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You are in hospice, but are expected to have 6 to 8 weeks to live. You are still ambulatory. You fall, you dislocate your shoulder, or your knee, or have a compound fracture. You are in agony, and know that will will only get worse. You don't want to go to the ER and be discharged from hospice. Do you have any other choices? What would happen if you got to an orthopedist and were refused treatment for the compound fracture because the office doesn't have the faculties for surgery?

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In the hospice that I work for, as long as the treatment in the hospital is for "comfort care" (a broken bone would qualify), you would NOT be discharged from hospice because you are not treating the underlying REASON for hospice care (cancer, etc.).

If you go to the hospital FOR treatment that has a link to your terminal diagnosis, then you will be discharged from hospice for the time you are in the hospital. You can be reinstated the minute you are out of the hospital.
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Your hospice provider should have given you a 24/7 number if you are unsure. A dislocation or open fracture is not the reason for hospice and it is a true emergency, especially for pain. The no resuscitation will still be in place except for a brief period of sedation for treatment. Hospice is for limited or no further treatment for a specific disease.
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This happened to my MIL. We were already unhappy with our hospice team and when MIL fell and was in so much pain, they were no help. We were inexperienced in this sort of thing so we signed her out of hospice, and went to the ER. They helped her immediately and put her on the hospice floor there, so she was signed back in. The hospice care there was far better than what we were getting at home.
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Sue; you make a good point about hospital treatment for an issue that is NOT related to the life-limiting illness. I think I would still call the hospice 24 hour line if a bone got broken at home and needed to be looked at. Medicare might balk at paying for an ambulance and ER visit while on hospice, so I would consult with hospice about the route to take in getting treatment.
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When you are on Hospice they become your 911.
In the scenario you give I would call for a lift assist and call Hospice. Once the paramedics determine that the possibility of a broken bone is very likely they will transport you. You should notify Hospice. Think of it just as you would if you were on vacation and you fell, broke a leg and were out of your insurance network. You would notify them of the emergency and most likely they would approve the hospitalization. Think of Hospice as your Primary.
If you fall you can call 911 and ask for a lift assist.
If you are transported to the hospital Hospice is not responsible for the bill. (main reason for this is Hospice is billing your insurance or Medicare for services now the hospital will as well, your insurance or Medicare is not going to pay 2 billers) You can drop Hospice an let your regular insurance take over. If surgery is required that will be through your regular insurance. Hospice does not do re-hab so that would be through your regular insurance. Once you have recovered from the fall you can return to Hospice.
The main goal of Hospice is to provide comfort, relieve pain and to make EOL as comfortable as possible physically, emotionally and spiritually. That does not include surgery or re-hab.
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You call the Hospice 24/7 line, as Mac indicated. You get discharged from hospice temporarily for treatment of an acute injury. 

When that treatment is done, you go back on hospice. Not unusual, and not a big deal.
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I'm not an American so I'm no expert, but from what I've read on the forum it really isn't such a big deal to be discharged from hospice temporarily, lots of people have gone to hospital to treat an infection or acute illness and then reinstated hospice when they are over the crisis. And I wonder if in a scenario like you have laid out whether treating the fracture wouldn't be considered a quality of life issue and they could have it treated without it causing hospice bow out at all?
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I would go to the ER and get evaluated. Then you can make decisions. If you are discharged from hospice, you can requalify easily.
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My husband did not have much pain, but one morning he awoke with agony in his gut. I knew the hospice nurse was coming in that morning so I just waited. She poked around his belly and said that she thought he needed a catheter, went out to her car and brought one in, and set it up. Immediate relief! I was so glad we didn't have to get him out of his bed and take him somewhere! This was just a few days before he died.

If the nurse hadn't been scheduled I would have called the 24-hour hospice line. There are some things that can't be handled at home and do need more than pain relief. But if your loved one is on hospice, that is who you should call first.
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You call Hospice and they will arrange for hospital care. You are discharged from Hospice but easily re-instated after treatment.
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