How can we get Medicare to pay for the additional nursing staff care for my Mom?

Hospice will send aides, they sent a bath aide, an RN, PT, OT to my daughter. What they won't provide is a cook, housekeeper or chauffeur. They even offered to have someone get the groceries or be a companion while WE go out.
They offered counseling to all of us. My cup runneth over.

Pam, that is not necessarily the case. Hospice - since it does not provide 24/7 care - expects others to be at the home or at the facility to do some aspects of caregiving. Like change their diaper, give medications, bathe, dress, etc.

Now if the person at home (like in this case, it's Law's dad who is at home) can't do what what is needed - like dad can't lift her for bathing, or has issues giving shots or dealing with lady things - then he can hire someone to help him do this. They are hired to help Dad with whatever that is within the care plan that hospice has for mom. Medicare isn't going to pay for them as hospice requires that others are there to provide some level of day to day care. It just has to be within the care plan that the hospice has set up for the patient.

Often families hire a sitter (could even be a LVN or an RN if they can afford that level) to come in so they can go out for the night or take a weekend away so that the family member on hospice isn't alone. Medicare doesn't give a fig about this, as it's just a substitute for the family member and everybody is all kumbaya on the care plan.

When you sidestep Hospice and hire your own, Medicare does not pay.
Work with Hospice. If they order it, Medicare pays.

Great suggestion from Maggie. I'd like to add that you clearly speak with the RN & social work with your hospice group as to whether realistically mom needs a different level of care to manage her needs. I imagine that your dad is just about worn out in all this. It may be that mom would be better in a NH. She would still be on hospice (Medicaid) but would have the 24/7 on-site additional care that a NH can provide. Now the room & board part of the NH would not be paid by Medicaid, that would be private pay, long term care insurance or Medicaid.

The hospice group probably has a short list of NH that they go to. If not they are going to be able to refer another hospice group that does at-home as well as in-facility hospice care.

Another thought, IF mom realistically has just a few weeks left, some larger hospice groups have an in facility hospice in bigger cities. In my mom's city, VITAS has a freestanding hospice that was the old Women's & Children's hospital at the medical center and then they also have a separate hospice wing at one of the larger IL/AL/NH tiered facilities. They both seem to be centered on cancer or extreme trauma patients as they require a higher level of pain meds which have lots more regulation (like 24/7 morphine pumps). Often the residents are younger too and the nursing staff has more training (than the aide that come for hospice).
None of this is easy but you don't want dad to wear himself out.

She's in hospice at home, I gather? Talk to the hospice people to see if they can provide more hours to help dad care for your mom. Ask them the question you're asking us. There may be help out there for you that they can put you in touch with. Time's your enemy right now.

Medicare will not pay for additional nursing staff beyond what hospice can provide and still be hospice-compliant. If your mom and dad have no assets, they may be able to get Medicaid assistance. Someone in the hospice "office" ought to be able to steer you in the right direction. Call them right away.