My dad (93) has been hospitalized for several weeks now (currently in the hospital rehab). They tried taking him off the IV but he quickly got more dehydrated and confused. They now have stabilized him with an IV but he is eating very little of the yucky pureed food. They don't want him eating food at all and want me to do a feeding tube because sometimes he aspirates, but I refuse. He has so many issues and I just want him to have as much quality of life as he can have.
He's not able to do much rehab at all so I suspect that soon (once his 20 days are up), they will request I take him to a nursing home where MAYBE they will do a little rehab with him. It is what it is.
He's been assigned a palliative care physician and nurse at the hospital so I guess he must technically be on palliative care now? He has some good days when he's able to talk and laugh and make a little sense. He is in good spirits. He's more alert now and not sleeping all the time, so I guess, physically, there has been a small amount of improvement in the last week.
However because he's been in bed so long, I don't know that he will ever regain the ability to walk. I presume he's incontinent but when they do get him out of bed he will ask to go to the bathroom. And I'm sure swallowing is going to continue to be a problem.
What I'm wondering about is the IV at this point. I know if I go to hospice, that will go away and then he will dehydrate, his dementia would become unbearable and eventually he would die peacefully. I know he may end up with pneumonia because of aspiration which is a worse death (I presume), but hospice can make it less hard for him. The main reason that I haven't done hospice is because I do want him to continue PT and OT and hopefully gain some strength back. He wants to live and doesn't want to give up and would be opposed to hospice.
I guess I'm wondering if hospice absolutely precludes the use of an IV and/or PT/OT?
The primary goal of Hospice is to keep a patient comfortable when all efforts to “cure” have been exhausted.
There my be therapies offered if they help minimize pain or discomfort. For example a light massage to loosen stiffed limbs, Reiki therapy is often used, music therapy as well to name a few.
PT and OT would be something that could be done on Palliative Care
You should speak with the local hospice providers to find out what they will allow.
My mother was designated as a risk for aspiration when she was in the hospital, but once she got out and was sitting up once again, they stopped giving her that awful baby food. She isn't really eating, but that's her own choice. She's existing mostly on Ensure and part of a one meal a day. The caregivers push fluids all day, and she has days when she's dehydrated, and days when she isn't.
If your dad has to be on an IV to stay alive, then that's pretty much against what hospice would do. Do the doctors expect his swallowing to improve at some point? If not, then I don't see the point of the IV. He'd eventually need a feeding tube, I'd think, and that's a big decision to make.
Palliative care teams and Hospice teams will communicate and if and when someone on Palliative care seems to be ready for Hospice this will be discussed with the patient, the family as well as the Hospice team.
Talk to the Palliative care staff and ask them what the policy is about IV’s. Often they will not do IV mainly because there is usually not round the clock staff to change IV or start one. (This is the patient is at home) Hospice also will not have a feeding tube inserted BUT a patient with a feeding tube already in place the feeding tube and nutrition can continue on Hospice.
The best thing to do would be to discuss this with Palliative care. You could also ask if they would permit private pay for IV hydration ( if so dad would then pay out of pocket for the IV)
my 86 year old gramd-mother fell, broke her shoulder (few hospitals stays) tried a nursing home for rehab that was a mistake and now is not walking i been dealing with this since Jan 2021.
You are correct in saying that because your dad has been bedridden for so long that chances are he may not regain his strength. My husband after having aspiration pneumonia and almost dying, where he remained in the hospital for over 2 1/2 weeks, came home completely bedridden and remained under hospice care for the last 22 months of his life in our home.
I certainly don't think it can hurt to get hospice involved at this point in your dads journey. It will be extra sets of eyes on him, and all they do and provide is covered 100% under dads Medicare. I wish you well in making these important decisions for your dad.