Mom in nursing home and on hospice. Do I need both?

Hospice is not an additional cost. It is covered 100% by Medicare. Yes, it is important to have hospice. Think of it as additional services, which those
near the end of life need.

Hospice care will help with pain management for mom and with her prognosis. End of life choices and comfort. She will have extra sets of eyes on her, making sure she is as pain free as possible. This is in addition to her normal care recieved by the NH. They will work with the staff at the facility enhancing her care for whatever time she has left with you. Medicare pays hospice and medication for mom. You've made the right choice to have them involved to make things easier on her.

My answer may differ from others but is something to look out for. When my mother was in a NH, getting good and attentive care, it was recommended at one point we add hospice. Quickly after the service was begun we noticed a big change in her care. It was so apparent that the NH staff was using hospice as an “out” not to do things they’d been routinely doing for mom. Suddenly when she needed a bath we started hearing “we’re waiting on hospice to come and do it” That’s one example of many caregiving tasks that were usually done without issue that became “let's wait on hospice to come” We soon canceled hospice and her good care from the staff resumed. I’d say it’s something to look out for in a NH setting. Hospice was invaluable to me much later with my dad in his home so I’d certainly recommend their services in many cases

My experience when I used hospice for my mom was very very sweet.

My last memories of her were of her little body massaged with baby oil in her little flannel nighties, lying on her side, cozy and warm.

Funny story, one of the “services” provided by the hospice was a Priest who played the guitar. My mother HATED live music, I think something about her hearing, and when I was notified that she’d be serenaded, I had to race to the nursing home and tell them that she wouldn’t want it. THAT I always felt a little guilty about!

Hospice is ‘comfort’ care. Please take advantage of their services.

My brother was kept comfortable during his final days.

They also provide a social worker and clergy for the patient and the family.

The hospice nurses where my brother was were angels.

I do encourage you to consider options if available. Not all hospice organizations are the same.

Read through the literature. Speak to the administrator of the organization.

Wishing you peace during this difficult time in your life and an easy transition for your loved one.

There’s no additional cost for hospice, it’s a Medicare benefit. It’s *usually* an extra layer of care in a nursing home situation and they provide support services to the family if they want it. My FIL was on hospice the entire time he was in a nursing home and he actually got better care that way. Hospice was an extra set of eyes and they managed his medications & kept him comfortable. Being on hospice didn’t result in the staff becoming lax in their caregiving duties BUT that is definitely something that can happen. Unless you notice she’s declining and seems to be neglected, I don’t see why you would take her off of hospice. If my FIL hadn’t been on hospice then he would have been in pain all the time. And at the end-of-life, hospice is really the only way to ensure your loved one isn’t suffering until the end.

I wasn’t aware hospice ever charged for their care . !

Do you “need” both? NO Should you have both. YES.
Hospice will take over bathing when they are there so nursing home will no longer do some of the things they had done previously. But having Hospice will have another set of eyes on her, Hospice can get supplies and medication to her faster. Hospice also supplies skin cream and pull up or tab type briefs.
There is no charge for Hospice it is covered by Medicare, Medicaid as well as most insurance. Because Medicare covers the services the nursing home will not duplicate what hospice covers. This is why if Hospice staff does bathing nursing home staff stops.
The other advantage is Hospice staff is probably in the building every day so if there is something urgent mom needs they can contact someone that is probably only minutes away.

I arranged for hospice to have their visits with my wife on days opposite her NH "bath days". That way she got extra showers.

They also provided therapy(counseling) for my 18Y/O special needs son.

She has been off of hospice for almost 2 years now and I am caring for her at home. However I am considering bring hospice back in.

I echo grandma's post.

Is your mother's NH stay under Medicaid pay or private pay? There is no cost for hospice care in either case. If your mom is a Medicaid patient her care, room, and supplies are all covered at no cost to her. Hiring hospice will be covered by Medicare also at no cost to her.

If she is private pay, she is paying for all care, room and supplies necessary for her care. Hiring hospice will relieve her of some costs. It will not cover the cost of the room but will pay for all nursing care, medications and supplies necessary for her care (incontinence pads, gloves, etc.). Hospice will not offer any curative care but will concentrate on comfort and dignity of life in her final days. Hospice will take over her care and relieve the facility of doing that.

If you want better updates and more frequent visits, talk to the case mgr about that. Also you may want to take advantage of other Hospice services such as chaplain visits and music therapy. My wife had a hospice nurse come very morning to get her day started by dressing her, showering and getting her to breakfast. I always recommend hospice care.

Contrary to popular belief, hospice does not do care other than provide supplies and a home health aid twice a week for a half hour. You get a weekly visit from the nurse and every six months a nurse practitioner will re-evaluate her. I had mom on hospice for over 2 years before she died, and I did all the care. I had to change mom at least 5-6 times a day so a home health aide did no good so I did not even bother with that. When mom was actively dying the nurse visits daily to make sure she is comfortable.

Hospice was very handy though--the diaper and glove supplies, ointments, hospital bed, oxygen were all free. I got her routine meds ordered, and occasional labs. Hospice was very helpful.

Alzheimer's did not kill mom. With insulin-dependent diabetes, kidney and liver disease she managed to live 90 years old. Those other diseases killed her, because eventually I got a feeding tube in and it kept mom very comfortable and hydrated. I knew mom was dying when she had residuals; normally she had no residuals from the previous day's feeding and water. As soon as I seen those residuals I called my brother to come down as mom was dying because her body was shutting down. She died exactly one week later. But comfortably. I never regretted the feeding tube because dying of dehydration can take weeks. I spared mom that. BUT that feeding tube was a LOT of work. I never had any problem with it. Mom never pulled on it, and I kept it covered with a "tube top" I found on Amazon -- so when I turned mom it would not get accidently pulled on by covers. It worked great around her abdomen and was very comfortable for mom. Mum was so comfortable not once did hospice have to break open that comfort pack. She really did die in total peace, and she did not have a single sore or mark on her skin.

But I had to care for mom 24/7 around the clock and she was my constant obsession as her level of care was frequent. Try doing that for YEARS and YEARS and see what that does to your mind. It's been over a year and I"m still recovering from mom's death, but I am gainfully employed, trying to get my Master's degree and just carrying on with the pulse of the living. Mom is in a better place from the ordeal called life. Only the living suffer.

The ONLY benefit to her staying in the nursing home is that it provides her familiar surroundings and people, and that may (or may not) be comforting to her. That's it. If she wasn't crazy about the nursing home, move her to a beautiful hospice facility instead. In my area we have one that's absolutely heavenly....

Talk to hospice and look over the contract. If your mother has24/7 care and you are OK with nursing staff in your home 24/7, you could take her home. If the care isn't 24/7 are you up for filling in the gaps for times that staff are not present top care for your mother yourself?

Your mom's Insurance should be paying for Hospice.

My Mom was in a nursing home before she passed and Hospice was the only way I could her the pain medication she needed. The NH also would send my Mom to the hospital when they couldn’t handle her. Each trip made her worse. When she went on Hospice the hospital trips stopped. You may need to change Hospice providers. The only reason Hospice should not be visiting your Mom is that the Nursing Home is refusing them entrance. Covid rules may be getting in there way but they should tell you that the NH is refusing them.

Hospice should be at no-cost or it is in California and I believe in most states. Could be wrong, if I am someone correct me please.

My mom was in Nursing home & got hospice the last 2 weeks of life. I wish we did it sooner. Hospice can move & administer medications so much faster to make the patient comfortable, better than NH. There are different hospice organizations you can chose, if you are not happy with the one you have talk to the Nursing home nurses they should have other names for you. We got to choose the hospice we wanted, but I asked the nurses who they recommend & I went with them. Hospice was great care & wonderful they are in charge of her care & NH worked with them. But I had confidence in them & didn't nick pick every little detail. Mom was comfortable & that is what mattered. Its hard to go thru.

My Dad just passed this week. Has been in an assisted living for 18 mos and Hospice for last month. Having that extra layer of support really helped. They could bring in resources/meds more easily, were another set of eyes/ears, could guide me/family in ways that staff may not know or have time for right now. They did keep in touch with me. I believe their presence not only helped me, but also the now besieged facility staff.

And there are unquantifiable benefits too. Despite lockdown due to COVID infections, I was allowed in to visit an hour each day; this made a world of difference for me and my Dad! Also, the Hospice Social Worker - who just happened to be fluent in Italian - Dad's first language - spent time talking/singing with him in Italian one day - this turned to to be my Dad's last lucid interaction with another human being. Priceless!

Also Hospice will be there for you AFTER you LO passes - to support you with grief - as needed.

And Hospice should not be costing you anything - paid by Medicare - at least here in NY.

Good Luck

Hospice is needed for her where ever she is.

Hospice brings kindness understanding to help those who are dying ..Usually you can sometimes get Medical to help for the Nursing facility. Getting the right help is the most important for your Mom. Jane

I'm no expert, so I can only share my mom's experience with this. I had my mom on hospice care for several months while she was still living in her own home. Recently, she ended up being hospitalized and was then transferred to a skilled nursing facility. When I tried to re-establish hospice services at the facility, my mom refused. First, I think the hospitalization was a real scare for her -- she can't accept that she is dying, and hospice is just a constant reminder of that fact. Second, the transition from living at home to living in a nursing facility was not a smooth one. My mom was angry about the intrusion into her life. She saw the hospice workers as just "more people that would come in and bother her." Basically, she wants as little "interference" with her day-to-day life as possible. The good news is that she is finally doing better at the facility (which means she no longer calls me on a daily basis demanding that I get her the *!*!*! out of there!). I would say that if your mom tolerates the hospice workers well, then you should take advantage of the benefits (which should be covered by Medicare). Also, if your mom is a more social person than mine is, she may welcome the extra visits, especially if Covid restrictions prevent in-person visits from her family for now. One more thing I would add is that hospice care is quite a competitive industry. If you are not satisfied with your current company, you are entitled to change to a different one (and keep changing until you find a good fit).

Yes, hospice will give your mother specific care, especially pain medications as needed. They will be there for just your mother with undivided attention.

My mom is in a memory care nursing home and has recently been put on hospice. I chose the hospice company that already handles a number of residents there, and they've been working hand-in-hand with the nursing home staff to continue my mom's care seamlessly.

Depending on the nursing home, the staff there may not be able to administer certain medications to your mom. The hospice staff are another set of eyes who are on your mom and will be available 24/7 to help her with any pain issues. I know that when my dad was on hospice (at home), there was a nurse there the last 24 hours he was alive. I know my mom's nursing home wouldn't be able to spare a staff member to be with her that long as she was dying.

Medicare pays for hospice 100%, so you shouldn't have any additional expenses. If you don't like the way the hospice people are doing their job, have a conference with your caseworker, and if you still aren't satisfied, fire them and hire another company. I fired the first company I used with my dad because they weren't responsive enough.

Imho, keep the Hospice as it's comfort care for your mother. Prayers sent.

Hospice shouldn’t be costing anything! It’s paid by Medicare. The supplies and equipment they bring like an air mattress, incontinent supplies, etc are cost free. On top of that the aids should be bathing her unless COVID restricts that right now. A hospice chaplain should be visiting. The nurse should be seeing her. Hospice will also pay for most of her medications. On top of that you have extra eyes on her. What is not to like? I don’t know why you say there is extra cost.