniques or diet

•Inability to use inhaler or spacer correctly

•COPD

•Pneumonia

 

MUSCULOSKELETAL SYSTEM

•Arthritis, fractures or trauma

•Any problems with transferring or ambulation

 

NEUROLOGICAL SYSTEM

•Alzheimer’s

•Memory problems

•Neurosensory deficits

•CVA

•MS

 

INTEGUMENTARY SYSTEM

•Any patient with an open wound that requires assessment and care instructions

 

RENAL/URINARY/REPRODUCTIVE SYSTEMS

•Chronic renal failure

•Urinary elimination disorders

•Problems with Foley or Suprapubic catheters

 

GASTROINTESTINAL SYSTEM

•Bowel elimination disorders

•Malnutrition

•Tube feedings

 

SURGICAL PATIENTS

•Patients having difficulty with management of wound, weakness, pain control, nutrition, etc.

 

PAIN MANAGEMENT

•Any patient who has not been able to obtain their pain control goal

 

MEDICATION MANAGEMENT

•Instruction for patient and caregiver

•Noncompliance

•New medications

•Memory deficits

•Abuse of medications

•Adjusted medications

 

PROFESSIONAL DISCIPLINES

•Physical or Occupational Therapists who can assess and treat patients who have problems with mobility, who may •need help navigating stairs in the home setting, or patients needing help with daily living skills, such as dressing, bathing and homemaking

•Speech and Language Pathologists who can evaluate speech and swallowing problems

•Social Workers who can evaluate and counsel on social, emotional and economic needs related to medical problems ¨ •Dietitians who can provide assistance with nutritional needs and prescribed diet

•Home Health Aide Services primarily to assist patients with personal care and some household tasks in addition to a skilled service (Nsg, PT, OT, ST)

 

 

 

 

Clinical guidelines for end-stage disease

The following provides general information about end-stage disease. In determining prognosis, it should be in the physician’s judgment that the patient’s life expectancy would be 6 months or less. Not all disease characteristics have to be present for a patient to be appropriate. If you have a patient that you feel needs hospice, please feel free to contact us. Ask this question: “Would the staff or the physician be surprised if the patient survived more than 6 months if the illness ran its normal course?” If   the answer is “Yes”, then that patient should be appropriate to receive hospice services.

END STAGE NEUROLOGICAL ILLNESS (includes Alzheimer’s Dementia, Parkinson’s Disease & Dementia, Lewy Body Dementia, Vascular Dementia, Supranuclear Palsy, Frontotemporal Dementia, Senile Degeneration of Brain)

•Ability to speak limited to six words

•Lost ability to eat, walk and sit-up without assistance

•Markedly decreased nutritional intake

• Urinary and fecal incontinence

•10% weight loss prior 6 months or serum albumin <2.5 gm/dl

•Signs of infection within last 12 months

 

END-STAGE RENAL FAILURE

•No dialysis

•Creatinine >8.0mg/dl & Creatinine clearance <10cc/min

•Hyperkalemia (  >7.0)

•Oliguria (  <400 cc/24 hours)

 

END-STAGE LIVER DISEASE

•PT<5 sec over control or INR>1.5

•Ascites, recurrent or refractory to treatment

•Hepatorenal syndrome (increased BUN, increased Cr, decreased Urine)

•Hepatic Encephalopathy (increased NH3)

•Oliguria(<400/24hours); urinesodium <10mEq/1)

•Hepatocellular carcinoma

 

UNSPECIFIED SIGNS OF TERMINAL ILLNESS FOR ANY DIAGNOSIS

•Frequent urinary tract infections

•Frequent respiratory infections–pneumonia

•Multiple hospital admission or ER visits

•Unexplained weight loss >10%

 

UNSPECIFIED SIGNS OF TERMINAL ILLNESS FOR ANY DIAGNOSIS

•Loss of appetite

•Withdrawal from the environment

•Unhealing decubiti

•Unexplained or refractory temperatures

•Hb<10, Alb<2.5, low cholesterol

•Disabled and requires considerable assistance and medical care

•Symptoms of multiple organ system failure

•Edema, decreased blood pressure

 

END-STAGE AIDS

•CD4 count <25 & persistent viral load>100,000

•History of successive opportunistic infections

•Wasting (loss of 33% of body mass)

 

 

 

Contact Us

Administration and Home Care Services

505 Main Street Northport, NY 11768

631.261.7200 631.261.1985
Hospice House 631.930.9399 631.261.5423
Hospice at Home 631.930.9335 631.930.9335

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