Mom is almost 99 and in assisted living. She has had a few instances of slow heart rate (in the 30s). Is this cause for her to have hospice?

As others have said, you don’t have to be dying to receive hospice care and you would have the assistance of aides for bathing, equipment, etc if her assisted living doesn’t provide that. If you’re uncertain though, I would highly recommend palliative care which is a step before hospice and does not restrict any treatment she might want. Their goal is to make patients comfortable by managing their symptoms and should your mom start to decline, they could seamlessly transition her to hospice care.

If I had known about palliative care 12 years ago, I would have utilized it for my dad. As it was, I was fortunate that a random specialist told us about “do not hospitalize” orders when he was in a snf briefly which put my mind at ease, meaning they would not automatically send him to the hospital before talking to me(I knew those were his wishes and was MPOA).

Check her meds. Don’t assume that since she is on the same meds as she has been for a long time that this couldn’t be the problem.
When my DH aunt, now 97 began to have lower numbers for pulse (under 40) I worked out with her geriatric primary that one of her BP meds was causing the problem. We adjusted the med and it helped. This had to be adjusted on a regular basis over several years. When she went off the “memory” meds, her pulse returned to normal. Her BP meds no longer had to be adjusted. She had been taking the memory meds for years. I suppose it gradually slowed her pulse over time. Not sure. All I know is it sure would have saved a lot of stress and worry if we had figured out which pill was the culprit earlier.
About hospice. The ALF may be required to take your mom to the ER for certain things even when they suspect she is fine. If she is on hospice, they would just call hospice. The hospice nurse would check her out. Easier for everyone. If, at any time, you wanted her to go to the hospital, she could still go. She would come off of hospice, go to the ER or hospital, have treatment, discharge back to the ALF and sign back up for hospice. It is just paperwork. No big deal for you. Aunt has done this a couple of times since she was first on hospice. I need to check but I think this fall will be 4 years.
Hospice that comes to you is covered by Medicare. You should receive more care, more often. You can call the hospice company to evaluate your mom and ask more questions until you are satisfied you understand it and feel comfortable with your decision.

Hospice is a good way to keep an eye on her and they're able to give her any medication needed to ease her pain she may have now or later,no hospital trips. My mother was in hospice care for over a year, doesn't mean end of life,just a more comfortable one. They were able to bring in a hospital bed that was adjustable, helped with comfort. I'm assuming that they will move her to memory care? (confined area,more staff)The cost will probably go up a couple of thousand per month. You probably will have to downsize her belongings,too. Staff usually does the move during lunch or an outing. This is a good thing by far! I do believe you might have to sign a waiver that states "do not recessitate." You know there's really nothing you can do for her given her age. Mom needed dental help but at 90 and bedridden couldn't go,let alone "go under"( might not come out?)for oral surgery. Hospice provided her with an oral mouthwash that helped immensely,that and lots of Ambisol!

She eats out. She goes to exercise classes. Let her keep enjoying her activities. Say no to hospice.

I'm PoA for my 105-yr old Aunt (who lives in another state). I grew up with her. She is in her own home with family caregivers. She has all her mind and is still mobile with a walker. We (including my Aunt) have all agreed that if she has any health incident that we will not be calling 911 or taking her to the ER or Urgent Care. No heroic steps will be taken.

Your Mom sounds like she's enjoying her life. Let her! No one gets to stay here forever. Don't worry about her heart. When it's had enough it will resign. If it were my Mom I wouldn't even put the monitor on her, if she didn't want to wear it all the time.

What does your Mom want to do?

One would assume they have looked at her current medications but in my experience this wasn't the case so it doesn't hurt to ask.

Hospice does not mean your mother will imminently die or, as many believe, they will "euthanize" her. It does mean she will stop getting dragged to the ER for every ache and pain she has, because ER= trying to cure her at 99 years old. The ER only causes stress and anxiety for many hours, and then the elder is sent on her merry way with no answers ANYWAY.

Last time my poor mother was sent to the ER for chest pains and I sat there with her for 5 hours, listening to her insist she NEVER said she had chest pains to begin with, I said THAT'S IT. After 10 years of ER visits, we were done. Nobody can fix 94 or 99 years old, nor should they try. I had mom evaluated for hospice the next week and all the insanity stopped. She was no longer poked and prodded but left alone to live what remained of her life in peace. Thank God.

Hospice is an agreement to STOP going down rabbit holes, in reality, and to allow nature to take its course.

Wishing you the best of luck with all of this.

Your Mom needs to have a DNR in place whether on Hospice or not. In my State, every facilty Mom was in Hospital, rehab, AL and LTC required a DNR signed by one of their Drs. That DNR has a list of things u do and do not want. Check to see if one is on file at the AL. If not get a copy and have Mom and a doctor to sign it. If Mom is taken to a hospital, this should go with her. Have a copy on yourself.

Hospice can be called in and they will determine if Mom fits their criteria.

Your mom is 99 years old, and is now having some low heart rate issues.
Would she qualify for hospice care? Of course she would. And the advantage of having hospice care in her facility is that she would have extra sets of eyes on her.
And having hospice care doesn't mean that your mom will be dead soon either.
My late husband was under hospice care in our home for the last 22 months of his life. So don't let the word "hospice" scare you.
And just because your moms brother lived to be over 100, doesn't mean that she will, nor should you want her to, if her health is suffering.

Well, given you are allowing the Holter Monitor for monitoring the heart the next decision a doctor will ask of you is whether or not you wish her to have a pacemaker.

My own option, for myself or a loved one in advanced age is "no". I say this as a retired RN. I would ask for palliative care, meaning a recognition that there is really "no cure" for "aging". I would discuss with MD whether Hospice is an option; ordinarily it is not, as a low rate doesn't mean someone will die of it. I would decline trips to the ER.
At her age death is ever more near, whatever the cause. The low rate may lead to a fall and falls are, for the elderly, often the beginning of the end.

It is time now to discuss with MD just what sorts of medical intervention you choose to allow for your loved one.

I am sure she would qualify for Hospice.
The big question is would she have wanted medical intervention if anything were to happen?
I will tell you that CPR works great on TV, works ok on a young healthy person. On an older person not so great. With CPR that is preformed correctly they will break ribs, the sternum will probably be broken, 1 or both lungs may be punctured due to the broken ribs being compressed when they are doing CPR. Would she survive that and if so would she recover?
If this were me or my LO I would opt for Hospice and hope that I would go to bed one night, or sit down for a nap and my heart would just forget to beat one more time, and one more time.....