Question about end of life

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(Sorry if this is a repeat - I got a little confused)I believe my mom is in the last stages of he life due to COPD, CHF, osteoporosis, and general failure to thrive. She is now in a transitional/rehab facility after her 2nd hospitalization within about 6 weeks. All she wants is to come home. I would like to take her home with hospice and know that an MD certification re: 6 months or less to live is required. However, the MD at the facility is not mom's primary & only scantily manages the patients there. Her primary cannot come to the facility because he is not credentialed there. Any thoughts would be most appreciated.

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nature73, please note sometimes when an elder who is quite ill and/or has memory issues, when they say they want to "go home", it could mean one of two things.... first, they want to go back to their childhood home where life was easier as a child... second, they want to go home to the Lord.
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The MD at her facility can order a hospice evaluation. You just tell him or her to do it. This doctor may not know you want to take her home on hospice. It's your legal right to ask on the best interest of your loved one. If they don't order a hospice evaluation then you should be told why not - don't let them give you the run around. You can contact hospice anytime and request that they get the ball moving on a hospice evaluation, asking the hospice to ask the facility why is there no hospice evaluation order on the patient's chart; tell the hospice facility that you want to take your mother home today; tell them the rehab doctor is not there on a consistent basis and you need help in getting a plan in a place. The healthcare system is very, very money-driven. The rehab facility is charging a lot of money to your mother's insurance company so there's no incentive for the facility to discharge earlier than absolutely required, i.e. insurance company stops paying the facility or your mother has declined even further and hospice is the next step. Don't do this to her.  Your mother has told she wants to go home. Find a way to make it happen. Demand she get a hospice evaluation immediately. FYI: The rule on dying within six months to qualify for hospice is no longer the case. The push now is to get patients who qualify for hospice but will not necessarily die within six months. There was a big write-up on this in a major newspaper. If all patients die within six months, hospice will not make money. Because of the aging population living longer with chronic conditions that aren't necessarily a death sentence right away, the rules of hospice qualification have changed. The goal is to get patients who qualify but don't die within six months to balance out the ones that actually do. If the rehab facility is telling you that your mother needs to die within six months to qualify for hospice - then they're wrong. It's very sad but that's how money-driven our system has become.
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From my experience any physician that knows your Mom's history can write the script for a hospice evaluation. The one at the SNF can do it probably does it OFTEN. The physician she typically uses can also write it without seeing her. (Unless he is opposed to an evaluation. ) Then the hospice team meets with her and you and you give permission for them to have access to medical records.
When my mom was in memory care and developed pneumonia, I asked the nurse if she was going to speak with the doctor for an xray order. She was and I asked her to have the doctor approve a request for hospice evaluation at that same time. The nurse told me my Mom wasn't ready for hospice. I asked her to let the hospice team make that decision. The doctor didn't come to see her at that time, it was all done by phone. My Mom passed away 6 months and 1 week after that day. And hospice was wonderful for the entire time.
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