My mother will soon be 95. She has been in a hospice facility for nearly six months and rallying. How long can a rally last?

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Because some days she is able to walk with the help of aides and her walker, and other days can feed herself, an evaluation showed she was not declining. When she was brought to the hospice center in NJ from rehab, we thought she would have under six months to live. Since she is at the facility nearly six months as I write this, now the board or committee asked us to find her a nursing home, but the inoperable mass in her pelvic region which got her into hospice in the first place, is still there and hasn't changed a recent MRI showed. Her children believe our mother is rallying at end-of-life, as on some days she stays in bed with her eyes closed and can't feed herself. Other days, maybe every third or fourth, she attempts to get out of bed herself (she fell twice) and go for a walk, or on a trip, before the aides step in. This is very recent, different behavior for her. We think this is an end-of-life rally, but the hospice center wants her out. She is well cared for and very comfortable there, and we need some expert advice! Her doctor vows to work with us, but unless that tumor, or mass, has grown or changed, the hospice center wants her out. We wish she hadn't been sent there in the first place, as we could have settled her in assisted care or a nursing home. At the end before she was hospitalized, I was my mother's caregiver and in the last three weeks she lost all bodily functions and the ability to walk, plus she was in pain, which we think was due to the tumor. She still cannot care for herself and is totally incontinent, unable to feed herself most days (unlike when she was at home), etc. Our goal is to keep her in the hospice facility because she cannot adapt to change and it took her three months to stop her from having panic attacks once she went in. Now she seems relaxed and comfortable. We feel that any change will kill our 95-year-old mom.

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Hospice is a big time money-maker. This facility will find a way to keep her based on hospice guidelines but if the patient no longer qualifies, then the patient has to discharged; incontinence and unable to feed one self isn't a unique qualifier for remaining on hospice - plus the tumor has stabilized - which is the big x-factor in her disqualification for continued hospice coverage. Her insurance company is thinking right now that you want hospice to provide full-time nursing home care, but have the insurance company pick-up the full tab of this cost. The insurance company doesn't care about her age, her state of mind, her other issues; they simply won't pay the facility if she doesn't qualify. I'm not friends with any insurance company - it's just that they're also not friends or family to its members so they're not interested in hearing members' difficulties, unfortunately. They have to follow of rules just like the facility is required to do so. This facility will get in major trouble the State for continuing to bill the insurance company for a non-qualified hospice patient. However, I personally know from my mother's hospice situation that some hospices do find a backdoor to keep the patient on-board. You are more than welcome to now call another hospice with a hospice facility to have your loved one re-evaluated. In the last few years, Medicare (this is my experience) has really tightened up the rules on who does and doesn't qualify for hospice because they're watching the dollars to stretch them for as long as possible due to the aging population living longer. Your options right now are to put her in a nursing home or take her home on palliative care service and then when she does qualify for hospice, she's automatically transferred back on service in the comfort of her home and put on a waitlist for a hospice facility.
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Is Mom in extreme pain? That is about all I can think of that hospice could perhaps do better than a nursing home, but maybe the NH can have the same orders the hospice house is using.

I don't think the Medicare decision has much to do with Mom's rally. Originally doctors looked at scans of the tumor and decided there was nothing they could do for this, the tumor would keep growing and most likely kill her within 6 months.

They were wrong. (It happens.) The tumor has not grown and there is no reason now to predict that she will die soon. Therefore Medicare will not continue to pay for hospice care.

Maybe the doctor who is willing to fight for continuing hospice can point to some other potential cause of death. Has Mom lost a lot of weight in the last few months? Maybe there is a failure to thrive.

Evaluate each of the nursing homes available to you. Pick one out. Even if the supportive doctor does their best, you may need to move Mom.

My mother went on hospice after a hip break that could not be repaired. She did not go to a hospice house, they came to her in the nursing home. She was reevaluated at 3 months, because she appeared to be thriving. She was discharged from the hospice program. She lived another two years, and she was content.

Yes, a person can go back on hospice if the situation changes and they now meet the terms of the program.
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I can't offer much support on this, but fear that something similar will happen with my father who just started his 6 months of Hospice a couple weeks ago.

Could hospice provide some medication to assist with the transition if it gets to that point, maybe?

Hugs to you.
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I'm sorry I'm not an expert on hospice. After reading what the Medicare site says about hospice, the only thing I can discern is that the hospice dr must re- certify that your mom is terminal. This is done for two 90 day terms ( the original 6 months) and then every 60 days as long as the patient is terminal. They must not be willing to do this? It sounds like they are saying one can live longer than six months with her current condition?
My question would be if you take mom  to NH and her private dr certifies that she is terminal within 6 months, will they let her back in right away?
What are the tests that have improved since her last certification? You mentioned the MRI that hasn't changed.  Does that mean she isn't getting worse,  therefore not terminal? It does sound like she is improving. Are you meeting with her hospice- dr?
Here is the website for Medicare hospice rules. Note it has a link for numbers to call for your state.
https://www.medicare.gov/what-medicare-covers/part-a/how-hospice-works.html
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