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Hospice question(1)
Love and Hope
Posted: Tuesday, August 13, 2019 9:33 PM
Joined: 11/11/2015
Posts: 21

If your LO is in a NH and has nurse checks, bathing and all NH Memory Care has to offer.  Is Hospice really needed?  I just don’t know if it would be worth going through the interview process.   The NH thought he would qualify and we have an appointment with the hospice nurse tomorrow. I used to think Hospice paid for the NH but found out then don’t.     Thoughts?  Thank you,
Posted: Tuesday, August 13, 2019 10:24 PM
Joined: 5/2/2019
Posts: 235

If he has Medicare, hospice will be free.

I can’t see why you wouldn’t do it. It will probably make him more comfortable, help the nursing home staff which helps them with other patients and I am sure it will help you since they will provide updates and let you know what to expect when it becomes time for your lo to pass on.

They are there specifically for your loved one so I do not see why you wouldn’t do it if it is free.

There is probably a lot of time in the beginning where they figure out your lo and your wishes on things and stopping meds, but after that, I imagine it is just updates and maybe a question here and there that you will need to answer.

Why do you think you are resistant to the idea?

Posted: Tuesday, August 13, 2019 11:01 PM
Joined: 4/1/2014
Posts: 5082

If the NH provides all the care your LO needs and your LO is comfortable, then I agree, why do it, but most NH are understaffed and the extra help, extra baths, maybe they even provide diapers and wipes, then it might be worthwhile to have them as part of the team. My mother is at home so hospice has been very helpful.

Our bath aide told me that once hospice comes into our local NHs, the staff takes advantage of them and don't do baths anymore! Do the family get a reduction in the cost-no! If you get hospice in for your LO, be very certain that the care your LO receives from the NH is in no way diminished because hospice has come in. Hospice services should be on top/or extra-not replacing NH care. 

 The services and care hospice provides when a LO is actively dying is very helpful and usually quite excellent. No harm in talking to them. You can use them when you think it is the right time, if ever.

Posted: Tuesday, August 13, 2019 11:07 PM
Joined: 5/2/2019
Posts: 235

TessC wrote:


Our bath aide told me that once hospice comes into our local NHs, the staff takes advantage of them and don't do baths anymore! 


Yikes. I wonder how common it is for a nursing home to do less than what they should because hospice is on board? I mean, I can see not giving them a bath twice because hospice already did it, but not give them one at all? 

Posted: Wednesday, August 14, 2019 8:10 AM
Joined: 9/3/2016
Posts: 215

My mom is in a skilled nursing home, and she is also on hospice. Her nursing home is a good one, and hospice would not be necessary but here is why I like having hospice onboard:

1) I get regular objective reports from the hospice nurse who visits her. I can get information from the nursing home too, but they see her every day (as I do) and so sometimes don't notice sutile changes that the hospice nurse picks up on as she sees her 1 to 2 times per week.

2) The only other family we have here is my daughter who tries to visit my mom once a week, but her job often requires her to be out of town plus she has young children. My mom did not grow up here, so she doesn't have a base of friends nearby plus at 88 not many of her friends are around anymore anyway. So having visits from the hospice nurse, aide, social worker, chaplain, and volunteer gives her more attention than just me alone.

3) If I think something needs to be changed or done, I can always get in touch with the  hospice nurse who can initiate any needed change quickly. The nursing home staff has to be first directed by the DON or the physician in charge of many patients where my mom's hospice team is only in charge of her.

4) It just makes me "feel better." Knowing that I am providing my mom with every single thing that can possibly be done.

My experience has been that hospice is easy to work with, very responsive, and the interview is very simple.

Eric L
Posted: Wednesday, August 14, 2019 10:59 AM
Joined: 12/5/2014
Posts: 1288

Our situation is a little different since MIL is still at home, but I there are some definite advantages to hospice regardless of placement.

Even bedridden, my MIL is still a difficult patient. Having a resource like hospice when her behaviors change or become too difficult for us to manage has been incredibly valuable to us. They've been able to change and adjust meds on the fly. If we have any concerns, we can call them 24/7 and they'll give us a recommendation or send a nurse to visit her.
Posted: Wednesday, August 14, 2019 11:27 AM
Joined: 10/9/2014
Posts: 1091

Hospice has a lot to offer, even if the patient is in a long term care facility, imo.  The more sets of eyes the better, imo.  Plus, they offer services to the family.  Our Hospice group has an excellent social worker who has really helped me a great deal with so many issues.  And, if my LO has any need, it is taken care of immediately.  When the end comes, I am assured they are familiar with my LO and will recognize when the time is near.
Posted: Wednesday, August 14, 2019 12:28 PM
Joined: 8/11/2019
Posts: 37

Hi Eric L,

I am a little confused.  You mentioned your MIL is at home but still gets care from a hospice?  Is that possible?

Posted: Wednesday, August 14, 2019 3:07 PM
Joined: 9/3/2016
Posts: 215

pa123, I'm not Eric but I can answer your question. Hospice will care for your LO wherever they live. It can be a facility or their own home, or there are a few hospice inpatient facilities. If your LO is in a nursing home, memory care, assisted living, etc. hospice does not pay for the room and board. You still pay for that as always, but they will care for your LO wherever once they have been accepted into hospice, and a doctor (I think it may be 2 doctors but not sure) states that it is reasonable to assume with normal disease progression that the patient has 6 months or less to live. This can be extended if needed.
Posted: Wednesday, August 14, 2019 4:59 PM
Joined: 10/24/2018
Posts: 1090

In addition to all of the thorough answers above-- we did not want LO to ever have to go to the ER or be admitted to hospital ever again. But the situation changed drastically two weeks ago, and all medical&family believed that the surgery and associated hospital were the only option if we wanted to se a pain-free end of life. You go off hospice to be in the hospital, and we came right back on hospice the minute she returned to her MC room. The same thing happened wit MIL. A couple of hospital visits for unrelated causes, and right back on hospice when home. 

This approach (no more hospital) is the right one for us, because Mom's living will directions make it clear what she did and didn't want at end-of-life. With the surgery, we are not artificially prolonging life; in fact, due to the anaesthesia and stress we may have shortened it, but she is healing very nicely, so appears aimed towards a non-bedridden short term future. Time enough for the bed in awhile. So LO's previously stated wishes were important to us when calling in hospice. 

Posted: Wednesday, August 14, 2019 5:25 PM
Joined: 7/30/2018
Posts: 156

Love and Hope wrote:
I used to think Hospice paid for the NH but found out then don’t.     


Medicare pays for Hospice, but they don't pay any of the charges associated with room and board, no matter where the person is. That said, I would get hospice involved as soon as the LO qualifies.  They are really helpful in more ways than can be counted.  And their frequency of visits is tailored to the family and patient's needs.  Just my 2 cents.

Posted: Wednesday, August 14, 2019 10:07 PM
Joined: 1/11/2018
Posts: 93

Hospice care has many benefits when your LO is in a facility. One of the biggest is relieving burdens on you, the family member, and having extra people to oversee your LO. 

If your LO needs a special mattress, wheelchair, hospital bed - hospice brings it in.

No more trips to the ER unless the hospice nurse authorizes it.

Hospice will pay for and supply diapers and Chux  (I had to buy these when my Mom was in MC. Maybe NH supply these.)  That can be a big help. 

Hospice meds (for comfort care) are provided with no copayment. 

They have counselors and chaplains and social workers to help you at every turn.

Hospice is comfortable with End of Life issues and will be able to help you see when the end is coming.  My own experience - maybe not yours - is that facilities focus on keeping folks alive, not necessarily on helping them to a good death. 

But - you have to believe and accept the hospice philosophy.  There will be no more treatment except that which is focused on keeping the patient comfortable.  


Love and Hope
Posted: Wednesday, August 14, 2019 10:27 PM
Joined: 11/11/2015
Posts: 21

Thank you. Our visit went well with hospice and everything she said you said. He is approved and starts getting the extra benefits tomorrow, plus I got to spend sometime with my LO to.
Posted: Wednesday, August 14, 2019 10:33 PM
Joined: 10/24/2018
Posts: 1090

Very good to know, LoveHope! If your hospice case manager is anything like mine, you will quickly for a good working relationship with this nurse who can make so much happen so quickly when you need it. We've had medication adjustments happen in 6 hours through hospice that could have taken six weeks through facility channels. The on-call nurse has been VERY good at talking me off ledges late at night on a weekend when I was frantjc with desperation. You will be very glad that we have this wonderful hospice system integrated into Medicare.