I have posted questions & responses on this forum before. Aging Care is a fantastic resource! Now I need recommendations from those with more experience than me.

My 89-year-old mom is in poor health, has dementia, and has deteriorated over the last 3 - 4 months, including about a 20-pound weight loss. Four days ago she fell & broke her right hip in the AL. She had surgery for stability & pain control. Now she is lethargic, on bipap with inability to be weaned. She looks absolutely pitiful & it hurts me to see her in this state. She has advanced directives that state no extraordinary measures to prolong life. I spoke to the hospitalist physician & told him that she had already been evaluated by hospice twice & that I would not object to yet another hospice evaluation. He said "Let's wait a few days..." This is now the 4th day after her fall. She is lethargic, dependent on bipap for oxygenation, cannot swallow, & I haven't seen her move spontaneously or in response to commands in 4 days. She looks like she has been hit by a truck. It is heart breaking to see this once feisty woman in this situation.

I don't want to be accused of "pulling the plug" too soon or appearing to want her gone, but I do not want my mother to be an extraordinary source of income for the hospital nor do I want her to continue suffering. I would appreciate any suggestions that would help decrease the amount of time that she is in this semi-vegetative state.

Also, my 92-year-old father is very distressed by this situation & it is extremely hard on him to see her this way.

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You can have her discharged to the AL and bring Hospice there. If AL is willing. Then you still have there aides to help and Hospice will supply one. Breaking a hip is a very serious thing for the elderly. Medicare determines the hospital stay. If rehab is recommended, say no, you want her evaluated for hospice first. You can talk to a SW but a Dr. Is needed to sign off on Hospice. Call Moms PCP. He can authorize it.
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Your experiences sound very bizarre. I'm sorry for you and your mother. I'm not sure what is wrong with that doctor. I had 3 ER doctors suggest Hospice for my LO, when she was in there due to various ailments and she wasn't nearly as progressed as your mom. It was explained to me that Hospice has their own doctor who can evaluate. I'd ask for someone other than the doctor who seems to want to prevent Hospice to get involved.

Also, Hospice has been wonderful with my LO. They got on board and got her everything she needs, regular monitoring, equipment, bed, etc. My LO is much more comfortable. I think my LO may have slightly improved, since they came on board.
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I would insist on a hospice evaluation today. I can’t believe a hospitalist would refuse that option at this juncture.
Do what you feel in your heart is best. No one has a crystal ball to see the future.
Your mother’s future is now.
IMO you are on the right track. Go with your gut on this.
My heart is with you on this journey. It’s so hard!
If you continue to feel torn, request a care conference with her providers - pulmonary, ortho, whoever is involved with her care. Inform them of your mother’s wishes, and as them what THEY would do if she were their mother.
My prayers go out to your dear father as well.
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I can't see what the physician can possibly have against a hospice evaluation. It's an evaluation, it's not a death warrant.

If he believes it's really premature and unnecessary, and might affect your mother's motivation perhaps, then ask him what he anticipates the timeline for recovery to be.

It must be very frightening for your father, I'm so sorry. I hope more clarity will make it easier for him to come to terms with what is happening. Do the both of you have any support from family, friends, the hospital's chaplaincy team?
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I would 100% bring her home if that's your wish. She should already be on hospices. Just remember Hospices is not there for you 24/7 you would need to hire someone to come help you. But it's your right to bring her home period. Am so sorry about her condition it truly is hard. Stay Blessed and keep us posted. Oh and what about her wishes? Are they going against them?
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JoAnn29 Dec 2018
Hospice will provide an aid for an hour or so a day to bath her.
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