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I have a family member who is in a NH's memory unit and is at the latter stages of dementia. The person barely speaks, can't walk or stand, has lost significant weight, is in pain (back) from inactivity and arthritis.

I've spoken with Hospice and since they've never been allowed to work in this NH, I'm planning to speak with the intake person at the NH to ask the NH to allow Hospice in. I feel, although the NH offers palliative care, that Hospice is more specialized, and can provide a broader, more comprehensive range of services and that their interest is focused on "comfort care, " as opposed to sustaining life, which I feel is a NH's focus.

What points can I use to encourage the NH to agree to allowing Hospice care in?

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ferris1, LOL There were many times I looked at my husband and said, "Remind me again, which one of us has dementia?" (He enjoyed remembering something I forget.) I know what you mean about starting to feel like YOU have the impairments of the person you take care of!
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Nursing homes are staffed so thinly, IMHO, they ought to welcome someone doing hospice or palliative bedside care--it means they can get out of doing so many potty-checks, turning checks, etc.... and it means better care for your elder....everybody wins.
NH's should welcome hospice people in.
While I worked at one HMO, they has their own Hospice unit, but welcomed hospice volunteers to come in and help.
Other NH's I worked in, also welcomed hospice workers in.
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Yes, I apologize for that insensitive remark. What I meant to say was don't have a fight with the nursing home & hospice people over the care. Yes, a private, non-profit can provide a 1 on 1 palliative care, and you should be able to have them come in. Most nursing homes do not have a policy preventing that, so bring them in. Unless it is a disruption, it will make you and he feel better for now. Again, my best wishes. (I'm starting to have overload with my memory-impaired husband and even I can say inappropriate comments).
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Oh ferris1, I disagree! Hospice care made a huge difference for my husband and for me. He still had a fatal disease and he still died. That's a given. But his comfort level and quality of life was much better for the hospice care he received while in the process of dying!
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I don't think the OP means "make a difference" as in making someone live longer, but only quality of life - someone with them all the time vs the 1/17 ratio some NH have. It's a huge difference for a bed-bound patient that if they ask for something they get it (and how many dementia patients can remember to use the nurse button???). About the only "right" thing the conservator has done lately has been to get a sitter for elder in SNF recovering from broken hip. He would have already been out of bed & fallen numerous times but for me or sitter intervening. He is NOT incontinent, he won't pee in the diapers except in his sleep, so it's a constant nightmare for him to be holding his pee for 10 hrs desperate to "go", but not allowed out of bed (today he was able to focus enough to use the urinal jug ---YEAH!!!). So yeah, if hospice can help with the "little stuff" like that it's night & day. The NH staff just doesn't have the time to watch, figure out what he is trying to say, take the 1-2 hrs to get a few mouthfuls of food in, or just make him feel semi-normal by "having a cup of tea" and talking. He may in fact be in "hospice" mode, but the conservator has told me nothing, so I don't know (not a good sign when someone from the staff asked if I was from Hospice though!).
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If your family member is in the "hospice" stage, nothing is going to make any difference. I'm sorry, but we nurses are realistic and tell it like it is. I am sorry you have to deal with this.
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The nursing homes I worked in LOVED it when we had hospice come in!! They did lots of cares and saved the nursing home money?!! (Labor.) I also don't see why they wouldn't want it? If it is needed? Unless they have something to hide? I can't imagine why they wouldn't want to go with it!
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Doesn't Medicare cover hospice services? So wouldn't it be a violation of the patient's rights to deny those services? If some of the other more collaborative solutions above don't work, would reporting the denial of hospice service to Medicare be a final option?
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My best friend's mother has hospice care, even at assisted living. (Illinois)
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Many Hospices do work with patients in hospitals and nursing homes and other elder care facilities. BUT and it is a big but there has to be a contract in place for the hospice to be allowed to come in and many nursing homes simply won't agree. There are many reasons, financial, standard of care, visiting rights (24/7 in hospice) use of medications, and just plain don't want to be bothered with someone looking over their shoulder. As Kaitlyn said Hospice is about helping people on their final journey, Palliative care is about helping people continue to function in the community. At the end of life it is often necessary to use pain medication in higher than usual amounts, but it is always increased in pre determined amounts until the pain is under control. Nursing Home and Hospital doctors are afraid to prescribe what seems to be excessive amounts and visiting hospice staff do not have access to patient medication in the nursing home in the same way as the RNs do in the home where the hospice Medical director can determine the dose and type of drug. Although the patient's own physician continues to oversee their care when in hospice there is also a hospice Medical Director who can also prescribe which is very helpful to nurses in the home who are experienced in end of life care and the special needs of the patient and family.
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My dad is on Hospice and in a NH right now. Same story as yours, dementia, barely speaks, can't walk and sore all over from inactivity. The NH suggested Hospice and offered two different agencies and I picked one of them. So in your case, I would agree with the others, that perhaps the NH doesn't have an affiliation with that specific Hospice. So ask the NH Director, (go right to the top), and ask which Hospice agencies are allowed to come in. The NH should not only give you that information, but should be guiding you through this. Good luck.

Peace and luv,
-SS
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I work for a Hospice and we have patients in many nursing homes. My husband is a assistant director of nursing in a local nursing home. If the nursing home is not familiar with the particular hospice that may be where the issue is. A family member can contact the hospice directly and inquire about service. We have a admit team that goes to the nursing home to see if the patient meets the criteria for the hospice program. If the patient does, then a contract is done between the nursing home and the hospice on what care, medications, room and board are covered by the hospice. Then a team of hospice personnel are put in place. Nurses, nurses aids, social workers, chaplans, volunteers and so on. It is custom fit to the patient and family needs. The business side of it consists of the nursing home being reimbursed for room and board and supplies for the patient. The nursing home may not understand this process or maybe has had a bad experience with this particular hospice. Again, contact the hospice directly and they can do all the leg work. We have had nothing but positive for the patient, family and nursing home. I work in the accounting department of our hospice and I ensure the nursing homes are not out financially and are paid in a timely manner. Our wonderful nursing staff and supportive staff have the privilage of taking care of the loved one, making their final days a little easier. It is sad that the business end can make the difference but with health care reform issues it is basic survival of the businesses. We are a non for profit so I know personally, we take a big hit finacially and write alot of $$ off but our committment to helping others in their final journey is what our hospice is about. My father is in the end stages of prostate cancer with bone mets. We are on the other side of the hospice coin too. He is still at home and we just live down the road. Hospice will come into the private home to care for the patient. My husband says the nursing staff appreciates hospice and the extra care they can provide in the nursing home setting. There is more one on one available for special need patients.
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I went through training to be a hospice volunteer (I didn't end up doing it as I got too overwhelmed). But, in the training we were told we could be assigned to a NH resident. So I know it can be done`` so, in agreement with the other posters here. You should be able to get hospice.
Blessings to you and yours.
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I agree with both NancyH and jeannegibbs..When my MIL was in NH with cancer, Hospice was with her everyday..It made me feel better and the NH home didn't need to keep checking on her... I live in MA, maybe it has something to do with the state you live in??? I highly doubt in though...Demand they be allowed to care for your loved one..
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Wow. I can't imagine why an NH would object. If they do, call the ombudsman immediately.

Perhaps it is simply a case of no one having asked for this particular hospice service at the NH before. I hope it is all routine for you!

And I am sorry that your family member is at this point in the journey.
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I don't understand why a nursing home would care. They're getting paid no matter what right? Plus it would free up their people to take care of other patients I would think. Go for it.
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