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My 90-year-old dad was diagnosed with osteomyelitis, a bone infection. He was in a nursing home for 6 wks of IV antibiotics. He had a heart attack and the hospital found he also has MRSA. His vascular surgeon said if he got an infection, there's nothing to do but try antibiotics and go on hospice. The infectious disease doctor wants him on vancomycin but the hospice people say that's too "aggressive" a treatment for him to go on hospice. Should I (POA) have them withhold all antibiotics in order to get him hospice care? Will Medicare still pay if I do that? Dad has dementia and now COPD, too, and he's ready to pass on. Has anyone else been in this situation or similar?

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O.K. thanks for the info.
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Medicare does not have rules about treatment. What happens is that hospice is paid a standard rate per day per person and they have to use that money to cover all aspects of a patient's care so they have to be frugal in their choice of medications. The hospice I worked for never spent more money on one patient than another. Each got what was necessary for them to treat the disease that they were admitted with that is the one most likely to cause his death. for example if someone is admitted with heart failure his heart medications will be provided free of charge but if he is also a diabetic. Things like Insulin will not be covered although hospice will still pay for supplies that anyone would need such as Depends and he will still get the same home care aides etc The Vancomycin would be considered potentially curative which is why they refused admission
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Veronica91............that's what I meant. There are certain rules that must be followed. I guess I should have clairified "Medicare".
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While the decision to treat or not treat a UTI is purely personal and should take into account the patient's general condition and there should be no guilt associated with it. Having a UTI is not a death sentence. I have seen patients with urine like pea soup clear up in a few weeks. to the poster above there are no such things as hospice rules. If Medicare is accepted then their extremely strict rules must be followed. Money grubbing is not part of the hospice rules.
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We're going through a similar situation with my 90 year old mom who is on Hospice care. She's had a chronic UTI for a couple of years. Finally a few months ago we decided to quit treating with antibiotics and let nature take it's course. She also got an infected wound on her leg a few weeks ago, and they gave us the choice of treating with antibiotics and we chose not to. She's been sick and ready for the next world for 3 years, and as someone else said on here we're letting her body catch up with her mind. Funny thing is, she keeps fighting these things off. However, she does have a UTI now, so I don't know where it will end up. It's a guilt trip though making the decission not to treat, but we know she would never want to live in the condition she's in, and has been in for over 3 years. I'm sorry for the bad experience the one person on here had. We have a wonderful Hopsice group, and love them. Some of the problems you've had may not be the fault of the Hospice company you are using, but just part of the Hospice "rules" in general. You can always change Hospice companies. The worst part of not treating the UTI is the added confussion along with the dementia. Good luck to you. :-)
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Dr. Cecily Saunders The Mother Teresa of Hospice Care must be turning in her grave to see the commercialization of her beloved method of taking care of each other at the end of life.
That being said to answer the original question why would you want to put an old man who is ready to die through this kind of treatment. Are you surprised when a family member dies on her way to chemo treatment? or dialysis?
It is wonderful to know that life sustaining forms of treatment are available in this modern age. In the case of the patient with osteomyelitis treating would probably hasten death or at least prolong it.
MYRSA has appeared in recent years due to the overuse (by us,Yes you and me) of antibiotics and Drs willingness to prescribe them. How often does a young mother take her child to the pediatrician and demand an antibiotic for a simple cold which is well known to be a simple viral infection. Her explanation is that they won't let her baby go back to daycare without it.
MYRSA is referred to as a hospital acquired infection. This is largely the case but how about the magazines in the Drs waiting room you have no idea who handled them last. Everyone should protect themselves when out in public by carefull hand washing. using a paper towel to tough door handles etc
Hospice care is about keeping patients comfortable at the end of life preferably in their own homes cared for by the people they love with the expert assistance of hospice nurses. It is at is a patient directed plan of care. Things are explained to the patient and their caregivers but the patient is in charge. If the patient says NO that is the answer. It is true that antibiotics are rarely used. It is a choice for example with a UTI. Treatments that are already in use may or may not be continued for example with dialysis until it becomes too much of an effort for the patient to continue. Dietary restrictions are not usually followed except in the case of Diabetics .If the patient is able to eat he/she can have anything. hospice care us usually covered by most major medical insurance. Medicare and Medicaid. You don't have to die within six months, as long as your condition progresses, although you have to be certified by the Hospice medical director at certain intervals you can continue. There is also a self pay option which is income related. All this is complicated but there is a social worker to work through the maize. Religious needs are also met if and only if desired. Hospice depends a lot on contributions to continue so has to have fund raisers through the year. There is also a big group of volunteers who are specially trained to provide respite run errand do light housework and transport mobile patients to Dr visits. If you reach a plateau and want to leave Hospice that is fine too, you are always welcome back. Don't be afraid to talk to them someone will visit the home or you can go to the office and meet there if you don't want to alarm your loved one. Don't be afraid
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When understanding that hospice is about HOPE, and honoring patients’ choices about how they want to live their final days, about providing comfort and managing pain and symptoms associated with an illness, it makes sense to take advantage of the services hospice offers at the earliest appropriate time. My mom was on hospice for the last 2 months of her life even though all 7 of us children are caregivers, the hospice team was of great support. I'm sorry to hear the bad experience the above person had with their hospice team. Such bad service would never be tolerated at Comfort Hospice and Palliative Care.
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I'm so sorry you're having to deal with such a hard situation. But only you know what is right for your dad. My husband contracted MRSA, and had to take Vancomycin. Vancomycin is really hard on the body. So in my opinion, I wouldn't have your dad take it unless your dad has a chance at a decent quality of life afterwards, but call in hospice to hopefully help with his pain and suffering. We used hospice with my mother-in-law, and, even though it took a while for her to pass, she was not suffering. She still had pain, but nothing like she had before she went on hospice. And the hospice agency we used could treat them at home until they pass or they can be transferred to their own facility when it gets towards the end. It was similar to a hospital, but more homey and comfortable, and had nurses on staff 24 hours handling about 8 other patients there with the same situation. And there were no visiting hours. You can come or go as you please. So every hospice agency is different. If you have problems with the first one you get - you have the right to call in another hospice agency. And Medicare pays for it. ((HUGS))
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Yes, my FIL is 86 and has several things wrong with him. He had a living will in place and his wishes in writing. He was being seen at his home by visiting nurses and after he put a gun to his stomach threatening to kill himself, they called in Hospice.
The meetings with the entire family never happened, the chaplain came and essentially told him she was whatever religion he wanted her to be, and many times the nurses would not show up when they were supposed to and they insisted that my husband leave work to come meet with them (often they were an hour late).
One day my husband gets a call at work from the hospice social worker who asked him, "hey, how much does your dad have in his bank account? Yeah, well that will cover him for a couple of months, we're talking him into the nursing home and he is going." We were told he had about 6 weeks or less to live.
I asked them about the 90 day stay through medicare and was told that only worked if he stayed 3 days in the hospital. My FIL waited until they left, called my husband and said, "take me to the hospital."
Well, needless to say this did not set well with the Hospice workers who informed my husband his dad should have not went to the hospital to begin with. He stayed 3 days in the hospital, one week in a geriatric mental facility and is now going on month 3 in rehab (where he participates in physical therapy every day but Sunday).
When he was at the mental facility, we were told outright that there were tests that would not be done on him as long as Hospice was involved. We got Hospice removed and he not only received additional tests but additional treatments.
His legs were not being properly taken care of by Hospice nurses (they asked at the hospital if he had received skin grafts they were so bad). His legs are now almost cleared up.
Oh -- one additional thing that Hospice is really good at is keeping patients doped out of their brain. My FIL was being given pain meds like candy (to the point he was becoming addicted). When I explained to the hospitals that he has an addictive personality and once struggled with alcohol and still with gambling, they went on a step down program for him.
Even with physical therapy, he now only receives a pain pill when he needs it.
He went to the hospital a couple of weeks ago and they said his kidney function is severly decreasing. They suggested we call Hospice back. We told them, "no thank you."
Our family is not the only one who has regretted ever being involved with Hospice. I know you hear glowing stories but it is by far not everyone's experience. I had heard wonderful reports from friends whose loved ones were dying and how Hospice made everything so easy and wonderful. We never used Hospice for my dad or grandparents, so this was our first experience with a direct family member. It will be our last Hospice experience too.
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Difficult decision. You are approaching it with humility (asking for input ) and love. The situation will likely change over the next few days as these things progress. To me, I may leave an advanced directive stating if I have advanced dementia to seize all my other meds in order to allow the body to catch the fading mind.
If you have faith, pray on it. You will make the right decision from a position of love and kindness. Whatever your choice do not second guess yourself.
God Bless,
L
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