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My dear mom has been in the hospital since Friday. She has late stage Alzheimer’s. She’s 87. She had other medical issues than landed her in the hospital on Friday. She had a myriad of medical issues to deal with. Today she has fluid in her lungs and they suspect she is aspirating. They also suspect her heart isn’t working as it should. She’s on lasix. We are not going to go ahead with a feeding tube. Does anyone have any advice on whether I should allow her to be discharged from hospital and back to nursing home or if I should dispute a discharge? I don’t want her going back to her nursing home as I don’t think she will get enough attention (short staffed as most of them are). I want her as comfortable as possible as I know what the outcome is. Any advice would be appreciated.

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I think in general a hospital is a terrible place for frail elders as their main focus is acute care, so for that reason I think hospice services at her NH could be preferable. Have you ever discussed end of life services at your mom's NH?
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Allmyheart Jun 2019
I have not discussed it but I will contact them. I think ultimately I would like to be with her as much as possible even if hospice were to come in. This way I will be assured that her needs are being met. Thank you. It’s helps to talk about it to see things a little more clearly.
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My mom was on Hospice in her nursing home, she had a Hospice Aide for five hours a day..she passed on June 14th with the people who knew her the best and loved her.. I didn’t want her with strangers when her time came.
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Allmyheart Jun 2019
Thank you for your advice. Although they are short staffed the people who work there are familiar to her so that would be comforting.
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Medicare will not pay for her to remain in the hospital. She will need to go back to the NH. You can then call Hospice in.
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Have you spoken to anyone about Hospice services?

Ask especially if there are any hospice organizations with dedicated "hospice house" facilities.

I'm so sorry you're going through this. (((((Hugs)))))
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Allmyheart Jun 2019
Thank your for your response and the hug 🤗
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I agree about asking for Hospice evaluation. They have been wonderful to my LO and me. They provide so much attention and ensure that the patient is not in pain. They come to the MC to see her several days a week for personal care and a nurse once weekly. They also provide a social worker. I can't say enough good things about how they have helped my LO so far.

Also, some of the Hospice organizations have centers where a person can be admitted for on site care. I have a friend who was discharged from hospital and went there since her condition from cancer was so severe. They told her husband that she had only a day or two to live and they were right. The facility was lovely with accommodations for the family on site.
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Allmyheart Jun 2019
Thank you for your advice. And I’m sorry about your friend.
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My best advice is ask the hospital social worker to call a HOSPICE FOR YOU !! ASAP THEY WILL HELP !! I SEND PRAYERS AND HUGS
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Allmyheart Jun 2019
Thank you for your prayers. I’ve been in contact with Hospice today.
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It's time for hospice. Medicare will not cover dying care in hospital, and so dispute will waste your time. Now get the care she needs. I am very thankful you will not be using the tube to feed. The end result at this point is diarrhea, possible restraint because tubes are pulled out and if placed down throat can displace, feeding into the lungs and killing quickly with aspiration pneumonia or slowly with bedsores and diarrhea. You have recognized you are dealing with end of life. There will be a way to incorporate hospice care or to have her moved someplace other than the nursing home. But I think hospital is not an option. She should now almost certainly be given medication hospice can administer for her comfort.
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Allmyheart Jun 2019
Thank you. Feeding tube was something we decided years ago that we wouldn’t do. I had not thought about the potential negative side effects so I’m thankful for this decision.
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Update on June 28: mom is back in nursing home on hospice. She has actually improved. Keeping her comfortable now and following her lead with how things will
go. Thank you to everyone who took the time to respond and share experiences.
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AlvaDeer Jul 2019
Thank you so much for your update. We don't always get them on the forum and I so often wonder about all the people out there trying to deal with what all are dealing with. Glad of this news, and the "follow her lead" is lovely.
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As others have suggested, it is time for hospice. Not sure where you are located but in NJ we have lots of hospices that offer different services in different locations. Some follow the family for months after the patient has passed. One is on the floor of one of our local hospitals and is decorated like home. Your hospital social worker can make suggestions and put you in touch with several so speak with her/him as soon as possible.
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As I think has already been suggested I would talk to the discharge coordinator and perhaps her personal doctor (the one most involved in her care) about the Hospice options. I think there are variations depending on the area but often there are several Hospice providers to choose from even which may have differing options and ways of working so getting information/guidance from several sources is a good idea to try and get a handle on everything available. Then you go to the coverage and these people will know about that too as will the Hospice elevator that comes to evaluate and discuss the options, no reason you cant "interview" more than one. You may find that going back to the NH and caregivers you all know, somewhat familiar to her, with additional Hospice care is the best option as moves and change can be so hard on patients but you might also decide that making one last move from the Hospital to a full time Hospice facility is right. You obviously care a lot and want the best possible experience with this end of life for all of you so if you do your homework and talk to people there the decision will come to you.

My thought's are with you and your family.
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Allmyheart Jun 2019
Thanks you very much for your response.
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