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StandstoReason Asked April 2018

What to do if you think your loved one needs hospice but primary doesn't think patient is in a near death experience?

StandstoReason Apr 2018
Thank you so much for your ideas. I am going to follow up with each of them. Kindly, StandstoReason

GardenArtist Apr 2018
Stands, ask the pulmonologist who's doing the SAT rate checking about multiple checks. As I recall, there was not only a resting SAT check but also a walking one. I think there was a third but I don't recall what it was.

But my best recollection is that the SAT rate wasn't just checked while someone was sitting and inactive.

If he's out of breath in a few minutes, I don't understand why a medical pro isn't checking his rate then.

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Veronica91 Apr 2018
Try talking to your local hospice and see if they will do an evaluation. If he meets their criteria they will contact his Dr and come to an agreement.
He has two definitely life limiting diseases that would qualify him for hospice. The COPD and heart failure, they are usually somewhat skittish about dementia.
Once in hospice all his needs like oxygen will be provided but he will only be provided with medications for his admitting diagnosis.
If he is not accepted by hospice at this time he would probably qualify for palliative care.

worriedinCali Apr 2018
Get a 2nd opinion. There is no cure for COPD or Alzheimer’s disease, even if your relative hasn’t been given 6 months or less to live, they may still qualify for hospice. The 6 month prognosis has changed as Joann said. He has life limiting conditions.

StandstoReason Apr 2018
Of course it's hard to say when he will pass...maybe longer than 6 months but he has Alzheimers, COPD, and Congestive Heart Failure that is rendering him pretty much in a prone position 90% of the time unless he's really motivated. (Thank goodness he's eating well and is not incontinent which probably are telling signs that there's still a somewhat strong life-force.) It hurts him to exert himself (breathing) but if he's motivated, he will try. We will be getting another primary soon, so I'll ask then, but also will question the present primary. My loved one refuses to use a nebulizer but will use an inhaler and I buy oxygen for him. (Medicare won't pay for oxygen at this point because his resting is about 94 oxygen count...but out of breath in about 2 minutes or less.) Thank you for all your suggestions.

JoAnn29 Apr 2018
Criteria for Hospice has changed a few years back. You Don't have to be dying in 6 months.

gladimhere Apr 2018
Try a second opinion. They have to be within 6 months to live and with a terminal illness.

BarbBrooklyn Apr 2018
I think you don't mean " a near death experience". Google that term and you'll see what I mean.

Hospice is the appropriate level of care if your loved one has a life limiting illness, one that cannot be cured, only ameliorated symptomatically, and which is likely to cause death within 6 months. ( There are places in which a different, looser definition is being trialed).

The thing is, you need to determine what treatments/ meds hospice will allow and disallow, since, as I understand it, they get paid a flat rate per patient. While PT, say, may keep your loved one mobile, Hospice may disallow it without a lot of arguing and negotiating on your part.

Talk with the PCP about why hospice isn't the right move. A lot of docs view hospice as their own failure. Perhaps finding a geriatrics doctor to review the case and see your loved one might produce a different opinion.

Countrymouse Apr 2018
Can you explain the difference of opinion? Why do you think your loved one is nearing the end, and why does the doctor disagree?

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