My Mom is 95 and has resided in a private pay ALF for the past 3 years with pretty minimal assistance just meds and putting on/taking off compression stockings. In May she fell and incurred a hair line fracture to her hip, blood on the brain which is expected to reabsorb into her system with time and a deep tissue injury from the fall stage 4 to the sacrum. She was in the hospital for a week, a rehab hospital for 3 weeks and moved to a subacute rehab/skilled facility which she will remain for 100 days anticipated discharge September. She is making some progress but needs 50% help with ADL's cant transfer without assistance is incontinent wound some progress but tailbone is exposed she is on a foley catheter to prevent infection. Mom has no assets left. AL costs $5000 a month in Illinois. I applied last October for dual Medicaid just to have it in place. I got the letter last week and forwarded the necessary paperwork along with a request for a temporary card the rehab/snf where she is at now is doing a wonderful job but they are a CCRC and does not take Medicaid. My Mom wants to go back to her ALF due to state laws they only way she can return to her apartment with a stage 4 pressure wound is on hospice we would have to move her bed out and put a hospital air bed in its place after a we would have to pay the rent but after a resident resides in this facility for 3 years a Benevolent Fund is in place to absorb the higher level of care. I am waiting for the Director to advise me if they will do that, they are dragging their feet. My Mom is 100% mentally with it and is an angel never complains which makes it more emotionally difficult and also has CHF. Most of the Medicaid SNF in this area are awful and the ones with great ratings that I have contacted don't return my calls. She is presently getting wound changes 3 times a day and being turned along with debridement by a wound Doctor. Since I have no experience with hospice would be still be able to be treated for say a UTI and CHF and have wound changes daily? She is not bedridden at this point walking 75 feet with assistance and feeds her self. Any advice would be greatly appreciated its a very difficult journey.

If the only way to get her there is to use hospice then use hospice. Do know that if she does not die within 6 months they will likely just sign her up again. A stage four to the bone pressure sore can easily kill, infection can go systemic, and they are almost impossible to heal even with the wonderful mattresses today. I am so sorry she is having to go through this torment. I wish you all the best of luck. Do all you can to get her the best and most complete care. When you speak to hospice tell her you understand the realities of age and prognosis with her condition, but that you do not want her snowed with drugs unless needed for pain, and want only her best comfort. As well as the dreadful sore she has the failing heart pump, and what is important now is her comfort. If she is in hospice they would treat UTI but they may not treat CHF aggressively and I would discuss with her MD what a move to hospice would mean. There are several people on the forum who seem not to have understood that a hospice move really is end of life care. If you are not ready to accept that it ispalliative care aimed only toward comfort, and not toward prolonging life, then it may not be right for Mom (if she doesn't agree) or for the family; but I sure don't know then where you go from there.
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Reply to AlvaDeer

I would plan and work for a return to the AL, but also start a plan B for SNC, particularly if many in your area accepting Medicaid are not ideal. It may take some time to find a facility you want.
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Reply to TNtechie

For now, I'd opt for AL and see where it goes from there.
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Reply to DollyMe

I'm answering to bump you up.

I think that since her AL is willing to have her back with the extra assistance of hospice I would opt for that if there are funds to pay for it, at least on a trial basis. If she is totally out of resources then you may have no choice but one of the medicaid places that will take her.
Treating UTIs, CHF and wound care should all fall under the umbrella of comfort care IF your hospice provider is flexible and agreeable, but I'd want to have it all understood and in writing before any contracts are signed.
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Reply to cwillie

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