When does hospice come in?

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When does hospice come in?

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Mom is medically "healthy" but 95 and weak, she sleeps a lot and is never hungry except when tea and cookies are involved. Mom has a catheter and always needs her walker. I physically hand bathe her as she can no longer use the stairs. How do I know whether or not she will need to go on hospice?

Care Decisions End of Life Signs Family Caregiver Hospice

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A lovely stranger I met while out walking one day recommended I seek hospice care as early as possible. My mom is now under community hospice, evaluated as having 6 months or less to live by the hospital physician after she fell and broke her hip. She eats well but cannot walk and needs assistance with everything from toileting (incontinent) to bathing, eating, and dressing. Fewer than 6 words in her vocabulary (generally). I was told she was borderline-hospice, but we did get approval. We still have to pay the hefty cost of her caregivers, but hospice supports us and provides many supplies and equipment (e.g., hospital bed). I'm so grateful a kind stranger opened my eyes to see the value of this. It would not have happened had I not stepped up and asked for an evaluation. No one mentioned it or offered it in the hospital. We had her registered with palliative care prior to her fall, but she was "stable" so very little assistance was given. Kudos to mom's PCP for signing us up with this company that is now providing Hospice care and will be with us 'til the end.

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Hospice is for a diagnosis of terminal illness with no chance of life left. Your mothers physician would be the one to determine that. At 95 it is not uncommon for her to be weak or sleep a lot but that doesn't mean she is dying as of yet. Many older persons do the same. Your mother needs a complete physical assessment and a plan of care, such as caregivers to attend to daily needs, any special equipment needed, a nutritional assessment, and review of medications. Review her needs with her physician and ask for referrals to social worker to help get a plan going. At 95 it is natural that she has become unable to perform self care but until a complete assessment is done you won't know where she might be in her life time-line. Good luck to you and your mother.

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CokeCanlala: Perhaps your mother's physician should be involved so that Medicare will pay. Imho, "being 95 and weak, sleeps a lot with a poor appetite" is not a valid reason to call in hospice.

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When I contacted hospice for my mother, her diagnosis of “failure to thrive”, age and weight were enough to qualify her for hospice. The hospice worker said people wait too long and most die before that 6 mos. Outside measure. The hospice worker said you can get decertified if the person doesn’t die when expected.

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Find a reputable Hospice/Palliative care center in your area. In my parents case the doctor wrote the order to have an evaluation done for palliative. Mom was immediately put on Hospice and Dad was on Palliative for awhile and then he was put on Hospice.

Your Mother may start with Palliative as she is still somewhat movile. They will visit every two weeks, work on meds, work with the primary doctor. They serve as an extra pair of eyes.

it is so helpful for someone to come to the house or facility and the support is amazing if you have a good team

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I’m sorry to hear about your mother. In order for her to go on hospice her pcp will have to say she needs. Then you can tell them which one you want and they will get in touch with you. Then there has to be two doctors that say she needs it and medically they believe she has six months or less. From what you have said it sounds like she is ready for hospice. I also think you could get a social worker from medicare to help you with trying to get on hospice. When she gets on hospice everything will be a lot easier especially on you and you only have to call them for anything she needs or questions you have and there available 24/7. I wish you the best.

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Your mother needs to have a terminal illness and be thought to have 6 months or less to live in order to qualify for hospice care. But, in order for Medicare to pay for hospice, there has to be a 'valid' reason FOR hospice, such as 'terminal cancer' or another disease that is thought to take her life within a 6 month period of time. With my mother, she had dementia, but since it was not Alzheimer's, which is terminal, the nurse had to get creative to come up with the right coding to get her approved for hospice. She came up with 'advanced senile degeneration of the brain' which is a category/code that is used by Medicare. All this to say that your mother will need to fit into a Medicare category in order to be approved for hospice. Being 95 and weak with a bad appetite & mobility issues is not enough of a reason for Medicare to approve her for hospice, so the nurse will need to come up with another, better reason to qualify her.

Sample is partially right, in that insurance companies determine our care, but not from a '6 months before death' perspective. But from a 'terminal illness' perspective when hospice care is desired. And insurance determines ALL of our care in general, let's face it! If they don't determine we're eligible FOR care in the first place, we don't get it. That's life in the 21st century, and was life in the 20th century too, whether we agree with it or not. Unless we have the money to self-pay the astronomical costs of medical care and can afford to bypass health insurance companies entirely, we are slaves TO them.

Wishing you the best of luck advocating for your mom to get her the hospice care it sounds like she would benefit from.

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We were told it's only 6 mos or less, not necessarily terminal illness. Dr approves it, not insurance.

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According to the hospice providers the insurance companies have determined it should come in 6 months before death. Once again insurance companies are determining your care.

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You can call hospice yourself. If you do not know of a hospice center your mom's doctor can suggest one or mom's insurance can suggest one. Question you want to ask is... When it comes to the last days, and mom is not leaving the bed... and it comes time to administer the morphine and other pain meds to keep her comfortable will hospice provide a 24 hour nurse?
My sisters hospice would not provide a 24 hour nurse however they did talk me through the whole procedure but I had already been through it with my mama and daddy. And my parents hospice provided a nurse 24 hours a day when they did not come out of their coma.
prayers

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Hospice can come and do an assessment. Contact her doctor for a hospice assessment.

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My dad (93) is on Palliative (a part of comfort care) care and is covered by Medicare. He receives OT,PT, nursing visits and a speech therapist who helps him with swallowing issues. An aide comes out twice weekly for bathing. He is a half step away from Hospice as he is refusing any life saving treatments (he has AFIB and heart failure) other than his medications. Quest comes to his home for lab draws (Dr. has to sign off on this through a formal request). He is ambulatory with the help of a walker. There are services out there to help families with aging loved ones stay in place.....for us it took a trip to the ER when dad was literally on his deathbed, and somehow managed to rally through with little residual effects. That said, his situation is precarious at best, but the services provided offer him comfort and a decent quality of life. Good luck....being an advocate for those we care for is a tough job.

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Thanks for the palliative information. I had wondered if medicare covers it. Can you still use your own doctor or did your dad have to use the palliative doctor? My dad has Medicare & BCBS.

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Hi, I'm a hospice volunteer. Anyone can request a hospice consult. You don't need to have a "terminal illness" if your life prognosis is 6 months or less (as it seems to be for your mom). It can last as long as needed, as others have said, as long as Mom isn't seeking a "cure." Since there's no cure for death, she would qualify.

I hope she has a peaceful ending. Sounds like she has started to transition already. Not eating and lots of sleeping are the ways we start ending life as we knew it. Don't try to get her to eat…it may well make her feel worse. Take good care of yourself, too…Hospice is for you as well.

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"..since there's no cure for death..."

Love that! It goes right along with all the "lifetime guaranties" we get. :)

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My (86yo) mom's doctor, geriatric doctor (and my therapist!...lol) all referred us to the hospice society for assistance as she's struggling with a few things, and they are still in their own home doing for themselves. We're all hoping they will be able stay there so hospice told us what helps we could get. Could someone from hospice pay her a visit and assess her for you? I would ask sooner than later so you can have an idea what to expect. When Is Hospice Recommended? - AgingCare.com This had some good thoughts to help you out. :)

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No one ever "needs" to go on Hospice, but that option is available if a person's condition merits Hospice supervision. Hospice does not take over day-to-day care but will oversee medications and offer emotional support to patient and family. Contacting a Hospice agency or two to discuss eligibility and services is an excellent idea. They will help give you guidance about if Hospice is appropriate for your mother.

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I too thought hospice was only for End of Life, but it's not! My dad just got put under hospice care because he's fell couple times and my poor 93 4'11" mom can't pick him up. Plus he began undressing himself in the living room. He does have dementia, but has NOT been diagnosed with a certain time to die. So, please know this is another avenue of care for your parent or loved one.

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You don’t need a doctor to ask for a hospice consult. If mom is appropriate, the hospice physician can write the order. Just call them.

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Has she been diagnosed with a terminal illness? A doctor has to determine if the patient has 6 months or less to live before they will sign off on hospice. I had a struggle with my dad’s doctor trying to get him on hospice. He kept ordering PT and OT for him to see if it would help. When I could no longer get him in and out of bed (he had vascular dementia) a doctor on call told me to call 911 so he could be admitted to the hospital. Finally, the doctor at the hospital was able to see my dad’s true condition and he signed him into hospice. He only lived 2 weeks past that time. It would have been enormously helpful to have had him in hospice care sooner. Sometimes I think you may have to push their doctors a bit to make them realize it’s time for hospice.

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Speak with her doctor, who can initiate hospice, if appropriate. Your mother may not be there yet. The "rules" are that the doctor must think she is within 6 months of passing away, but as my mother's doctor said, "who knows when someone will pass away?" Hospice also does their own evaluation and it has to be re-evaluated periodically. Try supplementing your mother's diet with Ensure or other meal supplement products, also smoothies, flavored yogurts, protein drinks, etc. may go down well. Changes of eating habits are often seen as people age. Sometimes there is trouble swallowing, when people need thickened drinks, or trouble chewing, when soft foods must be given. My mother (with dementia) forgot how to feed herself and had to be fed. All the best to you and your mother.

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If your mother is " alert and oriented" ( cognitively able to have a correct conversation and to make her wishes known) speak with her about the possibility of having hospice come in and assess her and speak with you both about their services . Her doctor also needs to be contacted and let him know, if you both agree, that you would like for him to write an order for hospice evaluation. You can even tell him/her ( doctor) which hospice you want if you have a preference. You can also have more that one hospice come out to hear from each and then make a decision. Hospice will send an RN out to do the evaluation for " hospice appropriateness" and will speak with her physician also. Then it is your and/or your mother's decision whether to accept hospice services. Also you can start, stop or change hospice services at any time as you wish. Hospice is a choice, not mandatory. Hospice is about living and quality of life, not death . Hospice can be very very helpful for the patient and the entire family , especially the PCG , primary caregiver, you ! You as the PCG and your mother the patient are in charge of decision making and a part of the " care team".
Most people ultimately say that they " wish they had started hospice care sooner that they did". Prayers and peace.

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What do you think she would want? If she's capable of having a conversation about this, why not ask her? Isn't it condescending to make this decision without her input if she's capable of weighing in on the issue? Does she have an advanced directive that would give you any ideas about her feelings about end of life care? If she's opted for no aggressive treatment, she's could be a candidate for hospice. If she wants the full-court press, probably not. And people of any age can be depressed. Has she been evaluated for depression?

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You can do hospice in home. They can get you help with bathing, support and comfort. It doesn't mean shes giving any less care to her mom, in fact she will most likely improve moms daily life. My mom would engage with the hospice caregivers and they were so kind to her and it provided her some extra attention (which she loved). It allowed me to keep her home until she passed. It's not wrong to need help with home care and these are normally the most qualified and compassionate people.

They will also be honest with you about when they think her condition isn't stable. Sometimes we are too close to see whats obvious to others. We thought my mom had a year when we engaged hospice but it was a matter of months, her decline was that rapid. I thank the universe I had hospice services in place. Without them I'm not sure i would have been able to keep my mom home with me (which was all she ever wanted) to die peacefully in her bed.

As far as a "full court press"...you can terminate hospice care in favor of hospitalization at any time if thats what she wants. In the meantime, hospice means help.

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Contact Hospice. Doctors do not bring this up when they see decline in their patients a lot of times as they are trained to "cure" them. I am giving you a response from my point of view only as a former Hospice Aide. I loved working with hospice as I was able to give the patient the extra TLC that they needed. I also was there to hear about their life and to hear their fears that they would not ever tell family.

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Call the Hospice of your choice, as a matter of fact call a couple.
Ask that mom be evaluated.
there are GREAT advantages of Hospice and many people get on Hospice at End of Life and they and family do not get to take full advantage of the support that it can offer.
If the thought of "6 months or fewer" cause you concern do not worry about that. As long as there is a "documented, continued decline" a person can remain on Hospice. My Husband was on Hospice for almost 3 years.

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They way you know whether she needs hospice is by asking for a Hospice evaluation.

Call her doctor and discuss Hospice and palliative care.

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When does hospice come in?

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