Should I try Hospice again?

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Should I try Hospice again?

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Mom was on hospice when she moved into the AL in Jan of this year. Then she had to go off when she fell in Feb and broke her leg (hospice doesn't' allow for surgery to fix anything).

I never put her back on because she was doing well.

Last month she started to go downhill and I wasn't getting any response from the doctor, so I called hospice. The first time, they pulled her medical records and said she qualified over the phone, just sent a nurse out to do the intake. This time they said they had to send a doctor. The doctor said she didn't qualify, so I guessed that they changed their criteria for admission.

Now I feel like she might be near the end of life, but am not sure if it's worth calling Hospice. Her doc has changed and increased her meds for pain as of 2 days ago, but she is still miserable, looks terrible and is under 95 lbs. Today they said they had ordered a hat to send her poop to the lab because they think there is blood in her stool. She pooped in her pull up today and it looked all green to me, so I don't really know what they mean. I don't even know how she can poop since she is not eating. She is not interested or hungry and eats a few bites and either says she is full or doesn't want anymore. This has been going on since prior to hospice saying she doesn't qualify.

I just don't know what to do. She says she's not giving up on life, but she won't last if she's not eating. She really couldn't express herself today, so I don't know what she wants. She was crying and moaning and couldn't answer whether she wanted to sit or stand or needed to use the bathroom or not. She is currently at level 2 and I think is really on her way to level 3/total care with diapers and not pull ups because she doesn't have the strength to stand on her own. She thinks Chapstick is heavy!

I want her to be happy and comfortable and she is not. My sister and husband say try hospice again, but honestly what will they do? Is it worth me throwing a fit to get her back on it? Maybe this is just how it is at the end of life.

Care Decisions End of Life Hospice

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I think it is definitely worth it and that you should demand hospice care. If your mom doesn’t qualify, I don’t know who does. She needs that level of professional care and you need the help. Don’t hesitate! Call Medicare if you have any problems. I empathize with your situation and am planning to get hospice care for my mother — whose condition is not nearly as serious at this time as your mother’s. Please reach out again — you need, and qualify for hospice care. Maybe your sibling can help you arrange this as it seems you have your hands full right now as is. Wishing you strength and patience. Be well.

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Contact her MD ASAP. Green may have something to do w internal organs = intestines, liver (ALTHOUGH I DO NOT KNOW. What I feel I do know is that this ISN'T A GOOD SIGN and she needs medical attention.)

In my limited experience with Hospice, they helped immensely.
If they will allow her back in the program, why not?
If it doesn't work out, she will be discharged. From my point of view, you have nothing to lose and everything to gain (all the support, equipment, meds).

Key is enlisting the support you need with the best possible care for her mom, too. This sounds like a win-win to me. They will make her as comfortable as possible and I am sure this is what you want. Gena / Touch Matters

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Call 911 and get them to have her admitted for an assessment. Obviously it is asking far too much to expect a relative to be able to determine someone's needs or if they are EOL - we just don't have that experience. Hospice probably is the answer from what you have said, but it may depend on whether the "confusion" today is a UTI, a mini stroke, or as you have said just getting to EOL - I do hope this doesn't sound too blunt, please excuse me if it does, being ASD I can come over sounding rather lacking in sympathy or empathy. You can fight hospice or if you lay on the weakness and confusion and can get 911 to take her into hospital then you can refuse for safety to take her home from there until they put a package together - how would you cope if she fell, either with or without you being present. I am sorry that you are having to fight for some support but you need to find out what is going on. Hugs xx

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Who ordered the fecal sample? Talk to that person to arrange a doctor visit for you and find out what is wrong. You may need to take her to the hospital and get her admitted so they can do some testing or figure out what is wrong. The diagnosis will let you know if hospice can be ordered again or if there is a medical problem that needs to be treated with meds or something

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Based on the description you give of her condition I think you need to make it a priority to get her effective medical care right away. While hospice can be helpful for people at the very end of life it can, from what I have seen and heard, also be ineffective since there are conditions hospice won’t treat and the main goal is to make the patient “comfortable.” This can sometimes lead to the patient being given medication to make them sleep when what they needed was to have a particular problem medically treated. She sounds like a candidate for a hospital evaluation or at least home health care. Please ignore the poster who said there is no home health care paid by Medicare. And understand the home health care is not the same thing as a home care aide. It is true that Medicare does not pay for an aide (like a CNA) to come to the patient’s home to assist with activities of daily living(ADLs). But Medicare WILL pay for home health professionals like nurses, physicians assistants, and physical therapists to visit a patient in their home to provide medical care if the patient qualifies for home visits by those professionals. To qualify, her doctor must certify that she is physically unable to leave her home (home-bound) or her condition has deteriorated to the point that having to travel to the doctor’s office would be extremely difficult and/or potentially harmful. It sounds like your mother would qualify - but she needs her doctor to certify that home health care is warranted.

She needs to be medically evaluated. Take her to a hospital or get home healthcare through your doctor asap.

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sandola: Imho, contact hospice again. Also make sure that her pain is better managed.

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Try again. No fit throwing should be necessary. Hospice services should "do" a lot to help her be happy and comfortable, as well as assist you with understanding, support, and guidance. Please make sure you research the hopsices in her/your area. There seems to be more agencies that offer multiple services including hospice, but are too focused on those "other services" to provide quality hospice care. My opinion, but worth the extra "research" effort for your LO.
A couple of sites that provide info about hospice, eligibility, what's covered, etc. are
1) https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/Hospice
2) https://www.medicare.gov/coverage/hospice-care

Peace.

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The only thing hospice does is come by, check them over and medicate them. My brother was up, playing the guitar and talking to people but died by the 3rd night on hospice. They give them enough morphine where they don’t drink or eat anything and you can only go approximately 3 days without water.
I’m sorry but unfortunately, It sounds like your mother isn’t going to get better so you could try hospice again.

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None of the above is true. Feel free to disregard it.

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Yes try again ….Hospice was a great help during the last month and a half of moms life . She was checked daily and they were able to get medication delivered when she needed stronger doses . They arranged for the hospital bed to be delivered, They were the ones that prepared the family . We were all upset with her about not eating .. It was them that told us her body was no longer able to process food and the appetite just shuts down . They also shared that we should all convey to her that it was OK to pass on . She just happened to pass the first day we could not get her to the bathroom and put diapers on her ..

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Your mom seems to be suffering and in pain, but why? At the point you are describing, I would get her back into the hospital for a thorough workup and diagnosis. Once that is done, the hospital will determine if she qualifies for hospice and they can set it up for you.

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I am an RN.

Seems like she would qualify for hospice. Please ask the hospice nurses which doctors are amenable to work with. Get an appointment for your mom with one of them. The doctor will be able to get her the hospice orders she needs for comfort care.

You don't have to see red in the poop for there to be blood in it. The best way to send in a poop sample is to get one of the labs sterile specimen cups. Use a clean plastic spoon to scoop a couple of spoonsful into the cup. Try not to touch the inside of the cap or cup with your hands.

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Call hospice back. Have them check for the last denial and why. Have them assess again. Hospice can be revoked and reinstated as the situation changes. My mom hospice revoked for hip surgery and afterwards restarted when we refused rehab and opted for hospice again. Hospice will take her on again when she transfers, self pay, to skilled nursing till she runs out of money then Medicaid will be next option

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Call her Insurance
Call her Dr
If she doesn't qualify for Hospice then she will qualify for Home Health which is actually better and does everything that Hospice does and more.
They will send Aids out 3 times a week to do showers/bedbath, ect and a Nurse will come out once a week and a Nurse Practioner will come out once a month and
RX's will be ordered for her which is nice so she doesn't have to leave the house.

There are lots of different Hospice and Home Health, just check with Dr and see which of the two he suggests.

Then call Insurance and tell them what you want.

She should be on Hospice or Home Health.

I like Home Health but if it's important you get free diapers, the use of a Hospital Bed, walker and potty chair then go with Hospice.

Not eating and drinking is part of the dying process but as Seniors get older, they start having trouble swallowin.

My 96 yr old Dad started having that problem.
I switched him to a soft diet where he didn't have to chew much and added a bottle of Ensure or any meal reacement drink like it.
Milk,
Juice,
Yogurt,
Oatmeal,
pancakes,
Applesauce, Avocado,
Banana,
Sweet Potato, Mash Potatoes,
Ice Cream.
He would also eat Ritz Peanut Butter Crackers and Little Debbie Mini Muffins.

Seniors are like Babies, they eat a little but often like every 2-3 hrs.

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By "put her on Home Health" do you mean hiring care takers to come into the home? There is no Home Health program as such that is paid for with Medicare funds the way Hospice is.

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Call a different hospice.

Edit: I see there is only 1, call them and explain what is going on and ask how to get her qualified. Maybe her doctor should make the referral. How could they say no when a physician makes the referral.

I would try to get her on hospice. They can help make her comfortable and help you understand what is happening, as it happens.

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Hospice will be another set of eyes on her.
They will do the bath and some of the other things that the AL does now. So if AL currently gives her a bath the CNA from Hospice will do that. She will not get double the baths.
The Hospice will provide supplies for her.
You can contact another agency. Or ask to talk to someone else and have her reevaluated.
Many people will go off Hospice for one reason or another and go right back on. One of the reasons that Hospice will drop someone if they go into the hospital is because the hospital will be billing Medicare and any other insurance and Hospice can not bill while the hospital is billing.
If she does not qualify for Hospice during the evaluation she can go on Palliative Care and in most cases the same Team that she would have for Hospice would see her on Palliative and they would recommend Hospice when she declines to where she would meet criteria for Hospice.

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This is so sad. I'm. sure you're right that she's nearing the end.

Are the meds her doctor gave her managing her pain? If so, I would not worry too much about hospice. If she's in pain, talk to her doc again for ideas. If he can't keep her comfortable, I would call hospice again. Is there another hospice agency or facility you could try?

Also I'd see about something for the crying and moaning. Of course that could be pain but could it also be from anxiety, etc.? If so, maybe an anti-anxiety would make her calmer and more comfortable.

I think it is amazing how much people who are barely eating or drinking still have coming out of their bodies!

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Try a different hospice agency. Poop is not just food and liquids but the used up parts of the body, like cells and bone that are constantly being replaced and a whole lot is bacteria.
I'm sure there is a more professional medical way to put how we expel waste from our bodiesn but that's part of it.

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Thank you. There is only one hospice agency around here.

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Also, she's sure to get a UTI soon from wiping from back to front. She is so confused. It is so sad.

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Should I try Hospice again?

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