I keep being told that hospice care is for when a person is within 6 months of passing away. How do we determine when he has only 6 mo left?

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I keep being told that hospice care is for when a person is within 6 months of passing away. How do we determine when he has only 6 mo left?

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He is 94. Sleeps most of the day, eats a fraction of what he used to eat, but still insists on going with me on outings even though he finds them confusing and tiring. I’m willing to take each day as it comes, but wondering when it’s time to ask for additional help.

Care Decisions Diet & Nutrition End of Life Hospice Sleep Issues

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If I'm not mistaken, a doctor must initiate hospice. They are the ones that determine whether the patient is terminal and whether they meet the life expectancy criteria.

The caregivers, and the patient if they are still aware enough, have to understand that they are accepting comfort care in place of curative care.

https://www.nia.nih.gov/health/hospice-and-palliative-care/frequently-asked-questions-about-hospice-care

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Reply to BlueEyedGirl94

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The hospice companies can do the evaluation, you can call them directly. They have a list of criteria and must meet certain things to qualify but you do not have to have another Doctor refer.

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At 94, hospice might consider him within 6 months of death. Someone that age with those symptoms could very well be dying. Ask for a hospice consult. They'll evaluate him and let you know if he qualifies. Also, the rule about 6 months till death - not necessarily a strict rule. My husband and his friends in memory care are all on hospice. It's been explained that a diagnosis of dementia, which is a terminal disease, and an observable steady decline in health qualifies them.

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Reply to Fawnby

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I am VERY PRO Hospice.
My opinion is that the sooner you call in Hospice the better.
The improved attention, the improved care from the Nurse, the CNA and the rest of the Team is immeasurable.
After my Husband broke his hip I happened to be passing by a Hospice and I stopped in to ask questions. I spoke with a Nurse, she asked me who my Husbands doctor was, she had me fill out some papers while she made a few phone calls. She came back and said after talking to his doctor he was approved for Hospice. He died almost 3 years later all the while on Hospice.
So...yes the standard is 6 months or fewer BUT as long as there is a documented decline that meets Medicare standards a person can be recertified and remain on Hospice.
So
Make the call to Hospice. If your LO does not meet the criteria for Hospice Palliative Care is an option and in many cases the Palliative Care Team will let you know when Hospice criteria has been met and the transition to Hospice would be easy.

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Reply to Grandma1954

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My 90 year old mother was placed on hospice a little over a month ago. They consider her an early admit. She's frail, disabled, and a wheelchair user but has no obvious end-of-life symptoms. Our Palliative Care team suggested it to me. I didn't know she would qualify. She will have to be re-certified every 6 months.

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Reply to shininglight71

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You don't. Only a doctor does.

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Reply to funkygrandma59

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Read this excellent article once @ https://www.mylifechoice.org/blog/understanding-end-of-life-signs-recognizing-symptoms-6-months-before-death.
Explains a lot of changes in the last months of life.
Let me know if you cannot find I will post few important points.

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Reply to Evamar

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This is a determination made by the doctor, and it truly does come down in most cases to their best guess. Often people on Hospice care don't pass away in that 6 months, but are reinstated. Many things will requalify the person. Even weight loss is a consideration. Speak with the MD about this.

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Reply to AlvaDeer

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My mother was in and out of hospice for 2.5 years! They'd show up for an evaluation (of a woman who hadn't spoken in months). They'd speak to her: "Merry Christmas!" for example. One time she said Merry Christmas back to them, and they kicked her off hospice. Out goes the hospital bed, the Hoyer, the oxygen, the meds in the fridge, and we had to replace such things. Then she'd go back to not talking and we'd ask for another evaluation, and back on she goes. Then off again. Once it was explained that they wanted to get some who didn't really need hospice off the rolls. She had private caregivers at home, but #%@!?! With my dad, it was an entirely different kind of experience.

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Please, if you bring Hospice in have another set of ears there when he is admitted. We have so many posts where people have no idea how it all works. He will be taken off any life sustaining medications. There will be no more doctor or hospital visits. You will be sole caregiver. An aide will come 2 or 3x a week to bathe him. If you need more time than an hour, you may need to ask prior for more time to run errands or just get away. The nurse comes maybe 1x a week. You will be trained on how to use the morphine, which is used for pain and ease in breathing. They may give you anxiety meds too. Read the info they give to you. Ask the Nurse questions. And know when his time comes the body shuts down. They loose the ability to swallow, no food or water will be continued because the body is shutting down. Hospice is end of life care.

We have people coming on here crying that Hospice hastened a LOs death. And what they complain about is part of the process. Your nurse should be available 24/7 by phone. She orders any equipment needed, meds and Depends, wipes ect. If you don't care for a certain nurse or aide, you can call the agency and ask for replacements. If you don't like the Hospice, you can fire them and hire another. And remember, they are coming into your home. We had a OP complain about a Nurse who seemed to take over. They are there to guide you thru. If you feel they are overstepping you have a right to complain.

My Dad had hospice in the home. They were good to him and Mom. His last day was Thanksgiving and his family was there. He could not talk but he ate his dinner and watched Football with my brothers. Sometime during the night he passed. Mom called the Nurse about 8am. She was there finishing up what she needed to when .I got there and then called the funeral home who was out in no time, but then they were just down the street. Equipment was picked up the next day.

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Reply to JoAnn29

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You can request an assessment, they will ask you many questions, get his medical history and do a medical assessment and determine if they believe he qualifies for hospice care. Once on hospice care the focus goes from trying to “cure” to comforting measures as life expectancy decreases. My moms hospice team worked with me in the beginning when it came to the meds I gave her vs what the give (which is usually comforting meds (pain management, secretion management and agitation management) She has recently declined even more and we have switched gears from the regular meds(meds for blood pressure, seizures, insomnia) to just the meds for comfort. Idk if all care teams are the same but they didn’t pressure me to take her off her meds as soon as she went into hospice care. You can also decide at any time (once using hospice care) that hey we aren’t ready for this and take him off hospice care and back to regularly dr visits. But once hospice steps in, there care team is primary. You call them first with any concerns and ask as many questions as needed. My moms hospice team currently consist of a nurse, chaplain, aide, massage therapist and social worker. Music therapy and pt were also optional. Hope this helps🙏

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Reply to Hardjourney

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Not sure who told you the wrong information about Hospice Care? You are recommended to put your loved one in Hospice Care that has a chronic condition and is inoperable based on their diagnoses from a doctor. You yourself may suggest it. A person can live in Hospice Care for years. There are evaluations that determine if Hospice Care is no longer needed too.

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Reply to Onlychild2024

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Re Fawnby’s note ( which I cannot reply to) that her very elderly loved one was kicked off hospice for saying “Merry Christmas” back to the hospice staff:
1- I thought “perking up” was a thing the dying did just before death
2- My brother was discharged from the hospital with a promise that needed (vital) medical equipment would be delivered and was actually enroute.
It never arrived ( machine for breathing treatments for COPD).
We were able to get the medicine for the machine the next day, but it took weeks and another doctor to get the machine needed to actually do the treatments.
He was not yet on hospice, but it scares me to think of them yanking necessary equipment and me( or anyone) having to do the kind of running around , fighting for needed supplies and maybe having to find a doctor and get the LO ( apparently the lady had been on hospice for some time) to the office somehow, in order to suddenly spend large sums of money to replace needed supplies like with my late brother).
Maybe I am missing something?

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Reply to Jo123456

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Don't wait. Be proactive. Get his doctor on board . Hospice will evaluate and if eligible, use all of the services provided. You still will manage day to day care, but the support given by hospice is immeasurable....nurses, CNA's, chaplain, touch therapist, music therapist, social worker, all there to help.
Hire a caregiver occasionally if you need a break....and you will need a break.
Respite care was available that hospice pays for.

Our mother was in hospice 4 years. The first months, we didn't think she had months to live. Our family gave 24 hour care and it was her strong will to live, our incredible family and the hospice care that kept her with us. She was reevaluated every 90 days.
Our mom recently passed at 97 and the support of the hospice staff has been a blessing.
Wishing you the best!

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Reply to Momto3

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Well it’s not true. Hospice care is for when somone needs more care than what they are getting with regular nursing care. One can always get off of Hospice care if they recover enough not to require such a high-level of care

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Reply to Sample

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No, this is NOT true. Hospice is when you have a terminal illness diagnosis and are not expected to live beyond 6 months and you agree to only have comfort measures taken .

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Yes. Hospicevis only for those who ate not expected to live beyond six months due to a terminal illness diagnosis. If the only diagnosis is a dementia diagnosis, I have been told by several providers that Medicare is cracking down on this. Unless your loved one says less than 7 words per day, they will not be approved for hospice.

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Reply to spectrum19007

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Wasn’t my experience but rules are different in different locales it seems.

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All the six months mean is that’s the interval at which hospices have to recertify that death remains likely. Hospices can also assess him for admission via home visit.

Hospice mostly benefits those who already need help with toileting or bathing. Chux, Depends, diapers, lotions, powders are all free. Bath aides come 2-3 times a week for free. If he’s still independent and not in pain, I wonder what hospice might do for him.

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Reply to PeggySue2020

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Not quite. The patient needs to have an expectation not to live beyond 6 months as determined by PCP/clinician. If they are still living at the end then they would need to be recertified at that time.

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Would just like to add that from my experience with older relatives of mine, there does not need to be a diagnosis that will result in death within a certain time period of six months, or whatever. I would definitely call hospice and explain the situation and ask what programs they have available and what they can do to help get his doctor’s cooperation. They have always been more than willing to provide advice and assistance in each case I’ve known of.

Wishing you and your loved ones well.

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Reply to Lmh9094

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Ever since hospice became a covered benefit under Medicare in the mid-1989s, the six months or less life expectancy has been a core component of Medicare-covered hospice.

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You can call a Hospice provider and they will do an evaluation to determine if he qualifies. Of course, you have no way of knowing when a person has only 6 months to live. Hospice can be renewed if the person continues to deteriorate.
If his condition improves, then Hospice may terminate their services, but can re-evaluate again at a later time.
I recently did this for my husband. It provides more services for him and more help for me. He seems to be pretty stable for now, but I'm going to accept the extra help from Hospice for as long as they will provide it.

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Reply to CaringWifeAZ

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My mama was 88, had been diagnosed with alz in 2013. She lived with me for past 10 years. The last months she was eating less, losing weight, etc. No actual physical diagnosis, but she was in pain, and I was exhausted. I called our dr, we had same pcp, and said I needed help, I couldn't go on much more on my own. He was well aware of her condition. She was on hospice within days, only a month before she died. I never had to deal much with hospice, aside from basic paperwork when social worker initially showed up. Sometimes I wish I had called sooner. They are there for the family as well as patient. Call his pcp. Sorry to hear about your situation. Get help when you can, sooner rather than later. And do know that if you have doubts or reservations about anything, let hospice know. I had to change aides twice. Prayers for you both. Glad you reached out here. Very caring and loving group here. They have helped me a lot. God bless.

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Reply to Tiredandalone

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Janet2710: Speak to his physician.

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Reply to Llamalover47

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We self referred to hospice twice (doctor did not make the referral.) Hospice sent an RN out to evaluate and pulled Mom's records from her PCP.

I called hospice when Mom became bedbound, eating very little and did not speak. She was in hospice for 18 months.

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Reply to brandee

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Brandee again--I picked up the phone and called hospice directly. They sent an RN out to the house to do the evaluation.

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Reply to brandee

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There are many different criteria. I would ask his doctor to evaluate him. Double incontinence as well as sleeping excessively are two things I know they look for, others are a terminal condition, refusing food, etc.

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Reply to Lovemom1941

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In my mom's (92) case, in March she fell against her bedside table while standing up, and was taken to the hospital. Xrays showed she had broken several ribs. She was considered level one trauma due to needing oxygen because the ribs were preventing her from taking deep breaths.

She also has stage 3-4 kidney disease, and has dementia.

It was in the hospital that a hospice dr came in to tell her that she qualifies for hospice.

So I called hospice to get her set up.

A hospice nurse came to her house to evaluate her, and while there, she noticed that my dad would qualify also for hospice, because of his dementia.

I was told that dementia is considered a terminal illness.

My dad was on hospice for four months (sadly he passed earlier this month). My mom is still on it. She will be reevaluated at the end of October.

In my experience, it does sound like it's time for you to ask for additional help.

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Reply to DaughterofAD3

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Like others, I suggest you contact a hospice directly (after researching ones in your area). When my mom (96 with chronic conditions) started sleeping even more than she already had been and was less interested in eating, I asked her doctor about hospice...he said we are not there yet. Months later, after another hospital stay, she started on hospice. She passed 2 weeks later and I feel we missing out on support that would have helped us during this difficult time. Seems it's common that people start hospice too late.

No one knows when someone will pass, so people are on hospice for varying lengths of time. If a patient continues to decline they can stay on hospice; if the patient improves, hospice is discontinued. While there can be exceptions, hospice means no more trips to the hospital...your care is managed at home.

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Reply to gnyg58

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You don’t know. I’ve been in hospice care for 6 months and just got kicked out because I didn’t die. I’m 90 years old and can’t walk and still need the hospice care.

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Reply to Sunnye

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Sunnye, hospice will only continue their services if you as their patient continue to decline. So the fact that they decided to stop their services means that you haven't declined in the last 6 months, which should be good news for you. Just because you are 90 and can't walk doesn't mean that you are dying anytime soon, and if and when you do take a downward turn you can always go back under hospice care.
In the meantime, if you're needing help with bathing(as that is all hospice pretty much does as far as hands on care, along with a nurse coming once a week to start to check your vitals,)then you will have to hire aides to come assist you.
I wish you well in finding joy in the time you have left here on this earth.

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You can get hospice anytime needed, not just when close to death. Talk to your dr or call hospice agency to discuss. Hope that helps.

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Reply to MeshellC

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This is incorrect. Hospice is end of life care. A doctor must attest to Medicare that the person has an estimated six months or fewer to live. This is on his best judgement as an educated physician. That some doctors "fudge " this requirement doesn't mean it doesn't exist.

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Would palliative care be helpful in this case? Just a thought. Here is a definition that may shed some light:

Palliative Care can help. Palliative care is specialized medical care focused on relieving the symptoms and stress of a serious illness. It is appropriate at any age and at any stage, and you can have it along with curative treatment. The goal is to improve your quality of life.

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Reply to CaringinVA

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I keep being told that hospice care is for when a person is within 6 months of passing away. How do we determine when he has only 6 mo left?

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