How does Hospice fit in with other services?

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My husband is receiving in-home help in the form of a PCA for a certain number of hours a week, and also homemaking services once a week, through Elderly Waiver. When the time comes for Hospice, will those services continue, or be replaced by hospice care?

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I agree with your Jeanne, maybe in the very end they will be good for medication. I was in desperate need for morning help to get my Mom out of bed and hired my CNA as Hospice couldnt do that aspect for me. My Moms probably 150lbs and to get up alone is brutal and my arms ache. When Hospice told me they hired 2 new caretakers who could come mornings I was thrilled, but it didnt work out as the 2nd one said she hurt her back here. I got my hospital bed right away thru the medicare pharmacy listed on their website. I would suggest the 80" gelpad also covered under medicare to comfort. My Mom cannot roll and I raise her head at night so she wont cough, there are stipulations. Good luck, oh btw, they have nice hospital bed fitted sheets on amazon if you want to get those ahead , the beds are twin XL.
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Reverseroles, I think it may depend a little on what your expectations are.

I am wanting someone knowledgable to help me understand the dying process. I want explanations of what is going on in my husband's body. I want someone to talk to about whether to encourage eating, and when to stop the encouragement. I want quick access to meds to eliminate pain, if that becomes an issue. I want to ensure as much comfort as possible in spite of increasingly difficult symptoms.

I am not expecting or looking for caregiving help. If baths become more difficult I may want help with that, but right now our PCA can handle that. I don't expect them to use one of their precious volunteers to assist me when I already have assistance through the Elderly Waiver program. They have explained that they will not duplicate services I already have. I accept that. I just wanted to be sure I wouldn't lose the services we already have, and now I've been assured on that score.

Medicare is paying for the equipment Hospice might order, so I assume (as you have confirmed) that I could get the equipment without Hospice. I've already been trying for a hospital bed his doctor ordered. That was about four weeks ago -- we don't have it yet. It has to go through channels, I'm told. But Hospice says they don't have to go through the same channels, that they are authorized to make decisions on their own, and they get equipment delivered the same or next day. Even if it took the same length of time, I would soooo welcome someone else coordinating and doing the phonework, followups, etc. Also I'm hoping that with their experience and coming into the house regularly they may spot something he needs or that would help him that I wouldn't even think of.

I've certainly had loved ones die. But I've never been intimately involved in the entire dying process. I want some help for me, to understand the process, as well as for my husband, to make the process as comfortable as it can be.

So, what I am hoping for doesn't seem to be what you were expecting. I think that will make a difference in our evaluation of the program's usefulness. I'll let you know!

I am glad you posted. It may help others have more realistic expectations of what Hospice can do for them.
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Just want anyone out there to know that you can get a hoyer lift and sling, hospital bed with 80" gel pad all free thru mediCARE also. All you do it get a doctors RX with 3-4 diagnosis's on the script (they know how) and bring or mail it to a medicare affiliated pharmacy. I got them all but instead of a semi-electric hospital bed I got a fully electric bed at $30 a month for 13 months, then we own it. I did it because I raise the bed a lot for changing and I wanted a brand new bed, not used as all the others. As far as Hospice, their diapers and disposible bed pads were useless and Mom soaked right thru them even with an extra pad in them. For me , Hospice came and after the 3rd day told me they could no longer help my Mom as she is a 2 person case and they are only supplemental care, so I canceled them. I do like the fact I can call an ambulance, or go to the Drs with her, and not have people callling and dropping by when they want, yet not helping me. I was hoping they would be great, but I tried 2 agencies and they were not. Maybe in the very end if Mom needs morphine they would be ok? As of now I hoyer her into her wheelchair, recliner and bed and still lift her on and off the toilet to wash her. I like reading of others experiences and hope you all have better agencies that I had.
PS On one morning I had my CNA here to help me and Hospice said that they wont need to come on that day if I have help. I said I PAY her. They shouldnt know if you have help because if you do, you are put on the bottom of the list. fyi
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As I understand it now, any items that fall under Medicare coverage will be handled by Hospice. For example, if equipment such as a hospital bed or oxygen or a wheelchair is deemed necessary for the comfort and safety of the patient, Hospice is authorized to order the item for immediate delivery, without going through any approval process. Hospice bills Medicare (and also uses volunteers).

If the patient is also on Medicaid (including Elderly Waiver), he continues in that program, and items that are paid for through that program go through whatever approval processes are in place for that. For example this might include homemaking services, aides, or incontinence supplies. If a patient is already getting a service, Hospice will not duplicate it. If there is already an aide who helps with baths, Hospice will not send a volunteer or paid person to do that task.

At least that is my understanding now. I'll let you know if my experience doesn't match that!
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Thank you for Info jeannegibbs on explanation of PCA etc...
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THIS DEPENDS ON THE TYPE OF WAIVER THAT IS BEING UTILIZED. IF IT IS A TRUE MEDICAID WAIVER, (SUCH AS EDA, CCW, OR OTHER) THERE WILL BE NO CHANGE IN THE SITTER SERVICES PROVIDED. HOSPICE TYPICALLY WILL NOT PROVIDE A NURSING ASSISTANT BECAUSE THAT WOULD DUPLICATE SERVICES YOUR CURRENT PROGRAM PROVIDES. DISCUSS THE OPTION WITH THE CASE MANAGER HANDLING THE SITTER SCHEDULES, KEEPING IN MIND THEY MAY HAVE THEIR OWN OPINION REGARDING HOSPICE CARE. ON THE OTHER HAND, IF YOU HAVE A STATE PROGRAM LIKE LTPCA, HOSPICE CAN NOT BE UTILIZED IN CONJUNCTION WITH THOSE SERVICES. MY BEST ADVICE IS TO FIND OUT ALL YOU CAN BEFORE THE CARE IS NEEDED. HOSPICE IS A WONDERFUL PROGRAM WHEN DONE RIGHT AND CAN BE A GREAT ADDITION TO SERVICES ALREADY BEING UTILIZED. IF YOU FEEL LIKE HOSPICE MAY BE AN OPTION, CONTACT TWO OR MORE OF THE LOCAL AGENCIES AND INTERVIEW AND ASK QUESTIONS OF THEM. THIS WAY, SOME OF THE DECISIONS WILL BE MADE PRIOR TO NEEDING HOSPICE CARE.
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PCA = personal care assistant.
Elderly Waiver = component of Medicaid that supports recipient in his or her home, instead of in a nursing home. For example, this program paid for Adult Health Day Program, and when Hubby's ability to attend that declined, now pay for a PCA. The total cost cannot exceed what it would cost to place the recipient in a nursing home.
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Hi jeannegibbs,

When my Dad was on Hospice, everything was paid for under Medicare and not medicaid, Dad got better and srvices under Medicaid returned. Now my Mom is under Hospice care in the Nursing home, and Hospice is in charge but the Nursing home still provides meals, and meds. Hospice comes in when Mom is having a server panic episode, showers, company, counseling, chaplancy, social worker all under medicare. When I say in charge, I mean Hopice over rules the Nursing Home but I still over rule them all! I am still the POA!

I'm told it will be the same regardless of where the person is, nursing home, home or a hospice home.

I hope this helps, thanks for all the help you have provided us with.
Best wishes!
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Hi Jeanne, I found the MN site and copied the following:

a) Hospice. Enrollees who elect to enroll in the Medicare Hospice program 10 while enrolled in MSHO are not required to disenroll from the MCO’s MSHO 11 product.



It looks (to me) like you would be able to have the same services but the EW case mgr will tell you for sure. (Unless I have the wrong pgm)

Is your husband nearing hospice time? I'm starting to get ready for that move for my Mom. Thinking of you. geewiz
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Thanks for the responses.

I realize that hospice is covered by Medicare, which is an entitlement program, and that we will not be billed. What I am concerned about is not the hospice side of things, but the Medcaid/Elderly Waiver side. That is not an entitlement program, but my husband qualified for it several years ago.

In my observations locally, hospice does not seem to provide the level of daily in-home care Hubby is receiving now. My question is, would accepting hospice disqualify us for the Elderly Waiver services?

I've spoken with a hospice administrator, who says they will coordinate to make sure no duplicate services are received. That if we are getting homemaking services through Edlerly Waiver, they will simply not provide homemaking services. Fair enough, if it works that way.

I also have a question in to the case manager for the Elderly Waiver benefits. I will share what I find out there.
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