When is hospice appropriate? Do I initiate the process with her internist or wait for her doctor to bring it up?

Bring up the topic and see what it recommended for your mom. Start researching hospice providers now so that you will be ready when the time comes.

I think your mom would definitely qualify for palliative care which provides home visits to chronically ill patients to address symptom management. Every palliative care group I’m familiar with is associated with a hospice so they could speak to you about which is most appropriate at this time. Under palliative care, a nurse practitioner would visit my husband every 3 to 4 weeks and was with us for at least an hour and we received excellent care. We wished she could be his PCP but you still need to keep your own physician, unlike hospice.

I think there’s a misconception that you need a doctor’s referral for a hospice evaluation. You don’t, but you do need a doctor’s order to be admitted to hospice care, which can be done after that evaluation if the patient qualifies, generally meaning they have a six month life expectancy. So if you want, you can do some research and find a well respected palliative/hospice group in your area and contact them yourself to request a home evaluation or you could go through her physician. If they know your mother well, it shouldn’t take more than a phone call or a portal message on your part. Either way, I would get started to get that additional support. Take care and let us know how things go.

All you are asking his PCP is for a hospice consult. You will find out if she is ready

Unless mother requests end of life care, or expresses she wishes this were over (it isnt always depression. Sometimes it is an appropriate wish. Certainly was for my Dad, who was well satisfied with his long life, but so tired), I wouldn't get Hospice care. End of life care should be requested by or discussed with the patient while he/she is able to express an opinion.

You certainly could/should if you are MPOA discuss palliative care with both your Mom and the Docor who can enter her into that specialty care where comfort is the MAIN goal but all other options are also on the table.

I brought it up with my mother's doctor and he agreed to call in hospice. In retrospect, I waited too long. She passed almost immediately after being enrolled. I saw her sleeping about 20 hours a day and eating less and less throughout her final year. She was 98. I think I should have asked last October-November and not waited 'til March. What prompted me to ask the doctor was that she suddenly lost the ability to stand on her own or walk. The Hospice nurse said that they admitted her based on her weight loss, she was down to skin and bones. I would go ahead and ask her doctor for his recommendation. It doesn't hurt to ask. They will keep her on beyond 6 months as long as she is showing continued decline. Sometimes medical people hesitate to suggest Hospice because some patients or family will be offended and think they are giving up on them.

With Parkinson disease it is very hard to determine EOL.
Generally most neurologists go by stages 1-5.
Determining each stage is difficult most are 2-3 years except for Stage 1 or 2 which could be 5 years.
Many people with PD don’t reach stage 5 as falls and aspiration pneumonia are the most common causes of death.
At stage 5 most people cannot walk anymore and are bedridden, get infections, pneumonia or different co-morbidity is present, like cancer, or heart problems.
PD assessment is based on all those factors and years of disease which on average is 16 years.

Yes, I would think so. They offer services that support, but don't medically intervene. And the support is for the physical body, emotional and spiritual as well. Definitely bring it up with her doctor. Sorry to hear that your mom is struggling❤️

Yes discuss with her doctor .