I'm confused about Hospice. My dad was recently put in their care without much other than CHF being wrong with him. Has something changed?

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My dad, 94, in AL with not much other than congestive heart failure being medically wrong with him. He's still in fantastic spirits. He gets around in a wheelchair, mainly because he stopped getting PT (didn't want it anymore, which I get). He refuses to sleep in his bed (I've purchased 4 dif beds, none were to his liking), so he sleeps in his power lift chair. At 94, I figure he gets to do whatever he wants. I was curious about hospice. When I asked the nursing coordinator at his AL place, she said he would be a candidate, and Hospice swooped right in and are taking care of him now. At first, I thought Hospice was for people who were, well, on their death bed with just a few days to go. Has something changed??? Thanks.

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My mthr was on hospice 2 years before graduation- she improved so much with the extra medical care! Hospice is for people whose doctors would not be surprised if they were dead in 6mos. Quite a difference from being on their death beds!
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Reply to surprise
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"Swooped right in"? Did you not approve? Did your dad understand what was offered and authorize it?

My husband was on hospice care 5 weeks in our home before his death. I wish I'd called them in sooner. It was a great help to have them involved.

My mother was in a nursing home when her hip broke. It was inoperable, and the palliative care nurse predicted she had less than a week to live. She returned to the NH on hospice care, which was a nice bit of extra attention. After three months they discharged her from the program, since she no longer seemed to be near death. She lived another couple of years.

Many people are on hospice only at the very end because their loved ones don't realize it is available for much more than the actual end. It is supposed to be supportive and comforting for the months at the end of life.

The program will have a chaplain, social worker, and nurses that you can talk to about any questions or concerns you may have. And feel free to come back here anytime!
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Reply to jeannegibbs
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It basically is for people diagnosed with terminal illness with supposedly 6 months to live. But waiting til the final days is generally not the best way to make use of services.
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Reply to rovana
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Criteria for Hopice changed a few years back. You don't have to be terminal. Basically just pass from what is wrong with you. In Dads case, heart failure. If you are paying for certain care of Dad in the AL I would review it with the AL. There r things Hospice will be doing that the AL won't need to. Is Dad in Depends. Hospice pays for them. To be honest, since Dad is in an AL I don't see the need for Hospice until he worsens. Now Hospice at home is a different story. A home caregiver would get an aide. Depends are paid for, saving cost. And there are other things.
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jeannegibbs Jul 7, 2018
JoAnn, do you know when the criteria changed? All the sources I look at still say "Hospice eligibility requirements: In order to be eligible to elect hospice care under Medicare, an individual must be entitled to Part A of Medicare and certified as being terminally ill by a physician and having a prognosis of 6 months or less if the disease runs its normal course. 42 CFR 418.20 § 418.20" This is to be based on the physician's best judgement: " that the hospice certification of terminal illness shall be based on the physician’s or medical director’s clinical judgment regarding the normal course of the individual’s illness." [These are quotes from the regulations.]

In the case of dementia this can be tricky. Dementia is fatal. But it can go on and on for years. At what point is death likely to occur within 6 months? There are generally other indicators, like weight loss, swallowing difficulty, etc. People with dementia can certainly have hospice care, but not based simply on the diagnosis of dementia.

I've had a loved on on hospice in home and another in an NH. In neither case did hospice provide daily care. Supplies and equipment supplied by hospice are great! And a nice savings. And no red tape to get them. Hospice care certainly does not add to the recipients costs. But I'm not sure what services AL provides that you could stop paying for once Hospice is in the picture. Could you give an example?

I did not get an aide at home when my husband was on hospice. I could have had a volunteer a few hours a week. I kept the PCA we already had. The nurse visited a couple of times a week. It is a great service, but I'm not sure it replaces any facility charges. It is additional care; not replacement care.
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He needed a doctor to sign off which probably happened. You also described that he prefers to sleep in a recliner chair rather than beds you purchased. Persons with end stage COPD and CHF prefer to sleep upright this way because it helps with their breathing at night. I dont think you are seeing the full quality of his life if you cannot see how he does overnight. Hospice seems to be his choice, so why do you want to interfere. Let him treat his symptoms rather than escallating care
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Reply to MACinCT
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From what I remember,there is a specific ehection fraction required for CHF. I'm sure all the right hoops were jumped through!

On hospice, mthr still lived in memory care, but she had an aide to bathe & dress her and 2x month visits from a nurse practitioner. The real help was in having no more ER visits! Hospice was called instead of 911 and she was treated by dementia spectialists instead of docs bent on over testing her and confususing her further. It was a true blessing.
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Reply to surprise
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My first reaction was same as Jeanne's - "swooped right in." Did you have a chance to interview them first? You do have a right to choose your own hospice company.

Is this hospice company affiliated with the AL facility? I have a feeling there's a cozy relationship.
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Reply to GardenArtist
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According to the National Hospice and Palliative Care Organization;

Hospice eligibility requirements-
In order to be eligible to elect hospice care "under Medicare", an individual must be entitled to Part A of Medicare and certified as being terminally ill by a physician and having a prognosis of 6 months or less if the disease runs its normal course.

In order to be eligible to receive this service, a beneficiary must:
be determined to have a terminal illness (which is defined as having a prognosis of 6 months or less if the disease or illness runs its normal course;
not have made a hospice election, and
not previously received the pre-election hospice services.

JoAnn,
The hospice I worked for (up until this year) had the Medicare requirements that a patient had to be declared by their doctor that they had 6 months or less to live.
That can give the doctor a lot of freedom and some have prescribed hospice (paid by Medicare) for patients (as seen above) that GREATLY outlived the 6 month mark. The docs know the the family could use some help and this is one way to get it.

Maybe the requirements are different in other states but I think Medicare is national.
I suppose you could pay for the services if you didn't have the doctor's order (?) but I've never heard of anyone doing so.
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Reply to SueC1957
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It's also possible that something has changed with the CHF.

When you say "not much wrong except..." CHF may be slow but it is often sure. Perhaps ask your father's permission to go through his latest test results with his primary physician?
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Reply to Countrymouse
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Hi c47090,
Mother's doctor told me he placed Mother on Hospice because he realized I was doing everything alone and it was to help me,but after she died 3 and a half years later,he admitted that he really thought Mother had 6 months or less to live.
Hospice did help me though.They brought supplies,ordered her medicine,had it delivered, had the oxygen sent,got her a wheelchair,sent a nurse twice week and a bathaid twice a week,and a Chaplain once a week came too and through a Grant Hospice had,Mother was approved to receive Compassionate Touch where a lady came and rubbed Mom's back and she was even treated to a Frank Sinatra show by her Hospice too.
My Mother lived and slept in her lift chair too like your Dad does too.She said she wanted to be out in the den where the action was.As long as your Dad is comfortable,that's all that matters.
I'm glad you're getting some help now too.Take good care~
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