How do you know when it’s time for hospice?

Hospice will evaluate. If they do not think the time is appropriate they will let you know. They may offer Palliative Care and if so the Team will be in place when they determine that she is ready for Hospice.
In my opinion it is NEVER to early to contact Hospice.

I know someone with a similar situation now (from tumour not fall though).

Leaving acute care for rehab was the initial plan, but it may be skilled nursing instead. The family still have hope but it is starting to fade.

Diet is small pureed amounts, but too sleepy some days. It is all still wait & see.

I think if liquids/food becomes more unsafe & nasal gastric feeding is needed, this will be a confronting choice.

I hope you can find the support you need though the decisions ahead. (((Hugs))) to you.

Can you have her evaluated for Hospice? They'll tell you if she qualifies or not. I'd be inclined to believe your neighbor with all her experience.

My mother is on hospice at her memory care, and little has changed except that she's getting a lot more attention these days. She has a dedicated hospice nurse who comes to see her specifically, the caregivers are more attentive to her eating and drinking.

While she's unquestionably declining, she's mostly living as she would have without hospice except she won't be going to the hospital any longer. She's not on special comfort care meds or anything like that. The nice thing about it is that it's now all about quality of life, and not about doing everything in our power to keep her going. She's annoyed at the endless treatment of a leg wound she has, but otherwise she gets to sleep when she wants and if they can get her to eat a cookie when she won't eat anything else, then that's OK.

Hospice isn't about giving up on someone. Rather, it's about shifting priorities.

Ask her Dr what he/she thinks. Most people wait too long before getting hospice involved. Your mom can be under hospice care while in the memory unit. It will just mean that she will have extra sets of eyes on her from the hospice nurse and the hospice aides, and of course all her needed equipment, supplies and medications will be paid for 100% under your mom's Medicare. And if your mom improves enough, she can always come off of hospice care too, so you're never locked in. I wish you the very best.

Discuss this with her MD. The lack of progress in rehab doesn't mean that there are fewer than 6 months of life left. This is not a deadly disease, it is aging. The MD knows your Mom's overall condition. I think that surely palliative care is appropriate, no testing, no working toward a cure (there isn't one for age). Comfort care primary concern. But I doubt it is time for Hospice, pain meds, medications for air hunger and etc. That is to say, she isn't actively dying and there is no reason to believe she will die within six months. Wishing you luck.