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Does anyone have any insights? Among many other things I am figuring out, I understand "getting better" is a criteria for coverage.


My mom is almost 92, being treated in a clinic bi-weekly plus VN at home over the past year for one deep ulcer. She had a stent put in, improved things a bit, but past two months not getting better, and wounds are now encircling her entire lower calf, skin is sloughing off, I see buckling on her upper calf. She can barely walk with the walker, but still does.


I asked Primary again if this qualifies for hospice now, and they wanted to know if she has fever or infection (No). So I guess they are awaiting some cruel event down the road. She's in a lot of pain now and obviously not getting better.

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Your mom should have a wound care specialist caring for that wound.
You need to put in a grievance through the insurance and tell them that the primary has not requested a wound specialist!
You can also take her to the E.R. and have them look at it - get a social worker involved - but those kind of wounds need a specialist! Also, continue to advocate for your mom! I tell you with my dad if I didn't they doctors would have screwed up his arms if I had not had my homemade medical kit with me! I had to be on them constantly!
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Reply to Ohwow323
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Ask for a referral to a specialist. Wounds that do not get better need specialized care.
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Reply to Taarna
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My late husband had an ulcer that wouldn't heal. He went to a wound doctor for a year to get it scraped and treated. Home health care came to take care of it. Hospice would only come in if this condition was leading to the end-of-life. Does she have any other comorobities like Alzheimer's, diabetes, heart or liver issues?. With my late husband, the ulcer got a bone infection that spread and led to amputation. He died four months later.
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Reply to DoggieMom86
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My mom had Peripheral Artery Disease in her legs and she had wound care. My mom was diagnosed through Hospice care and her doctor for Hypertensive Cardiovascular Disease. If you don't get any answers within a week, I would get another evaluation. Sometimes it depends on their overall health. My mom had multiple trips to the ER and there were thorough tests performed leading towards getting a diagnoses.
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Reply to Onlychild2024
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Jax123: Seek a pain management physician.
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Reply to Llamalover47
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Please contact your local Hospice agency to make a referral for your mother. It doesn't have to be the doctor that makes the initial referral. Hospice will send out a nurse intake staff to her home to do an assessment to see if she qualifies.
Just because someone is on Hospice doesn't mean wounds will get neglected.
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Reply to JanPeck123
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You don’t need a physician order for a hospice evaluation. The evaluation determines her eligibility and can get an order from their own medical director.
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Reply to Jdjn99
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Hi
no guessing - you want to know something ask
And if you ask and that’s responded either a question ask again - so sorry I was asking xxx - can my mother be admitted sort of thing.
i think you need to consult her doctor and advise leg not healing. Blood circulation issues can get serious
have them address it early
doctor will been to comcfufmmok. It leg elevated when sitting or laying down
is she getting pain relief tablets
her condition needs reviewing.
bd polite but be insistent- to them you really are just a number
fur you make sure that number counts
best wishes
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Reply to Jenny10
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Hospice has a doctor associated with them they can write an order for Hospice care.

My question is, why has your Mom not been referred to a wound care nurse. Medicare provides in home care for things like this. Why does her doctor not write up an order for this? My daughter ran a Woundcare Unit in a hospital. The patients came to them for treatment. So there is a way for the appropriate person to care for this wound.
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Reply to JoAnn29
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Sally047 Jun 4, 2025
My husband just passed after being on hospice for 9 months. He had a wound on his tailbone that hospice and I knew about. Hospice kept it clean but gave no antibiotics. They are there to give comfort to the dying patients. Perhaps palliative care would be the right move.
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Brandy again. Don't even mention the PCP physician when you call. Tell hospice what you have described to us and tell them you want to see if she qualifies and if they can send someone out. Hospice requested Mom's records from the PCP.

Mom was admitted into home hospice within about 24 hours.
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Reply to brandee
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In Mom's state we self referred to hospice. I picked up the phone and called them and they sent an intake RN out to see if she qualified. The process was easy.

Hospice also treats pressure ulcers and provided wound care.
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Reply to brandee
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Time for a new doctor, one for pain management and wound care, if that’s deemed possible to truly heal, and a hospice evaluation. What’s going on now sounds needlessly cruel.
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Reply to Daughterof1930
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By pass her primary.
YOU can call the Hospice of your choice and ask for an evaluation.
If they want (and probably will) mom's medical records from her primary I am sure the description of the leg wound (if the doctor and VN have documented how serious it is) mom would probably qualify.
You can tell the person at Hospice that is taking your call that mom's doctor is resistant to referring to Hospice for some reason.
If you have a list of declines mom has had in the past several months let them know. things like...
She used to walk across her living room but no only walks 5 or 6 feet.

The wound used to be only the size of a quarter, it is now the size of a dinner plate and the Visiting Nurse does not seem to be able to manage it.

She used to not be in pain but the pain is now constant.

If they say that since her primary does not think that she is eligible for Hospice you might even suggest that a visit be made for Palliative Care. From your description I am sure as soon as someone sees it they may realize she would benefit from Hospice.
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Reply to Grandma1954
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Jax
Perhaps see a wound care specialist for a second opinion.
You might feel more confident that mom is getting the care she needs.
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Reply to 97yroldmom
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Your mother would have to request hospice and refuse care and treatment aimed at "recovery". She would receive treatment for such things that caused pain, and would get wound care to prevent pain and infection. Her primary should order this for her. If she doesn't pass within six months she can re requalified. If he will not consider asking for a new physician, a gerontologist. It is cruel not to allow her to have end of life care when she clearly is moving in that direction, if this is her wish and her family advocates for her.
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Reply to AlvaDeer
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