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My mother recently relocated to South Carolina. She suffers from congestive heart failure & CKD. She had a recent consultation w/her new nephrologist. Test results show that her kidney function has worsened. Her nephrologist recommended that she get hospice care to better manage her condition.


The thing is, my mom can still function — she cooks, dresses herself, and she’s alert mentally, though she has mild dementia. How would hospice work in this case?

If she is expected to have 6 months of life remaining, then hospice is the right option for care. If she needs care that focuses on comfort and quality of life rather than "curing" disease, then palliative care is the correct service. Many times the same companies that provide hospice also provide palliative care. Ask her doctor for clarification of why she needs hospice.
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Reply to Taarna
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What I was told is that Hospice is best suited for people that are expected to die within six months. In my case, it was a way to get good care while still being at home my wife died about three months after starting hospice.
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Reply to Sample
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My sisters and I decided to put my mother on hospice while she was still living in her home. She had congestive heart failure and mobility issues. She was still functioning, and was still living alone.

We found hospice very helpful in our situation. Through hospice we were able to get oxygen and many of her medications at no cost. She also qualified for an aide for three hours a day, five days a week. The nurse visited once a week and monitored her. It made things a little easier for us.

When my mother was hospitalized for Covid we took her off hospice because we wanted her to be placed in a nursing home.
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Reply to Hothouseflower
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As others have said, the nephrologist appears to be misinformed, but is may be a semantics issue. Hospice is basically for end-of-life care. You don't have hospice to manage a condition, except for pain relief. Could that be what the nephrologist was trying to suggest? You can't improve kidney function (except by a transplant, which is not a consideration here). You can also prolong life with kidney failure by having dialysis, which, similarly, is not being considered. So perhaps the nephrologist is talking about managing the effects of kidney failure.
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Reply to Igloocar
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My sister the doc mentioned getting dad into hospice about a year before he went. Dad was mostly continent. Dad could descend and climb stairs after family dinners in which he was lucid. Mom helped bathe him, but didn’t want a bath aide just for that.Dad didn’t need comfort meds or a hospital bed. So sis and I concluded, why bring in hospice as most of their services won’t be utilized?

Instead, we brought in palliative care through Kaiser. An md did house calls. A pt came. There was, then, still hope that my dad could retain his gait and his mind.

For our family, this deteriorated very quickly once dad was found on the floor upstairs. He hadn’t broken anything, but he was delirious. And stayed that way. And couldn’t walk.

That’s when we involved hospice.
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Reply to PeggySue2020
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I don't know the correct answer that works for you, but I can share my own experience with hospice.

So far, it has been a huge relief.

My parents started hospice two weeks ago, (92, both w dementia, plus my mom has chronic kidney disease, stage 4).

Because of hospice, my parents no longer have to be taken to drs appts. The RN case manager has come to their home at least twice a week. This alone has been a huge plus, because we no longer have to coordinate driving one parent to the doctor while another stays home. No more convincing my parents they need to go to the dr. No more getting my parents up and ready for their trip to the dr. Plus no more making drs appointments, period. No more dealing with drs offices, receptionists, messages not being delivered to the dr, etc.

A social worker visited. First she spoke to me to ask how I was doing. That has never happened with their former doctors. She asked me what my specific concerns were regarding my parents.

The RN removed medications that my parents were taking that were, at this point, no longer necessary. They have their medications ordered and delivered by hospice now. No more trips to the pharmacy or requesting meds from their drs and having to wait.

Hospice gives me access 24 hours a day if I have any questions or concerns. They give their assessment of how my parents are doing, instead of at the doctor's office, in front of my parents.

We have 24 hour caregivers, so hospice also guides the caregivers in their care, specific to each parent's situation.

Also, after 6 months, they are re-assessed, and either taken off hospice, or it is continued.

So for me and my specific situation, it has been very helpful.

I hope you find what works best for you.
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Reply to daughterofAD
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LinakaLou May 17, 2025
Are your 24-hour caregivers private pay?
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Use your Own Intuition . I had a hospice nurse come in and felt it was not the right time for my brother and I would use them at the end . At the beginning Of October I asked the Nursing home to have him sent to the ER , He was retaining fluid and was having spasms . The ER said " I did The correct thing " he spent a week in the hospital . I spoke with My brothers Psychiatrist and we talked for a Hot and I said " Do you think it is time for Hospice ? " He said " yes " and then we had a appointment with the head doctor of Dana Faber ( I asked My son to be at the meeting ) at the end of the Meeting I said " Is it time for Hospice ? " he said " yes " Then I called the Hospice company and we met at my brothers Nursing Home . They would send in Nurses to check on Him . it was Columbus Day weekend . I was crushed and drove to cape cod to see my Psychiatrist and Go to My Moms Grave and asked her " To help My brother . " In The end I was the One who had to make the decision about Morphine and His social worker and I had a Lengthy talk . Let your Mom be and speak with her primary care Physician .
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Reply to KNance72
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I thought an explanation of hospice might help:
most people look on hospice here as end of life
we have them as backup for my dad when I need advice or help in addition to the nurses here. It kind of depends if mother has care and support around her maybe?
if she’s functioning well then I’m not sure a place surrounded by end of life people would be ideal ?
I think you should make an appointment and go visit and discuss with them fir best option advice then make your decisions on the info and feel you get of the place
in the meantime - hospices:

Not just for the dying:
While some people might stay in a hospice to receive end-of-life care, many people utilize hospice services for symptom management and support, even if they are not nearing the end of life. ( In The U.K. they are viewed as end of life and ensuring person gets best quality of life as they go. The hospital did a good job on my dad! And he left in critical condition. We were referred to hospice- by their visit- at home we had turned dads health around and when they saw that they said they would hand back to nurses so they clearly demonstrated why they are here- that says theyve never abandoned us- call up to check how dad is and how we are and visit and say anything you ever need call us.

Palliative care focus:
Hospices provide a variety of services, including medical, nursing, emotional, and practical support, all aimed at improving the quality of life and well-being of those with a terminal illness. 

Holistic approach:
Hospice care takes a holistic approach, addressing the physical, emotional, social, and spiritual needs of both the patient and their family. 

Variety of settings:
Hospice care can be provided at home, /in a care home,/ in hospice
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Reply to Jenny10
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If her doctor suggests it, there should be no harm on speaking to a hospice consult (or Palliative) Her nephologist might more know about the certain future.
The consultant can give an estimate if her end is close or not and whether they would accept her at this time. After speaking with the consult, you both still get to decide if she is ready.
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Reply to MACinCT
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To be honest, with someone who is functioning well on her own at this point, I cannot begin to imagine why hospice is suggested by this doctor.

Do ask doctor this question as regards this recommendation: "WHY?"
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Reply to AlvaDeer
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Hi - I would not think twice about having hospice come in and do an assessment. So many people still think of hospice as only needed when someone is actively dying. It is not that any more. If your doctor suggests hospice, there is a reason, and even if your mom is 100% independent (as my 95.5 year old mom is…) the decline is present and while you may have her for another couple years, being able to have hospice come in 1-2 times a week is such a blessing and help. It’s a visitor for your mom, it eliminates the need to pile your mom into a car to go to the dr., and if she does have an emergency, you call them (vs an ambulance) they will assess if she needs to go to an ER. (And if she does, your hospice will (or should) quickly take her off of hospice and put her into a home health plan so that she can be treated in hospital. Understand that Medicare will and does cover this 100%. We are now 14 months into using hospice and I cannot tell you how thankful I am to have them.
Ask around and/or look at reviews and find a hospice group in your area. You will be so glad you did, even though your mom is independent. The fact of the matter is…between CHF and kidney disease, she is in decline…
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Reply to VSHill
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Hospice does not "better manage care." Hospice is for end of life if you want access to strong pain meds like morphine. Once on morphine patients don't last long.
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Igloocar May 19, 2025
Morphine is usually offered in this country only near the end of life or om a very short-term basis. This is partly because of the legal issues currently associated with narcotics prescriptions, as well as the need for careful medication management, partly because of the possibility of physical dependence (NOT the same as addiction). It's not the morphine that causes the end of life, but the conditions that occasioned the morphine administration. Sometimes burn patients, for example, are on morphine for a very long time because of the severity of their pain.
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Hospice, or palliative care, focuses on quality of life and not extending quantity of life. Her kidney doctor is letting you know that her kidneys are not working well and will not work well enough for her to have a long life. With palliative care/hospice, she can have health care that focuses on her being comfortable and able to enjoy the amount of life that she will have.
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Reply to Taarna
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I am of the firm belief that a person should have an evaluation for Hospice as soon as possible. The help, support that you get from Hospice is amazing.
Ask for a Hospice evaluation. If she does not meet the qualifications for Hospice she can receive Palliative Care and as she declines she will meet Hospice guidelines and the Palliative service can be transferred to Hospice service.

Hospice does not necessarily mean a person has "6 months or fewer" after the initial period a recertification is done if she still meets the Medicare guidelines for Hospice she will remain on Hospice. My Husband was on Hospice for almost 3 years. He continued to decline and continued to meet the guidelines at each recertification.
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Reply to Grandma1954
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From what you’re describing, it seems like palliative care might be a more appropriate option. It’s for people that have chronic or complicated medical issues that are not going to improve significantly, with goals to manage symptoms and reduce medical appointments. A practitioner will come to her home, usually monthly and can prescribe medications.
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Reply to MidwestOT
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"hospice care to better manage her condition"

Hospice does not care for conditions. What does this doctor think they can do for kidney failure. Dyalisis would be the next thing I would think. When that is not an option and kidneys shut down, then its Hospice because you will pass. Hospice is end of life care. Extraordinary measures are stopped. Life giving medications are stopped.

Doesn't seem to me Mom is there yet. You could have a Hospice consultation to see if it is something Mom could use.
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Reply to JoAnn29
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I would get a second opinion and a dietitian consult. My dad had the same ailments and the dietitian gave him great advice on eating and drinking, his kidney function improved pretty drastically.

She spent 2.5 hours with us and made sure that my dad understood how he needed to eat and drink to help himself feel better and not end up on dialysis.

I would be concerned that her new doctor doesn't want to deal with an elderly person and just gave her a death sentence because of his personal choice. Get a second opinion.
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Reply to anonymous749199
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KNance72 May 17, 2025
I find second opinions even Third Opinions count . Great advice . especially with the dietitian . Food is everything and you can heal from Illnesses with diet .
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Hospice is end of life comfort care when no further medical intervention is desired. No more doctor visits, no more hospitals, no life saving measures taken....just comfort medications are given to ease pain.
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Reply to lealonnie1
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Hospice would send a nurse once a week to start to check her vitals and such and would have aides to come help her bathe/shower about twice a week. You/she would have access to the hospice chaplain, social worker, and volunteers as well.
Hospice would supply any and all needed equipment, supplies and medications all covered 100% under your moms Medicare.
Other than that, they really don't do much, and 99% of your moms care will still be on you or other family members if she remains at home.
It can't hurt to bring them on board early as most people wait too late to bring hospice on board. Just don't expect much from them at this point.
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Reply to funkygrandma59
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woe8myte May 13, 2025
Thank you.
I work/live in another state. I was able to set up home health/home care services for mom. My brother & I plan to discuss this with her-not sure if she’ll be receptive to it.
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