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Mom appears to be going down now, and dimentia has set in extreme weakness etc. She is 92, all alone, and 1K miles away. Needs 24/7 care. Currently have caregiver who is great @ 12/h , = $280 /day Cannot afford much more of that... I had heard some live in might charge $150/day , and I may have to look for that. What criteria does hospice need to come in? No real terminal illness, just worn down and give up ready to go... We live very far away, and she desires to be at home when her time comes. Any suggestions? Thanks

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Mthr was on hospice for life limiting condition of cancer as her primary and dementia as secondary. The rule is 6 mos life expectancy, but renewable after that infinitely as long as she continues to decline. Hospice care was so super that mther stopped declining, so when she hit her 5 years from cancer surgery anniversary, she had to go off service.

To get a house call doctor, she had to be home bound and unable to get out on her own. (Check!) The doctor asked us goals of care, and we told him palliative. I don't think they are supposed to offer that from an insurance perspective, only curative goals. But if it's asked for, they must put the goals of care as palliative and treat that way.
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Grandma1954, my mother's life limiting condition is AD, for which there is no cure. All of her current meds will be continued except for the mulit-vitamin. She is on a blood pressure med, an allergy med, an acid-reflux med and the drugs to calm her down. If she were to develop an infection such as pneumonia, she would be treated with antibiotics if indicated, but she would not be hospitalized. Mom is nearly 91 and has advanced AD. When she was more aware she made comments such as "I don't why I am still alive" and "I should be in the cemetery with your dad". It is a tough call to make, but I don't think she would want any heroic measures and signed a DNR several years ago. As far as PT or OT, it was considered as a way to minimize swallowing issues, but it was determined that she would not be able to participate effectively or to remember what she was instructed to do. I appreciate the weekly evaluations by the RN and the extra personal care provided by the CNA. Also, the visits from the other hospice workers and volunteers help to distract her and keep her calm. I don't know a lot about Palliative care, but it is my understanding that it is primarily comfort care and pain management.
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The criteria for Hospice would be the "life limiting condition" but one must no longer be getting treatment. Also no PT or OT therapies would be done. There needs to be a documented continued decline. The re certification is about every three months and during that three month time there must be documented decline.
One can be on Palliative care and continue treatments and therapy. Once the treatments or therapy are no longer effective one can then decide to go on Hospice.
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Forgot to add, some hospice services also provide palliative care. The CT Hospice is a not for profit and I would definitely choose a non-profit over a profit based hospice!
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Here in Connecticut the options for at home care are greater than in the hospice facility, itself. My mother received daily visits from a Hospice CNA for 2 hours every morning, nurse weekly unless I had a concern and then he came as needed, and a social worker weekly. Services I did not need but that were available include music and art therapies. They also provided us with a sling lift, an undulating mattress, and side bolsters, as well as creams and meds. My mother had at hospice for a year from the first hospice in the USA: the Connecticut Hospice. I have nothing but praise for them. Except for their bereavement aid could be a lot better. I think they are working on that, though. My mother had medicare and medicaid.

Given what you have said, you should look into palliative care.
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AK, I wasn't aware of this and now am wondering how the "life limiting condition" differs from a "chronic condition", the basis for the Palliative Care program.

Or are they the same level of program, with different names? Palliative Care has been recommended for my father, with the suggestion of a doctor monthly and nurses biweekly. What I haven't yet determined (haven't done that much research) is how much therapy can be provided. I've found a good palliative care company which I'll probably use; it's the best I've found through interviews so far.
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Hospice no longer requires a six month life expectancy. I recently had my mom (AD and in a memory care facility) evaluated for hospice and she was accepted. The folder given to me says that hospice serves people with a "life limiting condition". The hospice nurse told me that they prefer to start services before the patient gets to the point that the hospice workers don't have a chance to get to know them and their needs. Mom gets limited services now, and I am very happy with these services. She gets a weekly RN visit (her facility has LPNs during the day shift), twice weekly bathing help from a CNA, a bi-weekly massage, chaplain and volunteer visits. There is a hospice doctor available if needed. Mom loves the extra attention, even though she does not remember any of it. The nurse has adjusted a couple of her meds to try to improve her bowel health and breathing issues. She seems to be cleaner than before. Hospice provides some of her incontinence supplies and meds. There is a possibility that she could "graduate" from hospice if they determine that she is no longer eligible, but that is unlikely.
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Carerick, you don't say where you live so I can only speak to what I know about Ohio from helping my parents. There is a senior service called Passport here that provides a wide variety of services for seniors, costs determined by income. This included free legal advice pro bono via phone. They also suggested I call Chatholic Family Services who were a big help with advice and direction in filing for Medicaid. In the end there was not much help in day to day physical care, you have to private pay that until you qualify for Medicaid. I hired Visiting Angels to come in 3x a day, cost here is $23-30 an hour but they are trained, always cover the shifts, and are licensed and bonded.
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Thank you freqflyer. I wish I could hire an attorney. O well God will see us thru this bump in life as he has many times before.
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Carerick, no you wouldn't be required to add "workman's comp" to your homeowner's policy as you are a relative and not being paid. The workman comp is for someone who is an "employee" working in the home.

Have you looked into Medicaid [which is different from Medicare] to help you place your wife into a continuing care facility once it becomes too difficult for you to care for her at home. Medicaid will pay for all of her care. You would need to hire an Elder Law Attorney to help you through this maze, with you being the spouse still living at home, especially if you own a house, so that you can keep your fair share of house and savings.

Oh why does getting older have to be so darn complicated :(
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Hospice is a wonderful service but as others have mentioned does not cover home care other than a very limited support at end of life. And it can be even more difficult to be approved when you only have a dementia diagnosis to work with and typically they will not come in until they are bedbound in that situation.
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Oh my wife has alzheimers. No cure. She also has hip back and shoulder problems. An implanted morphineump for pain. Every time I mention those the price for care increases. : ((
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I care for my wife 24/7. Does that mean I have to pay all the added taxes and insurance's specified. I looked into a home for my wife and it cot 3 times our income each month. Very ugly getting old and no care after supporting all the politicians all these many years. : ((
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Hospice is an awesome program. It does not solve the basic requirement to have someone in the home with Mom 24/7.
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Hospice will not come in and be there 24 hours a day, 7 days a week.
They will come in a few times a week, more if needed to shower, dress and take care of some needs but that is the CNA and she/he would be there probably an hour at most.
A nurse would come in 1 time a week, a Social Worker, 1 time a month.
You need someone that will be with your Mom 27/7
Hospice will come in and assess if she is a candidate for Hospice or maybe Palliative Care.
Hospice will go wherever your Mom is so at home or in an Assisted Living or Memory Care facility.
What you are paying is about standard.
You will probably need someone at night as well. That may cost more.

When you look at the cost of staying at home VS a facility take into account you will no longer pay property tax, homeowners insurance, gas, electric, garbage pick up, water or sewer bills (if you are on city water and sewer) and your food bills will go down drastically since meals are provided. And you will not be paying the caregiver unless you wish to pay someone to come in and visit or take her out in addition to outings provided by the facility.

You can check cost where she currently is and compare costs closer to you then make the decision to keep her where she is or mover her closer to you.

I know she wants to remain at home but that may not be possible if she is at risk, if the house is not adaptable to her changing needs as she declines.
Are bathrooms large enough to maneuver a wheel chair, could you get a Hoyer Lift or a Sit to Stand into the bathroom.Are there stairs going into the house? To the bedroom? Is there carpet that might have to be torn out to make it easy to move a walker or a wheelchair or to prevent trips? Are doors and halls wide enough to get a wheel chair from one room to another? Do you have grab bars where they are needed? Are toilets elevated?
All these things will cost money to change.
Unfortunately a move often comes after a catastrophic event that requires surgery and rehab.
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I kept my mother home til the very end. She had hospice for a year. I called her PCP who was totally in favor of hospice for her and he called a 3rd party agency to send a nurse to do a quick examination. Her report gave him the go-ahead and he then called the Hospice provider I had chosen. They sent their own intake nurse and that was that. this all happened in two days - one of which was a Saturday!

Now to the other point of your query, my mother only asked to "go home" for a short time before I realized it meant she needed to go to the bathroom. Everyone is different!
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Dear jlm,

I know you are trying to keep your mom at home as per her wish. Have you tried talking to a social worker? Maybe she can help access more resources in the community.
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JLM, does she have any chronic conditions? If so, she might be a candidate for palliative care, either in her home or at a facility providing that level of care. She would still be treated for medical conditions but a visiting physician could be part of the team to treat her at home, to preempt the necessity of going to urgent care or the ER.

Palliative care is a fairly new program, from what I've been told by providers, and is a step up from hospice care.
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Thank you so much for your reply..

The actual nurses that have looked at her say now she IS NOT a candidate for Assisted living, as she would still require someone there 20+ hours a day.

Really tough stuff...
Thanks again
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jlm, a live-in at $150/day would be like paying someone $6.25 per hour to take care of your Mom. If Mom starts to need a lot of help, then the live-in will burn out very quickly because she wouldn't get any sleep.

Plus Mom would need to add a "workman's comp" rider to her homeowner's insurance to cover if the live-in gets hurt on the job. And you and the live-in would need to decide who pays the payroll taxes. There are payroll groups that one can use.

I can fully understand that Mom wants to pass away at home. I know this is a delicate question, with Mom's dementia at this stage, does Mom know where she is living? Eventually with dementia the patient will go back in time and wants to go "home" to the place where they grew up. My Mom did this. Mom resided in long-term-care but she thought it was a motel and that I had a room down the hall.

Wonder if Mom would accept an Assisted Living complex [not a nursing home]. The cost is less than what your are paying the caregiver you have now.

My Dad had a caregiver at home, then he moved to senior living and was able to bring his caregiver with him, but the number of hours were reduced and she didn't mind. She was with an Agency so she could work a client in the afternoons.

Oh you asked about Hospice. Only a Hospice doctor can approve a patient for Hospice. Usually Hospice comes in if the person has 6 months or less to live.  And Hospice isn't full-time or part-time care.  You would still need to have a caregiver or Mom living in Assisted Living.

Lot of options to think about.
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