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So at 91, Mom with a broken kneecap from osteoporosis, wearing a brace for the rest of her life, confined to bed because she is not progressing in PT and refuses to get out of bed most days because the Hoyer lift causes her too much pain, severe arthritis, macular degeneration, usually only eats 1 meal a day and a few bites for lunch or dinner....this person cannot receive hospice care. What more has to happen to "limit" her lifespan. The doctor and staff of the nursing home called hospice but it seems she is not eligible. What now? Just let her lie there if she chooses, get mild pain meds that do not help, treat her aides, nurses, and family badly because she is so frustrated and in pain? Is there no other answer?

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I understand what you are dealing with. I've been in similar circumstances where quality of life continues to get worse but there is no terminal disease. It's hard for you to watch, but there's not much you can do but continue to make sure the doctor does what he or she can to keep your mom pain free. It's frustrating, because doctors are limited with what they can prescribe unless a patient is terminal and on hospice.

Hospice care is covered by most insurance and Medicare, but the person must be deemed terminal with an approximation of six months or less to live. Of course, many people live longer than that on hospice care and some get better and go off. Your mother doesn't qualify because there's no terminal disease.

Keep tabs on your Mom and watch carefully. Also, keep in touch with the doctor. If your mom shows any signs of terminal disease then she would quality. Meanwhile, urge the doctor to go for quality of life management.

Take care,
Carol
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Sounds like what your mother needs is pain management instead of Hospice anyway. If her pain is so bad that she can't get out of bed she'll start getting bed sores, then she'll be in worse trouble. I'd start with her doctor and have him/her put in a recommendation for a pain clinic or pain study first. You need to get her up and out of bed and moving around. Also find a doctor that will agree to ANYTHING at this point in your moms life, to relieve pain. My own moms doctor told her that he would prescribe marijuana in pill form or they also make a caramel of the stuff, to help with her pain and nausea that came with her cancer. Our family all decided after watching mom die from cancer, just give us the caramel already!! :)
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Only - been there, eventually something will happen that allows her to clear the medical scoring system for hospice. My mom fell (in a NH) and shattered her hip at the end of May and now is on hospice as she is totally bedfast. Your mom sounds too cognitive to qualify. I bet she is not considered truly "bedfast" but rather non-compliant for ADL's.

But a couple of years ago I tried to get her was evaluated for hospice when she was at her first NH - she had gone through a very bad patch, with back to back TIAs, persistent fever and more than 10% weight loss within 30 days - got evaluated and accepted by the hospice group. Then rallied, gained weight and got out of hospice within the 30 day window at the beginning of hospice. The hospice MD approved her but her NH MD didn’t… so no hospice. Most facilities have it such that both the medical director of the NH and the medical director of the hospice group BOTH have to approve for hospice.

There is a evaluation system for hospice. You should ask what in the evaluation kept mom from being accepted. Most NH & hospice providers use the FAST evaluation or a Mitchell score. Some use both.

Functional Assessment Staging Test (FAST)
Stages:

1. No difficulties;
2. Subjective forgetfulness;
3. Decreased job functioning and organizational capacity;
4. Difficulty with complex tasks and instrumental ADLs;
5. Requires supervision with ADLs;
6. Impaired ADLs, with incontinence;
7. A. Ability to speak limited to six words & B. Ability to speak limited to single word
& C. Loss of ambulation
& D. Inability to sit & E. Inability to smile &
F. Inability to hold head up
. Seems they have to be at a 7 to qualify.


Mortality Risk Index Score (Mitchell)

Points & Risk:
1.9 Complete dependence with ADLs;

1.9 Male gender;
1.7 Cancer;
1.6 Congestive heart failure; 1.5 Bowel incontinence;
1.6 O2 therapy needed w/in 14 days;
1.5 Shortness of breath;
1.5 less than 25% of food eaten at most meals;

1.5 Unstable medical condition; 1.5 Bedfast;
1.4 Age over 83 years;
1.4 Not awake most of the day


Risk estimate of death within 6 months
(Mitchell score):
Score Risk %

0 8.9

1-2 10.8

3-5 23.2

6-8 40.4

9-11 57.0

= 12 70.0
Mitchell seems to be used more. Dr Mitchell has done alot of studies and articles on dementia. Good luck, none of this is easy.
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oh also my mom's Mitchell was 10.8 so she has a 57% probability of death within 6 months so she was OK'd for hospice. Now hospice is for 90 days acceptance for the first 2 - 90 day periods and then every 60 days. They can be removed from hospice
if they get better too.
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NancyH, to make matters worse, Mom has a 2nd degree burn on her thigh. They gave her re-heated tea in a styrofoam cup while in bed with unsteady hands. They will not get her out of bed when she refuses, believe me, we/they have tried. I'm told it is her "right" to refuse and they cannot do anything about it. Oh, I have "ordered" that she receive no hot beverages; when they said it is her right, I asked them if they would care to discuss her "rights" with an attorney.....now she gets no hot liquids. Wish they would over-ride her "right" to stay in bed. Thanks everyone.
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