Conversation nurses are helping chronically ill seniors age as gracefully as possible, just by talking to them.
The conversation nurse model trains providers to discuss serious illnesses and care goals with patients. These nurses are available to the patient, from the hospital to skilled nursing facility and back to their home.
To date, the “conversation nurse” has decreased hospital admissions, increased consultations for hospice placement, and improved daily conditions for chronically ill seniors.
Conversation Nurses: Helping Seniors Age Gracefully
This Conversation Nurse model was developed over a five-year period. Nurses are trained to follow patients from the hospital back to the skilled nursing facility as a way to reduce re-admissions. They also help smooth transitions for seniors with serious chronic illness either to palliative care or straight to their home.
Conversation nurses also act as a go-between for the senior and hospital to insure correct care is provided. This insures that the aged patient gets the care they want. Because people with serious illness are cared for at multiple sites, these skills are urgently needed across the continuum of care.
There are many cases where a chronically ill senior receives care that is not in line with his wishes. As the population of aged seniors with chronic illness increases, clinical expertise in complex care and talking about goals of care are necessary.
Conversation nurses therefore, act as liaisons between doctors, skilled nurses, clinical caregivers, and pharmacy.
The results thus far are encouraging. It has increased the number of palliative care consults in inpatient settings, decreased hospital re-admissions, and improved daily quality of life for chronically ill seniors.
With the Center for Medicaid Services (CMS), mandating increases accountability between caregivers and patients, conversation nurses are the perfect liaisons to help deliver quality health care.
In addition, by increasing the identification of persons with serious illness at an early stage, the aged patient is assured of getting their healthcare requests fulfilled.