My husband went on hospice 5-1/2 months ago. There is talk of not recertifying him because of his improvement. I'm really sorry to hear that because I think his improvement is due to the excellent care he is receiving from hospice.
I just went thru this process with my mom yesterday. My older sister worked for the local Hospice agency for 10 years a number of years ago and she was adamant that I get the referral from mom's doctor for the Hospice evaluation. I'm located in New York, so I don't know if other states are different, no doubt they are. But my mom was not approved base on the FAST-Functional Assessment Scale. There are 7 levels in the scale and mom falls at the end of level 6 but you need to be at 7C minimally to be approved for Hospice. As it was explained to me, Hospice works with the patient and family in getting the patient's comfort under control. It does not mean that they remove all current medications from them. Often times people come off Hospice because they have some level of improvement and when they decline again they are put back on the program. Dementia patients can also have some level of improvement with better management of medications. Hopefully it's alright to put the web address here of the requirements for Hospice. (www.http://geriatrics.uthscsa.edu/tools/Hospice_elegibility_card__Ross_and_Sanchez_Reilly_2008.pdf) You will want to look at the first page, top left for the FAST requirements. There are other specific illnesses with their requirements stated as well. So for Dementia they have to be at 7C or beyond on the FAST. Then on the bottom right of the first page it lists the other requirement. I am finding that Hospice is not there to aide in ending someone's life necessarily, depending on where they are at with the illness. I had to press hard with mom's doctor to get the referral. It didn't make sense because I couldn't understand what the problem was, let the Hospice nurse make the determination, but I'm finding the whole medical industry is a bit messed up. FYI - the Hospice nurse that came out also said that they determine eligibility at the time they do the evaluation. In other words, when she came to my house mom was irate because there was this unknown person in the house. Then her sun-downer episode kicked in so she was up and pacing, etc. Normally she walks with assistance but not when she is in the flight-or-fight state which is what happened because she was so mad at me for this stranger being in the house. The nurse, before she left, gave me the packet of information even though mom was not eligible and said if mom were to go several days without eating or sleeping to call the 800 number in the packet. In other words, the next time mom is down and out and would meet the requirements in level 7, at that particular moment in time, then call the 800 number. I can bypass the doctor at this point because I have already had one evaluation and they have a baseline for mom and now I know what to look for. So, all was not lost because I learned a lot from the visit. I also lost a lot of sleep waiting for mom to calm down because the nurse didn't arrive until after 9PM, which was fine because mom does not go to bed early, but I didn't think she would react the way she did. Such a crazy disease this dementia :) I hope my post helps some of you. I know up close and personal who difficult and frustrating this process is. Take care.
Many people live longer than 6 months when they are on hospice and some even improve enough to temporarily go off the program. It's never too early to investigate. Carol
My mother did not need morphine until very near the end, and then not very much. It did not make her any more sleepy than her own natural inclination. It just allowed her to be comfortable.
Thanks for the info on morphibe. Part of the great blessing if having hospice is having someone to help guide you. I trust that between hospice and me (and the very good advice on this board), we will make the best decisions for my husband.
@Jazzy2...Please do not consider Morphine as "the last drug" It sort of implies that when you say you will not give it to him until it is the very end. Morphine can be a great drug to allow someone to relax enough so that they can breathe. Morphine is great when you have tried other medications to relieve pain and none of them work as well as you hope. Morphine along with other drugs can relieve pain so that one can have a more pain free day and night. Morphine is not a "killing" drug that you give when the end is near. Yes it is given as a last drug mainly because at that point many people have stopped taking anything by mouth. Hospice does not do IV for fluids. (not good to give fluids after one discontinues taking anything by mouth anyway but that is another topic.) Typically the doses start low and are gradually increased to relieve pain and allow one to relax so that breathing is easier and so movement is easier. (I could not believe how easy it was for me to move my Husbands arm after a very low dose of morphine. I had not been able to move his arm without it causing him discomfort in at least 1 year.) So do not be afraid to use Morphine if it is necessary. If you are unsure how your husband will react have the Hospice Nurse give him his first small dose so you can both see how well he tolerates it and what his reaction is.
My experiences with my mother in law and my husband in Hospice care were both very positive. I certainly want it for myself if or when I qualify. I don't want to be kept alive in a nursing home--or even my own home--if I have dementia.
When my sister's sister-in-law (married to neurologist) suggested I get hospice I had already been contemplating it but did not think she would be accepted. I opted for at home hospice because I saw no reason to stop caring for her at home. She lived as full and happy a life possible for another year (Nov 19 2016). As bereft as I am I am so glad I had The Connecticut Hospice working with me. She did not start morphine until the last two weeks. On the tiniest dosages possible (5 drops) she was pain free.
My husband has been under the care of hospice for 5 months and instead of declining, he is improving. I'm assuming he will be recertified in another month. I have his morphine here if it becomes necessary but I don't believe anyone is going to give it to him unless we know it is the very end. I think you are in control of when he gets it and you will know when it's time.
As long as the person continues to decline There is no cure There is no improvement These things will be determined by a "re-certification" evaluation. These re-certifications are done about every 3 sometimes 6 months. Usually the re-certification is done by someone other than the nurse that is assigned to the patient. The person uses the notes from the assigned Nurse, CNA, Social Worker as well as a "face to face" visit to determine if the decline is consistent or if there has been improvement. As long as the patient continues to decline and is not seeking treatment they will usually continue hospice. A person on Hospice can take medications but the medications are not to "cure or improve" the diagnosed illness. For example A person with cancer would discontinue chemo and or radiation. A person with Dementia would discontinue meds like Aricept, Namenda and the like.
It's really a clinical decision. When I first moved mom into assisted living her vitals were so bad, they thought she was going to stroke out. After months of hospice here medications were adjusted so that she no longer qualified for hospice. That was four years ago. She's declining again, but from dementia, this time.
JoAnn, 6 months is a guess at best. It's not a time limit. It helps Hospice Care with their paperwork, that's all. If your loved one goes into Hospice, that doesn't mean they "have to die" in 6 months.
Hospice criteria changed a few years back. You no longer have to die in 6 months. Ask the facility who they recommend for Hospice. A doctor's order will be needed for the evaluation.
tvidos, your dad and uncle were ready to go. No one gave them 'excessive morphine' to hurry them along, they were ready to pass on. (And even so, it's not like they had rich, full lives ahead of them, they had one foot in the grave and the other hovering on the edge.) Be GLAD they passed, peacefully. They were never going to get better. When your time is up, a good peaceful death is a blessed thing.
tvidos, if a person is seriously ill, they will pass on the same timetable whether they use Hospice or not. Usually if a person passing within a couple of days of Hospice, that means they were placed on Hospice very late in the timetable.
There are NOT excessive dosages of morphine given to a patient. Morphine is between 5 to 20 mg. To cause a person to die quickly, morphine would be 200mg or higher. No doctors would order such an extreme dosage.
And there are times when a person "graduates" from Hospice, thus is taken off and continues to live for many more months or years.
Hospice is for people who are literally "on the brink" of death. When a person enters into Hospice Care, the general time given is six months, but no one can know for sure how long a person will live, Hospice Care or no. Signing papers for the approval of Hospice Care is not giving the Hospice workers or the facility staff permission to euthanize your loved one. When a facility decides to call in Hospice, through their experience, they realize a person does not have much longer although they don't know HOW much longer. The person in Hospice Care is kept comfortable and peaceful by the Hospice nurse and staff. If family feels their loved one is being abused, there are agencies in place to report to. If family feels a loved one has been intentionally overdosed, an autopsy should be called for.
Be very sure the minute I gave that order my Dad died then same for my uncle. Excessive dosages of morphine, slows their heart they become letargic & unresponsive don't eat or drink just scival away very quick.
I just went through this with my mom. She was at a great facility. The social worker called me and set up a meeting. She explained everything to me about how my mom had been declining and the facility felt she was a prime candidate for Hospice care and the Hospice agency would be assisting the facility with my mom's care. I signed papers and that was it. Unfortunately, mom lived just a little more than a week after that so Hospice didn't really have much chance to do anything for her. But it was all taken care of by the facility.
In Michigan at least, a terminal illness is not a necessary diagnosis to get hospice care. My mother is 97 living in an assisted living facility. She has dementia and she can no longer walk or even stand by herself, and she needs assistance with almost all of her daily activities (she can still feed herself). She has been under hospice care for six months because of her steady decline. She is evaluated every 60 days, and if she continues to decline, the hospice care will continue. It is paid for by Medicare. Keeping her comfortable and safe is their main focus. The nursing home may be able to give you more information about how it works in your state.
Call the Hospice of your choice and ask that your Mom be evaluated to determine if she is eligible. the call will cost you nothing and the evaluation will cost you nothing.
She will be asked to discontinue any aggressive treatment that she is doing. (If any)
To be eligible for hospice a person must be in the final stage of their disease and in the opinion of a doctor be within 6 months of death. That is more difficult to determine in some diseases than others, and no doctor can predict a future death date accurately. The person must be willing to give up any attempts at curing the disease and instead accept medicines and procedures for pain relief and comfort.
As it was explained to me, Hospice works with the patient and family in getting the patient's comfort under control. It does not mean that they remove all current medications from them. Often times people come off Hospice because they have some level of improvement and when they decline again they are put back on the program. Dementia patients can also have some level of improvement with better management of medications. Hopefully it's alright to put the web address here of the requirements for Hospice. (www.http://geriatrics.uthscsa.edu/tools/Hospice_elegibility_card__Ross_and_Sanchez_Reilly_2008.pdf)
You will want to look at the first page, top left for the FAST requirements. There are other specific illnesses with their requirements stated as well.
So for Dementia they have to be at 7C or beyond on the FAST. Then on the bottom right of the first page it lists the other requirement. I am finding that Hospice is not there to aide in ending someone's life necessarily, depending on where they are at with the illness.
I had to press hard with mom's doctor to get the referral. It didn't make sense because I couldn't understand what the problem was, let the Hospice nurse make the determination, but I'm finding the whole medical industry is a bit messed up.
FYI - the Hospice nurse that came out also said that they determine eligibility at the time they do the evaluation. In other words, when she came to my house mom was irate because there was this unknown person in the house. Then her sun-downer episode kicked in so she was up and pacing, etc. Normally she walks with assistance but not when she is in the flight-or-fight state which is what happened because she was so mad at me for this stranger being in the house. The nurse, before she left, gave me the packet of information even though mom was not eligible and said if mom were to go several days without eating or sleeping to call the 800 number in the packet. In other words, the next time mom is down and out and would meet the requirements in level 7, at that particular moment in time, then call the 800 number. I can bypass the doctor at this point because I have already had one evaluation and they have a baseline for mom and now I know what to look for.
So, all was not lost because I learned a lot from the visit. I also lost a lot of sleep waiting for mom to calm down because the nurse didn't arrive until after 9PM, which was fine because mom does not go to bed early, but I didn't think she would react the way she did. Such a crazy disease this dementia :) I hope my post helps some of you. I know up close and personal who difficult and frustrating this process is. Take care.
Carol
Morphine can be a great drug to allow someone to relax enough so that they can breathe.
Morphine is great when you have tried other medications to relieve pain and none of them work as well as you hope. Morphine along with other drugs can relieve pain so that one can have a more pain free day and night.
Morphine is not a "killing" drug that you give when the end is near.
Yes it is given as a last drug mainly because at that point many people have stopped taking anything by mouth. Hospice does not do IV for fluids. (not good to give fluids after one discontinues taking anything by mouth anyway but that is another topic.)
Typically the doses start low and are gradually increased to relieve pain and allow one to relax so that breathing is easier and so movement is easier. (I could not believe how easy it was for me to move my Husbands arm after a very low dose of morphine. I had not been able to move his arm without it causing him discomfort in at least 1 year.)
So do not be afraid to use Morphine if it is necessary. If you are unsure how your husband will react have the Hospice Nurse give him his first small dose so you can both see how well he tolerates it and what his reaction is.
There is no cure
There is no improvement
These things will be determined by a "re-certification" evaluation. These re-certifications are done about every 3 sometimes 6 months. Usually the re-certification is done by someone other than the nurse that is assigned to the patient. The person uses the notes from the assigned Nurse, CNA, Social Worker as well as a "face to face" visit to determine if the decline is consistent or if there has been improvement.
As long as the patient continues to decline and is not seeking treatment they will usually continue hospice.
A person on Hospice can take medications but the medications are not to "cure or improve" the diagnosed illness. For example A person with cancer would discontinue chemo and or radiation. A person with Dementia would discontinue meds like Aricept, Namenda and the like.
There are NOT excessive dosages of morphine given to a patient. Morphine is between 5 to 20 mg. To cause a person to die quickly, morphine would be 200mg or higher. No doctors would order such an extreme dosage.
And there are times when a person "graduates" from Hospice, thus is taken off and continues to live for many more months or years.
the call will cost you nothing and the evaluation will cost you nothing.
She will be asked to discontinue any aggressive treatment that she is doing. (If any)