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trying to make the best choice for end of life care

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Rick, typically when hospice is done in a nursing the nursing home staff continue to provide basic care, meals etc. Hospice provides RNs, bath aids, meds and care is managed by a team. Hospice services are funded by Medicare while the nursing home costs remain as is under what ever private pay, insurance or Medicaid. This is a very general description and may vary.
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Rick, scroll up to igloo572 posting above for your answers.
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my mom has advance dementia and residing in an SNF. i plan to put her under hospice are.question is - would it make the nursing home unhappy and/or perhaps reduce the quality of care for my mom, if i chose a hospice that is not contracted by them? also is hospice only good for 6 months?
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Barton, medicare does not pay for the room-and-board portion of hospice. Sometimes there is financial aid available to pay for that in a hospice facility. Ask the hospice social worker what is available in their program.
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my mother-in-law is self pay at the nursing home she is on hospice and still paying room and board. If she is moved to a hospice facility will she be completely covered by medicare? She is 75 lbs and bedridden and not eating.
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Lilliput is spot on with her point on hospice.

Just have been dealing with this issue this month for my 90++ yr old mom in LTC.

Bit of background: she has LewyBody dementia (which is more episodic) and moved from IL to NH/LTC in January because of a more than 10% weight loss and general inability to function on her own and a TIA in Dec. Because of the weight loss & advanced age, she went to LTC rather than AL.

At her care plan meeting last month, I asked how the NH did hospice. I think my mom has now entered the final stage of life as she is not eating, still serious weight loss and is starting to loose muscle use of arms and legs. She is DNR.

What I found is each NH is different: some move the resident to a separate floor
where everyone is on hospice, others leave them in their room, some NH do not allow hospice. Hospice has to be done by a licensed hospice agency - they will be separate from the NH staff and hospice comes to the NH to see the patient. Most NH have a short list of the ones they work with. At my mom's NH there are 4 different hospice agencies that see residents. One factor to look for is how the hospice handles drugs - some have a kit with medications that they carry from site to site while others have to contact the residents MD and ask for an Rx to be done and wait for it to come to the NH and call them to let them know the med's are there then return to administer. Ask the staff @ the NH, which ones do this. The drug thing is all about one's license to handle class 4 narcotics (which matters especially for cancer patients with severe pain) and how each state regulates it.

Some hospice companies have a free standing hospice facility (either in a wing of a rehab facility or their own free standing building, that probably was a hospital or clinic in it's past life) that take patients with 6 mo expectancy or get transferred to for "end of life" care in addition to going to take care of them at the NH. IMHO one's that have this is going to be especially good if the family lives miles away.

Hospice is paid by Medicare - the hospice will bill medicare directly and not the NH/LTC. An MD will need to make an order for hospice evaluation. This can be written or by phone. We got one place in her chart so when it seems "time", hospice can be contacted to do the evaluation. Keep in mind, although Medicare pays for hospice, the "room & board" at the NH still needs to be paid - either through Medicaid, LTC insurance or private pay.

You need to make sure the AL/LTC/NH knows that you are having them evaluated for hospice and that you, as MPOA, have requested it & the doctor has done an order for it. You may need to send a fax over for this. Otherwise the hospice RN
&/or social worker won't be allowed to evaluate. This can be sticky......

Hospice also does at-home care. I don't know how that works as my mom is in NH. For my MIL, she fell at her AL, then went to the hospital. From the hospital to a hospice facility (her AL which is also a NH facility did not take hospice residents) where she died after a few days in May. The hospice staff was great, compassionate and contacted the son's twice a day.

VITAS and Compassus are the big players in hospice care.You could contact them to see what is available in your region.

There is no time limit on hospice once they are evaluated and approved. What happens is that they get certified and then after 90 days again, then after that every 6 months(? if not it's something along those lines). You shouldn't have to deal with this part, the hospice does this.

Remember hospice is all about comfort and palliative care. There is nothing that will be done to make them get better or get cured. If you haven't had a reality check talk with your parent's MD then you really should do that before requesting hospice evaluation and placement. Good luck none of this is simple.
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That's right lilliput, I think they just need a "failure to thrive" diagnoses. We have one resident where I work that is in the last stages of alzheimers, she's been on hospice for 3 years.
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Hospice is a wonderful program, but not all hospice companies are created equally. Ask around and get a referral from a friend or some who works at a hospital or ALF, etc.
I think hospice provides the most humane environment for end of life care. If possible, the patient can stay in his or her home, family member's home, or they can have care in the hospital, ALF, or NH too.
They will provide basically everything the patient needs including medical devices, pull ups, etc. They send whichever personnel is needed including: nurses, aides, and spiritual advisors. Hospice also helps the family prepare for all the end-of-life issues.
You can check out several websites for qualification requirements. There are certain diseases that are covered. Also, a doctor does an evaluation and makes his or her recommedation. Then the representative of the hospice will come out for a visit and to get the paperwork signed. Then they send a nurse and an aide out. You do not have to have all the services they offer...which is great. Too many people coming and going agitates most seniors who are ill.
Btw, the patient need not be terminal to begin care. The doctor needs to determine "decline" and current quality of life.
I think it is the best thing our government ever created for elder care.
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It can't hurt to call a hospice facility right away. They'll have a social worker out to access your needs and help you make the right decision. You are under no obligation to accept their services and they'll give you an overview of what hospice provides. For us, it worked as my dad had a fast-growing brain tumor. He was able to stay in his home until the last two weeks of his life.

The hospice itself, was just beautiful, as well as the people working there. I can't say enough good things about a hospice house. It made a very difficult time a tad bit more comfortable. They deal with death and dying everyday. In my mind, a nursing home is still for the living.
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A nursing home gives 24/7 care. Hospice comes out a couple times a week to monitor vitals, assist with hygiene and grooming, feed the patient if they are unable to feed themselves. They will provide depends, waterproof pads etc. They will order hospital beds, air mattresses, broda chairs, etc to make the patient more comfortable. They also manage anti anxiety medicine, morphine if needed. I work in a nursing home, many residents have hospice come in as an additional level of care, extra attention and pampering if you will.
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Hospice care is end-of-life care provided by health professionals and volunteers. They give medical, psychological and spiritual support. The goal of the care is to help people who are dying have peace, comfort and dignity. The caregivers try to control pain and other symptoms so a person can remain as alert and comfortable as possible. Hospice programs also provide services to support a patient's family.

Usually, a hospice patient is expected to live 6 months or less. Hospice care can take place

At home
At a hospice center
In a hospital
In a skilled nursing facility

Hospice can be given in the Home or a facility, whereever the patient and or family feels most comfortable. Hospice is covered my Medicare and or Medicaid as long as the patient qualifies. Hospice is a great program.

Blessings,

Bridget
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