Wanted to know how different Hospice is in 2019 compared to years ago?

I can’t speak to what hospice is like in a nursing facility because my experience with it was with my mom living in my house, though she did spend about a week in-patient at the hospice facility, and ultimately passed away in the facility, too.

In order to qualify for hospice, the patient has to be diagnosed as terminally ill, with a life expectancy of six months or less; however they can be renewed in hospice if they survive for the entire six months and are still diagnosed as terminal. Agreeing to hospice means that the patient declines to seek any treatment that would be life-saving and instead only receives treatment to relieve pain and maintain as much comfort as possible while the illness takes its course. So in that regard it is very much end of life care, but it is also very helpful—my mom had CNAs who came to bathe her weekly, she was prescribed very strong pain medication that was delivered to the front door, there were social workers who came to visit, a nurse came to see her once per week, and when she was in the facility, there were volunteers offering things like aromatherapy and reflexology or massage. I found it kind of ironic seeing the striking difference in the level of care from how she was treated in the hospital by doctors and nurses alike, and kind of felt like, okay so an old woman has to be dying to be worthy of high quality care?

My mom had never been officially diagnosed with cancer, but had a colon tumor that, although it biopsied as benign only a month earlier, the doctors decided must be malignant when I asked about hospice, and that was the diagnosis they used. That seemed questionable to me, but at the same time she was very clearly terminal, weighing under 70 lbs, constantly needing blood transfusions, unable to walk, etc. She spent only 2-3 weeks officially on hospice care before she passed away in August 2018.

Best of luck if you and she choose to pursue this. It’s an intense decision and time, and very hard to accept, but it is invaluable in terms of the level of care and the help transitioning.

The ninety-day period followed by the sixty-day periods are Medicare regulations. The person is reevaluated at the end of each period by hospice nurses with various requirements to be met re: if they are still declining (even if it is a seemingly minor decline). The patient always has the option to discontinue hospice care and, if later wants to be re-admitted they begin again at the 90-day period. I hope that helps - it does seem confusing.

Hospice(Going into One, hun)Means only 6 Months, This is their own Time Limit...Is this What is Going on Now?
It is Better Now, Yes, There are Facilities to take them to and Great Help.

From my perspective, hospice care is still end of life. My special needs older brother went on hospice at a nursing home with stage 4 cancer. I suppose they did well enough, but I don't think they took his pain level seriously. He was in the final days of dying of cancer and they only wanted to give him minimal pain meds. Did they think he was going to become an addict? Gave me a real bad taste in my mouth.

I used Palliative Care for my late mother. Was not happy with it. I wasn't experienced as to what Palliative Care was and was at the end of my literal rope, having had to live out of state to care for my mother for an extended period. So what the hospital told me was that Palliative Care was basically Hospice Care. It's a moot point now as my mother passed away.

Please don't be fooled by hospice care - in my opinion, they are end of life care and as far as they take very good care of their patients - well some do - it is End of Life and that is what happens.
My father had recurring uti's - almost one a month for his last year - the hospital felt his kidneys were being compromised - even tho there were no signs of such - and maybe I did not follow through but took their word for it - which to this day feel guilty about. The hospital suggested "end of life care" and offered hospice to come in.
My 98 year old father - who did not have anyhing else wrong with him - no high blood pressure - no high cholestrol - no diseases -no dementia - just a urinary tract infection once a month - had hospice come in.
Yes they took good care of him, answered all our questions but he just deteriorated within a month's time - stopped eating - would not get out of bed - and died in six weeks time !
I know you are saying - he was 98 - but he was a very well 98 - he got up every morning - had his coffee -ate breakfast - read the paper - sat out on his deck on nice sunny days -had lunch - watched the ballgames - took a nap - people would visit - ate his supper - went to bed ! My brother was there to take care of him - cook for him - watch tv with him - keep him company - he was fine!
Hospice - End of Life -
sorry for going on - it's only been a few months since he passed.

My mother received hospice service in a nursing home for about 3 1/2 months. She had been in hospital for pneumonia, and in my estimation wasn't receiving enough help when she returned to the nursing home. She had a condition (primarily severe orthostatic hypotension) that qualified for hospice services so she signed up. What that meant was she had one hour of help 5 days a week from a CNA whose main job was to help bath mom, wash her hair once a week, and assist her with lunch. Mom also was visited by a hospice nurse once a week who more actively advocated for whatever mom needed like an air mattress or changes to her medications. That nurse reported to a hospice doctor but also communicated with the doctor at the nursing home. Hospice service definitely improved mom's care. I could better supplement mom's care too by planning my visits at supper time and/or on weekends. If mom had managed to improve enough, she might have "graduated hospice," but could enter hospice again when needed. As it was, she didn't. But when she passed, she didn't have a single bedsore and her passing was managed well. Although not promised, I was able to request that mom be moved to a private room for her last few days. Don't be afraid to ask for that. I hope that this description helps.

My 97 yr old mother has been on Hospice for one week at her AL facility. Her cardiologist recommended Hospice b/c mom has stage 4 heart and kidney failure and is unlikely to improve as time goes on. She is physically active with a walker, but is a fall risk, and has severe short term memory loss. The goal is to try to keep her out of the hospital, and/or fewer ambulance calls to her facility. Within the last six months her primary doctor and two other specialty doctors were prescribing her meds (adding and subtracting) which caused her to go into distress, resulting in hospital stays for a period of one or two days. Hospice reviewed her meds and took her off two BP meds (fall risk from low blood pressure), and added something for the anxiety/depression (her panic attacks were minicking heart failure). So far so good. I'll know more in a couple weeks, but I truly think Hospice will be very beneficial to all concerned.

I've been in a Skilled nursing unit. Believe me, I needed all the help I could get to have the nurses and staff be checked up on regularly! You need someone you can trust to watch out and protect you while you're unable to protect yourself! That's where Hospice care helps. With all the information you need to help your loved one! And a support system for you, to help you through the process.
I hope this helps.

I asked the Dr to put my friend (in Skilled Care for almost 2 yrs) on hospice (I’m the POA) Jan 3rd to eliminate the SNF sending him to the hospital. He passed away Mar 10. I was not impressed with hospice. Always had to call for diapers and in some cases had to use my own supplies. They did one shower day and the SNF did the other. He screamed with hospice CNAs but not with SNF CNAs. All the nurses did when coming out is check his vitals. The day before he passed hospice was called twice and never came out. They maybe more attentive to home patients but not in a SNF. Not impressed with their equipment. Had to fight for everything. They never came out to feed him. I fed him lunch and dinner every day. Sorry this is a negative story but this is my experience.

We used hospice for my father also. He was in NH and his doctor was the medical director there. His health was rapidly declining & we asked for a hospice consult. We felt that the hospice staff responded more quickly to his needs than the NH staff ever did. The hospice nurse requested a private room for him (and family) after he lost consciousness. She bathed him, changed him, and gave him pain medication when she observed any facial grimacing or elevated blood pressure or pulse- when he was unable to communicate. The nurses took shifts around the clock and explained the reasons for everything that they wanted to do on his behalf. What a comfort!

Yes, both are true. Hospice is end-of-life care AND it can provide ‘extra’ care for someone who’s already receiving care in an AL or SNF.

Typically, a patient needs a 6 month prognosis to have hospice covered by Medicare.

It’s not unusual for patients who are not actively dying to ‘graduate’ from hospice. Often, their multiple docs have them on so many meds that, once all the pointless meds are discontinued, they improve and their prognosis improves.

One thing that has not change, all about the money

My dad was under hospice care about 14 months. He had to be recertified after 6 months but had a combination of increased dementia and non treatable prostate cancer.

My mom has Dementia and was in the hospital for eight days in January 2019 being diagnosed with Congestive Heart Failure. Prior to this hospitalization paperwork was done for DNR and not to send out to ER unless it was something SNF couldn’t handle . About four weeks ago I received a phone call from the Nurse Mentor with the other medical staff telling me that mom is declining and it’s time to bring a Hospice in. I have to say the people from Hospice have been wonderful. Mom has good days and some bad days. Yesterday was a really bad day for her and I pray she doesn’t linger on.

Hospice was suggested for my mother several times over the years. Each time I declined to pursue it because I knew she would bounce back quickly. Then when I knew she was not getting better, I had a very hard time getting her admitted. So it's not so easy to do, especially if there is no straightforward diagnosis like end stage cancer. My mother had moderate dementia and chronic intestinal blockages as a result of colon cancer surgery 30 years ago. She absolutely and adamantly refused the treatment for the last blockage so I knew she was done with living. Finally I got my mother on hospice and they were very helpful. She did stay on her blood pressure meds and blood thinner. She got better pain management which she'd been begging for. She died within a month.

Hospice has expaded. Both of my parents qualified because neither would get better. My 92 year old father has heart, COPD and prostate issues and is on 24/7 oxygen. My 89 year old mother has Alzheimer’s. They both live at AL with my mom in the memory unit. She will be receiving a wheelchair and a comfort care chair this week. We had supplied what we could from their home and our resources. It is more cost effective to service at home or AL than expensive hospital. My husband’s mother and sister were under hospice care and died in peace at their home. The sister lived six months after the initial 2-3 weeks.

Not where I am. Hospice can help bathe and help end of life. Hospice can go into facilities if they have contract with that place.

My experience with hospice early 2018 was that they encouraged discontinuing prescription meds while encouraging the use of pain meds. These pain meds hasten the dying process and serve to comfort the patient to death.

There are guidelines for Hospice.
A person does have to have a Life limiting condition, be seeking no further treatment for that illness. Generally 6 months is a guideline but and this is a big BUT..
As long as there is a continued, documented decline a person can remain on Hospice. My Husband was on Hospice for 3 years.
With Hospice you and your Mom will have a Social Worker, a Chaplain if you want, a CNA that will bathe, dress and possibly feed your Mom. They will not be there all day but probably an hour or so a few times a week. (The bath that they get from Hospice CNA will be in place of the bath that the Nursing facility would have given they will not get more than the necessary baths)
You will also have the ability to request volunteers. Someone that can come in and visit, they can do no hands on help though. A variety or therapies can be requested like music, art, pet, massage (usually Reiki therapy)
Hospice is focused on Pain and symptom management so the entire goal will be to keep your Mom comfortable and to help you through what may be a difficult time.
If you know that name of the Hospice that will be helping your Mom go to their website and see what they are all about, see what they offer, see how they can help your Mom and your family.
I could not have done what I did for my Husband without the help, support, supplies, equipment and education that Hospice provided me.

A person can’t be admitted to hospice because they want to. There are very strict guidelines as to who qualifies. You can find this out easily with a google search. Medicare dictates a lot of this. With dementia it is quite strict unless you have another co-morbidity. A doctor must approve it and then hospice service will make a case evaluation.

My aunt (which I'm very close to) had a heart attack 3 yrs ago, was in and out of hospital after that with pneumonia time after time. She started falling more and more at home, her kids got tired of being called in middle of the nite to help so now she's in skilled, on hospice. Hospice intervened last hosp visit. I worked healthcare for over 30 yrs, and to my surprise, Hospice is totally different. She did not need it when she left hospital and to have it about 3 yrs now.... you stay on all your meds, when it used to be just morphine to keep a passing patient out of pain, so much has changed. Because of hospice, therapy was not elected in facility therefore her muscles have totally lost their use and she can't even pull herself up to rail in bathroom. and keep her so medicated that she can barely wake up to talk to us, a woman that's smart, witty, and very intelligent, but as soon as she mentions how she needs to be home instead of nursing home, they shove more pills down her. Makes me sick. So this new hospice is sickening!!!!
Tammy Fox

Hospice facilities' policies can vary, usually dependent upon state and federal regulations and are strictly regulated by Medicare. As a FCG (family care giver) volunteer with my local Hospice, I am familiar with the basics of their operation. This particular Hospice accepts patients in-home, in skilled nursing facilities, and in hospitals who are deemed by the patients' personal physicians to have six months or less left to live. The patients are regularly evaluated to determine if less or more time in Hospice is required. If the patient improves and no longer needs Hospice care and is terminated from the program, he/she can be reinstated if/when the health condition again deteriorates and the criteria is met. The skilled Hospice nurses work closely with and coordinate care with patients' personal physicians, keeping all actively involved, and supplement, but do not replace, the care provided by the doctors and medical staff, including the private physician(s). The "extra eyes" of the nurses, home aides, and volunteers are a plus in many ways, including monitoring the care being provided by the family and/or living facility, which can sometimes be substandard. Even if the patient doesn't want or need the full medical care provided by Hospice, often the family requests some of the services for the peace of mind it provides, knowing that they are doing all they can to ensure their family member is receiving the proper care.

Palliative care is one of the most important functions of Hospice. With the personal physician's knowledge, they are permitted to administer medications and drugs to alleviate the pain and discomfort many end-of-life patients experience that, by law, the regular physician is not.

It is always advisable to investigate each individual Hospice being considered as they are not all of the same caliber. The one I am associated with is 5-star rated in every aspect, and had I been aware of their services years ago when my mother was dying, I would certainly have enlisted their help.

I wonder about that too. My sister is in a skilled nursing home (Medicaid). "They" wanted sign her up for hospice. But she is not end-of-life and is in no pain. I suspect the nursing home wants it to decrease their workload because it would bring in more help.

When my mom was in nursing home, at one point hospice was recommended. We didn’t keep them for long as we quickly found out hospice care was an excuse for the regular nursing home workers, who’d been very good with mom, to back off care. We constantly heard “we’ll wait and let hospice do it when they come” when her needs were immediate. If hospice workers were running late, no bath for mom, things like that were common. We stopped it and all went back to normal. I know hospice is often good, but our experience within a NH was awful

Hospices that are medicare approved no longer require Do Not Resuscitate (DNR)--but they will be pushing it heavily. Private owned hospices require DNR. Regardless a DNR in a nursing home means when they go into distress they will mask it with narcotics and they won't be sending her to the hospital. If you as a family member insists on Emergency Room (ER), they must be notified because hospice has to pay the bill. If your mother is already in a nursing home (NH), their care will most likely not be any different than what she's getting now by NH staff, but you can bet a DNR regardless of hospice--or no hospice--means if they go into distress they stay at the nursing home. Hospice is more comfort care. Hospice doctors, however, will still prescribe antibiotics.

Be mindful with every new admission to the hospital, a new DNR must be reordered, even if the nursing home has them DNR status. they are supposed to treat DNR patients in hospitals, but not intubate and shock--no cardiopulmonary resuscitation (CPR). BUT many doctors and nurses still believe DNR means just let them die without conservative treatment. You will be surprised.

I don't know if you mom can still swallow or tends to aspirate but think carefully when that option about feeding tube pops up. Feeding tubes have their own set of complications--they can get infected or pulled out. and they can still vomit if inserted in the stomach. If in the intestines they can get dumping syndrome which means diarrhea and more urinary tract infections (UTIs). Feeding tubes are a surgical operation and if pulled out she MUST go back to the ER and it must be reinserted within 24 hours or it will require another surgery. If she is on hospice they will frown on feeding tubes. Not sure if they will approve of that. Still, that's a hurdle you will have to face. Feeding tubes should only be considered as a last resort..but if she's at end stage is it worth putting her through all of that. that's something you have to think about and your family.

My mom is at end-stage Alzheimer's and I care for her at home..she's a living nightmare when she catches a cold. Near end of life they get frequent infections. The slightest cold will quickly become an upper respiratory infection (URI) and pneumonia. Chances are they will be on antibiotics every month or two for either an URI or UTI their immune system is so compromised. because she is on hospice I don't have to drive her to a doctor to get her routine medications ordered--right now she is so weak I cannot get her into the car. so this is the only way I can get her meds reordered. Now your mom is in a nursing home and they have their own doctors/nurse practitioners so getting routine meds ordered is no issue.

So think twice before going back to the nursing home with hospice. If on hospice they most likely will not send your mom to the hospital.

the nursing home is already providing doctors and nurses aides to care for her, so there is no advantage going on hospice just for that.

Yes, that is correct. My mother has been determined/recommended by the NH staff right now that she doesn't need hospice at this time.
(This of course will change over time.) She resides in a NH that doubles as a skilled nursing facility. Hospice is still used for end of life care but it's also meant to help the staff at a NH keep an extra pair of eyes on the patient. Everything does stay the same, just with an extra pair of helping hands.

Hospice criteria changed a few years back. My daughter said a lot of her residents who had been there for years were put on Hospice who would probably live past the 6 months.

Be aware that some meds maybe stopped. She may not be sent to the hospital or go to doctors. Check this out.

My mom graduated out of hospice 2 times - alive. The last time she went to Heaven.

They will come in an evaluate her after 3 months, or something like that. If there is anything that may look threatening, they will let the doctor know, and they will evaluate you mom. If they do graduate her, you can ask for palliative care.