Mom removed from hospice is wheel chair bound in Geri Chair they are taking it away and only a wheelchair She does not want therapy tests surgery or any treatments they recommend therapy
Medicare determines if MIL stays on Hospice. No way would Hospice discharge her if Medicare was willing to pay. Hospice criteria changed some years back. My daughter said people came into her NH and evaluated every resident. Some were placed in Hospice because they would be dying from what they had. None had terminal illnesses as such. They could die in 6 months they may not.
Mom being wheelchair bound does not mean she needs Hospice. Just because she wants to die, does not mean she needs Hospice. You need to talk to them and find out what has changed that its felt she no longer needs Hospice,
After the initial Hospice evaluation there are recertification's that are done to remain on Hospice. As long as there has been a continued documented decline a person can be recertified. You can ask ask for an appeal of the discharge. If the person has declined and the declines were not noticed or documented by Hospice and you have documentation you can present that. Things indicating a decline can be: *Weight loss. this can be verified by actual weight taken or arm measurements or even the way clothes fit. *If a person was able to walk across the room and are no longer able to do that without stopping to rest, that can be an indication of decline. *If a person used to eat an entire meal but now can't or won't or needs help that can indicate decline. *If a person used to sleep 8 hours and is now sleeping 10, 15, hours a day, that can indicate decline. Anything that is "different" should be documented.
I think my MIL wasn't ever re-certified for continuing Hospice--but I could be wrong. Since I am persona non grata in this ongoing mess, I don't get any real news.
She doesn't take morphine, she takes Tramadol, and a couple of benzos. Maybe she's in Palliative Care which is different from Hospice.
Whatever.
If she gets taken off care of any kind, then the kids will have to do ALL the stuff that the CNA's do now. Which isn't much, TBH, but it's something.
Weird--she fell yesterday @ 5 am and all 4 people on the call list were called. Nobody answered the phone so the EMT's came and got her back in bed.
I heard the phone ring and tried to get DH to wake up and answer but he wouldn't. He gets a call from his sister at about 9 am that she had seen the call on her & her hubby's phones and had called the EMT's about it.
I can't BELIEVE that the EMT's didn't keep trying to get SOMEBODY to tell them what had happened. But, like I've said before, this Hospice Co has a lousy reputation and that could extend to the EMT's they use? IDK.
You are saying that Hospice refuses to re-qualify her? Is that because she is not dying, nor expected to die? If that is not the reason, what IS the reason?
Your Mom will enter placement in facility care, then without Hospice, which when you think of it really gives you VERY LITTLE other than that nifty little morphine bottle that in facility care doesn't give you. Make it clear that mom is DNR if that is her wishes and put her in palliative care where visits are minimal.
Curious as to how someone 'graduates' from Hospice.
Do they get better and the docs, etc, feel that they no longer require that level of care (which is palliative in nature and not providing life-sustaining meds, right?)
My MIL was considered imminently dying in Jan (?) last year and went home to die--10+ months later she is better AND worse. Her cognitive skills are worse, but she's more able to do for herself. She's off her BP meds and heart meds and since she's in Hospice, we don't actually KNOW anything. Is she getting worse or is she stable and likely to last years more like this? I mean, she's getting the best care from her 3 kids and the CNA's (well, not great care from them, but at least she lets them in the house).
Whenever I ask DH how she is he ALWAYS says "Oh, she's FINE." Which makes me wonder why she still on Hospice care.
Of course, taking her off Hospice would mean a return to finding our own CG's and dr appts, etc., which she won't do. IDK...since the 3 stooges are running this show I cannot get a straight answer. End of the day, I don't guess it makes any difference.
My mom was removed from hospice when a new evaluator came to the house. Mom hadn't spoken for months. We think he was tasked with getting people off the hospice rolls, who knows. He said, "Merry Christmas," and Mom said "Merry Christmas" back. Then she lapsed back into her nonspeaking, nonwalking, and barely-eating bedridden life. But the guy had judged her responsive, and so hospice removed the oxygen tanks, the meds from the fridge, every bit of equipment that they'd brought, and we had to find replacement items for her to use until the next evaluation when hospice decided she belonged in hospice again. Then off again. Then on again. This went on for about 5 years.
If Mom is in Rehab, this is a good time to have her evaluated for 24/7 care. If found she needs it and you can't provide the care and she can't afford to pay aids 24/7 tell the Social Worker upon discharge she will need to be placed. If she can afford Assisted living, then transfer her there. If she will need Medicaid to cover her care, then a Long-term care facility. I would have a Nurse tell her that if she does not improve, she will be considered 24/7 care. Its an "unsafe discharge" to send her home without the appropriate care. She will need to go to a LTC facility. And you make it clear, you are not an option. Then its all up to her. If she winds up in a NH, that is her fault not your. The pros feel she can improve. Its all up to her.
Contact her PCP and discuss the situation with them. In the meantime contact different hospice providers. If you don't know who to contact, reach out to local nursing homes and ask for their social worker, maybe the local hospital social worker, or the local division of aging. Just because she is ready to give up and be done with it all doesn't automatically qualify her for hospice services. You may have to get her into therapy and if she is non compliant and won't cooperate maybe they can help you find help even if it's not hospice.
Also maybe division of senior services or someone else can direct you on how to get another geri chair and whatnot for her. Also sometimes churches, associations, charities can assist with such assistive devices.
What is your question? Medicare requires that hospice patients get recertified every 6 months to make sure they still qualify for the very expensive services Medicare pays for. Your mom was dismissed from hospice care because the hospice company no longer feels she is likely to pass away within the next 6 months. While mom is wheelchair bound, and no longer wants therapy, tests or treatments, she is still not hospice worthy due to the reason I explained. Mom does not have to have treatment or therapy or tests, that remains her choice moving forward.
When you feel mom has taken another step down medically, ask her doctor to write another order for a hospice evaluation again. Just bc she wasn't recertified this time does not mean she will not qualify again in the future.
I don’t know Lea. I feel hospice shouldn’t be discontinued at 6 months just because the person hasn’t declined yet.
My hospice grief counselor told me that his for profit hospice gets 50000 from the government every time they sign a new patient. My dad had a couple of nurse and cna visits before he died.
If true, no wonder hospice just bounces ppl after six months.
Mom being wheelchair bound does not mean she needs Hospice. Just because she wants to die, does not mean she needs Hospice. You need to talk to them and find out what has changed that its felt she no longer needs Hospice,
As long as there has been a continued documented decline a person can be recertified.
You can ask ask for an appeal of the discharge.
If the person has declined and the declines were not noticed or documented by Hospice and you have documentation you can present that.
Things indicating a decline can be:
*Weight loss. this can be verified by actual weight taken or arm measurements or even the way clothes fit.
*If a person was able to walk across the room and are no longer able to do that without stopping to rest, that can be an indication of decline.
*If a person used to eat an entire meal but now can't or won't or needs help that can indicate decline.
*If a person used to sleep 8 hours and is now sleeping 10, 15, hours a day, that can indicate decline.
Anything that is "different" should be documented.
She doesn't take morphine, she takes Tramadol, and a couple of benzos. Maybe she's in Palliative Care which is different from Hospice.
Whatever.
If she gets taken off care of any kind, then the kids will have to do ALL the stuff that the CNA's do now. Which isn't much, TBH, but it's something.
Weird--she fell yesterday @ 5 am and all 4 people on the call list were called. Nobody answered the phone so the EMT's came and got her back in bed.
I heard the phone ring and tried to get DH to wake up and answer but he wouldn't. He gets a call from his sister at about 9 am that she had seen the call on her & her hubby's phones and had called the EMT's about it.
I can't BELIEVE that the EMT's didn't keep trying to get SOMEBODY to tell them what had happened. But, like I've said before, this Hospice Co has a lousy reputation and that could extend to the EMT's they use? IDK.
Is that because she is not dying, nor expected to die?
If that is not the reason, what IS the reason?
Your Mom will enter placement in facility care, then without Hospice, which when you think of it really gives you VERY LITTLE other than that nifty little morphine bottle that in facility care doesn't give you. Make it clear that mom is DNR if that is her wishes and put her in palliative care where visits are minimal.
Good luck.
Do they get better and the docs, etc, feel that they no longer require that level of care (which is palliative in nature and not providing life-sustaining meds, right?)
My MIL was considered imminently dying in Jan (?) last year and went home to die--10+ months later she is better AND worse. Her cognitive skills are worse, but she's more able to do for herself. She's off her BP meds and heart meds and since she's in Hospice, we don't actually KNOW anything. Is she getting worse or is she stable and likely to last years more like this? I mean, she's getting the best care from her 3 kids and the CNA's (well, not great care from them, but at least she lets them in the house).
Whenever I ask DH how she is he ALWAYS says "Oh, she's FINE." Which makes me wonder why she still on Hospice care.
Of course, taking her off Hospice would mean a return to finding our own CG's and dr appts, etc., which she won't do. IDK...since the 3 stooges are running this show I cannot get a straight answer. End of the day, I don't guess it makes any difference.
Also maybe division of senior services or someone else can direct you on how to get another geri chair and whatnot for her. Also sometimes churches, associations, charities can assist with such assistive devices.
When you feel mom has taken another step down medically, ask her doctor to write another order for a hospice evaluation again. Just bc she wasn't recertified this time does not mean she will not qualify again in the future.
My hospice grief counselor told me that his for profit hospice gets 50000 from the government every time they sign a new patient. My dad had a couple of nurse and cna visits before he died.
If true, no wonder hospice just bounces ppl after six months.