I've said this before and I'll say it now - I think that perhaps due to things we see in movies and on tv there is a wide misconception of what hospice is and does. There is no angel of mercy sitting next to the bed round the clock. Typically a visiting nurse will see a hospice patient once a week to take vital signs, weight and documentation of continued decline. They will check to see that the patients pain is being managed and that the current care plan is being followed. Usually this visit is an hour or so - if a patient is starting to show a more rapid decline this nurse may come more frequently. Hospice will provide a bath aide if one is needed and there is also a Chaplin that is available for a weekly visit that can be spiritual in nature or not - it can just be a friendly visit. I suspose hospice could be abruptly stopped by the patient or by their health care proxy - but that isn't hospices doing. If you mother did have someone with her 24 hours a day it could be that they were expecting her to pass any moment - but still, I have never even heard of 24 hour hospice care unless someone is in a hospice facility and that still doesn't mean there is someone at her bedside round the clock. You mention your mom was taken off critical care - perhaps a crisis passed and her status was redefined but that doesn't mean she was removed from hospice care altogether- maybe just back to more typical hospice service. You mention your mom is no longer taking her medication - this tells me there is some misunderstanding somewhere - hospice programs almost always stop all medication that is designed to treat a medical condition- that's part of the whole point - to stop fighting the ailment and let nature take its course WITH pain and anxiety medication only - perhaps allowing mood medications like an antidepressant. It's understandable that you are frustrated, angry and scared at this point - but it definately seems like you do not have all the information you need to better understand what's happening with your mother. If this is true - it's not hospices decision, they are bound by HIPPA laws. Talk to your mothers medical POA and ask them what's going on with your mothers seemingly abrupt cancellation of hospice care.
Currently my mother is under hospice care - my father passed under hospice care a few years ago - so I've got a bit of experience and knowledge in how it works. In the situation you site, based on the limited information you've provided- I have to say there has to be more to the situation. To my knowledge hospice providers have to follow specific guidelines which would not allow them to stop care based on a few meals/days.
I have to agree with Rainmom. Hospice providers don't just remove someone from their service based on one thing. After being on hospice for about 6 months there's a recertification process by the hospice provider. They look at everything and have a meeting with all interested parties (family, caregivers, nurses, etc.). When someone is taken off hospice it's a process that can take several weeks.
I work in home healthcare hospice and we would never remove someone from our service based solely on that person beginning to eat a little more. I'd praise the person, encourage them to keep eating, and document it. I would never use it as an indication that the person doesn't need hospice anymore. There are way too many factors to consider besides appetite.
You mention that she is in a facility, so I expect she is at least being checked on and tended to routinely? Even hospitals or skilled nursing facilities aren't going to assign someone to sit by the bedside. It is a sad reality that dying of old age can be a long, uncertain affair. The nurses can usually tell when someone is reaching their final days and hours, but before that it is just a guess so everyone just has to carry on as usual. What exactly is it you want to happen?
No, an assisted living facility does not have the authority to take someone off hospice care. Neither would a nursing home of any kind of care center. The person receiving the care can make that decision, as can family -- in particular the person designated to make medical decisions.
Hospice does not provide 24-hour care. The base care is still provided by loved ones or hired help at home, or the staff in a care facility. Hospice staff provide some supervision, some problem solving, and the medication decisions. Hospice provides additional help but does not replace the main caregivers. All care centers have "24 hour care" in the sense that there is someone on call or on the premises to help at all hours of the day and night, but there is seldom one-on-one care.
The role of hospice is widely misunderstood. We see lots of posts that claim a relative has called in hospice for a loved one in order to have them die quicker. We see claims that a relative wants to speed the death and took the loved one off of hospice. But the fact is, hospice has nothing to do with how soon a person dies. Nothing.
Hospice attempts (usually very successfully) to reduce the pain and suffering during the dying process, and to help the dying person's loved ones cope better, too. They do nothing to attempt bringing about the death sooner or delaying it. They provide comfort and less pain.
Hospice is not about when people die, but about how.
Even if the POA is a greedy pig and wants Mom to die soon, the POA has no way of knowing which way Mom would last longer ... on hospice, or without it.
People die when their bodies are ready for it, whether they are on hospice or not.
Here's how it works with my mothers hospice provider: Mom was assessed to determine if she met the criteria to be placed on hospice. Once accepted into the program mom is monitored/ treated for six months with the expectation she will pass during this time. At the three month point hospice did an evaluation to determine if she still met the criteria and that the care plan for her was appropriate. If my mother is still alive after six months hospice will determine if she is still meeting the criteria to be under hospice care - this includes that mom is continuing to decline in a measurable manner. Things like continued weight loss and increasing amounts of time spent sleeping are only a couple of the things hospice condiders. If mom is continuing to decline she will remain under hospice care but will be reassessed every two months. As long as mom declines in a measurable way - meeting their guidelines she will remain on hospice. If however, at any point during thentwo months reassessments mom plateaus she will be remove from hospice care and placed on palliative care. So - you see, hospice care is not just determined by one factor and it is not stopped and/or started at a moments notice. Hospice providers are certified, inspected and regulated by state and federal government so it is highly unlikely that the practices of one will differ greatly from another.
What worries me is that the POAs are somehow involved & are putting their own non-professional opinions in on this. They are greedy, selfless pigs hoping mom will die sooner than later, without costing them too much of their inheritance! Sad, but true! From what I have been told by the 24 hour hospice care worker who was assigned to my mom for 2 days was the reason they were taking her off critical care was because she started to eat a smidge* & she didn't have any more bowel movement issues. She is still nauseous & won't eat anything but a sip here & a tablespoon* there (that does not even qualify as nibbling). She is still deteriorating with her dementia. Now, she doesn't even want to take her meds. She can no longer move around with her walker & just lays in the bed saying she just feels like she is going to throw up and is so tired that she just want to sleep. None of this makes any sense to me; and I thought the purpose of hospice was to make her comfortable in her final days - not just lay in a bed - ALONE! - without anyone. I am the only one who consistently visits her, except for one other person who sweeps in and out (she is non-medically trained) and is only there to make a quick $ - pathetic. Half the time she doesn't show up. All of this is so wrong!!!!! And it does appear things stop and start constantly. The facility itself is horrible to begin with. Everytime I visit, there seems to be new personnel. The only nurse/CNA I was able to befriend is no longer there either. He was the only one who would give me straight answers - because the POAs sure wouldn't/won't.
I work in home healthcare hospice and we would never remove someone from our service based solely on that person beginning to eat a little more. I'd praise the person, encourage them to keep eating, and document it. I would never use it as an indication that the person doesn't need hospice anymore. There are way too many factors to consider besides appetite.
Is transfer to a skilled nursing facility an option? As mentioned above, hospice does not generally provide 24/7 care.
Hospice does not provide 24-hour care. The base care is still provided by loved ones or hired help at home, or the staff in a care facility. Hospice staff provide some supervision, some problem solving, and the medication decisions. Hospice provides additional help but does not replace the main caregivers. All care centers have "24 hour care" in the sense that there is someone on call or on the premises to help at all hours of the day and night, but there is seldom one-on-one care.
The role of hospice is widely misunderstood. We see lots of posts that claim a relative has called in hospice for a loved one in order to have them die quicker. We see claims that a relative wants to speed the death and took the loved one off of hospice. But the fact is, hospice has nothing to do with how soon a person dies. Nothing.
Hospice attempts (usually very successfully) to reduce the pain and suffering during the dying process, and to help the dying person's loved ones cope better, too. They do nothing to attempt bringing about the death sooner or delaying it. They provide comfort and less pain.
Hospice is not about when people die, but about how.
Even if the POA is a greedy pig and wants Mom to die soon, the POA has no way of knowing which way Mom would last longer ... on hospice, or without it.
People die when their bodies are ready for it, whether they are on hospice or not.