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My 90 year old Father was sent directly home from the hospital 4 weeks ago. This was an insurance driven decision. He had a bleeding ulcer in June, had a two week hospital stay and was release to my brother and I to care for him at his home. Up until May of this year he lived completely independently, neither of us live full time with him or even close. Both of us have homes hour away from his home. Since hospital release we have been splitting time at his home maintaining care. He was set up with Home Health Care, which provided, nurse visits, PT, OT, and health care. These services are intended to help him become self sufficient. However, we are 4 weeks in and there has been no improvement. Actually he is worse now than he was at release. He refuses to leave his bed, refuses food, and has to be given water or he would not be drinking. When do we know that hospice is a better choice in care? Has anyone had personal care help that stayed for longer than 4-6 hours at a time? Need some advise. Thanks

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You do not mention dementia. As he has been living alone all this time I assume it is not an issue. Therefore this is the time to discuss this with your Dad. You call in hospice when the person does not want any curative care, when death seems a likely outcome, when you want palliative care only, comfort care, good pain medications and etc. Unless the patient is doing hospice in inpatient facility there is extra care and help, but not a tremendous amount of it any more. Is this what your Dad would want. Is he tired of the fight and wants only now to be made comfortable. Has he discussed this with his doctor and etc. All things to consider. When a patient is mentally able they should always participate in interviewing hospice and learning what it all means.
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Where I live the "In home" care given after a hospital/rehab is also our Hospice. Did you hire this "in home" or was it suggested when Dad was discharged? If at discharge Medicare is probably involved. If so, they will not pay for care if Dad not improving. I would talk to the therapist and ask about Hospice. Be aware, that in home Hospice still means the family needs to be there 24/7. A nurse only comes 2 or 3Xs a week same with an aide and thats only an hour or so. The family has the brunt of the care.
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