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My 92-year-old father-in-law has dementia. He has lost 30 pounds in the last year, has a Foley due to an enlarged prostate and is very weak. With the catheter we see blood every day, sometimes so much it looks like someone poured a cup of strong coffee in the bag. The home health nurse said it appears the cancer has spread to his bladder and we assume it's in the spine too, based on his pain in the area. About 18 years ago he had a PSA test and it was 44. He never went back to the doctor or decided to pursue another appointment, treatment or biopsy. Today the home health nurse is saying he cannot be on Hospice without a definitive diagnosis. And the only way to do that is for him to have a biopsy or CT scan. It's virtually impossible to get him out of the house-he uses a walker but can barely walk with it. He's confused the vast majority of the time. Failure to thrive or dementia can no longer be used to admit a patient to Hospice. The nurse is checking with her office to see what our options are and I was just wondering if anyone else has dealt with this. Thank you.

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Have you asked the hospice people about this issue?
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I've never dealt with that. Hospice has doctors on their staff that MAY be able to diagnose him at home...using lab work...I don't know that for sure, but they most certainly have docs that come to the house.

If he has cancer pain in his back, he is probably in severe pain. Let's face it. Dementia'd patients should not have a say.

If your only option is hospital tests, then call a medivan and have him transported. Get a doctor referral from hospice.
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Investigate the possibility of having an ambulance take him for the scans and/or biopsy. There are also private medical transport vehicles that can take him; I don't know whether he'd have to be able to walk outside though.

However, I wouldn't automatically assume he has prostate or bladder cancer; let the diagnosticians make that determination.

Who scripted for the home health care? I would also call that doctor, explain the situation and ask what suggestions that office has. If he scripted for the health care, there had to be a diagnosis at that point; perhaps he can do further testing and go from there. His office may also know of some services that can provide transportation, although I wouldn't expect them to be cheap.
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