When to go for Hospice?

It is my personal experience after a lifetime in nursing that we wait to long to call in Hospice. Definitely call them when you are at the point where you will not transfer her for treatment, when she doesn't wish to be transferred for treatment. My brother went into the hospital with septicemia from a cellulitis of his leg after a non healing wound. I wish the hospitalization had been skipped; it was hideous with the antibiotics giving him constant explosive diarrhea and him begging to go home to die, home with Hospice, and me in another city trying to advocate for him in covid times. I can sympathize with you completely. Get Hospice in would be my recommendations. Keep your Mom comfortable. I wish you very good luck ongoing. Only you can decide what is right for your Mom right now; wishing you luck in your decision.

I would like to encourage you to request a hospice consultation.

With hospice the life expectancy is 6 months or less, but that doesn't mean that it won't be longer. As long as they meet the criteria (declining or not improving) and the life expectancy is still 6 months or less, she should stay qualified. Hospice is a godsend, which you probably already know from having them with your Dad. It is also an underutilized Medicare benefit, maybe because people feel like it's "giving up" when in reality it's accepting the reality that death is probably going to happen sooner rather than later and welcoming the help hospice provides.

We requested hospice with Daddy when his Parkinson's started getting worse faster. We realized at his 91st birthday that he probably wouldn't make it to his 92nd, but didn't think he would meet the criteria (he probably would have in retrospect) but after a fall (mom has dementia and was unable to realize how much more help he needed and we hated to interfere) my sister and I asked the doctor for it. On the way home from the hospital I asked Daddy if he knew what admission to hospice meant. He didn't so I told him that if he didn't improve, it was possible he wouldn't live more than 6 months. He was quiet but I don't think he was surprised. He wasn't opposed to the idea of having hospice come help.

Mom, like your mom, on the other hand, is not so clear cut. The only ADL she is independent in is feeding herself. She can't bathe herself, dress herself, toilet herself (though she tries), fix herself meals - I don't remember what all of the basic ADLs are. For hospice for dementia, one of the criteria is that they can't communicate coherently, supposedly less than 5 intelligible words at a time.

But I digress. My suggestion would be to ask for a hospice consult. If she meets their criteria for admission, welcome their help!

Hospice is a difficult decision because it means we accept that life is coming to and end, but life is going to come to an end whether we consciously acknowledge it or not. Reaching out and accepting the help that is available isn't giving up, it's giving your Mom the best qualify of life she has for the time she has left.

My heart goes out to you. I can't imagine how difficult it is for you to not be by your Mom's side while she's in the ER. Around here they make exceptions for patients with dementia like they do for dependent children. I don't know what I'd do if they tried to separate us if I had to take Mom to the ER. Prayers for you and your Mom.

I am so sorry for your mom and you.

I would choose hospice for my mom at this point.

To much trauma and pain for her.

May God guide you through this and bless you with strength and wisdom.

It certainly won't hurt to see if your mom qualifies for Hospice at this time. I would imagine that she would, but all hospices are not the same. And unlike your dad, just because your mom would qualify for their assistance, doesn't mean that she will be dead within hospices 6 month guideline( My husband was under their care for 22 months.) For you it would mean extra sets of eyes on your mom, and to make sure she's receiving the care she needs and deserves at this stage in her life. Wishing you the best.

Hospice is terrific. Many people get back to baseline in it because it's a different orientation of care. You can be in it for a year, get better and come off of it!! I recommend it highly. The world (medical system) sees it as a last ditch, end of life route, but it can be an amazing opportunity for all kinds of things to happen. If comfort and consistent low intensity care is what you want, then go for it. Your mother might turn a corner or she might be allowed a safety net to begin to let go on her own terms. Either way, it'll be different than what the hospital can offer, especially right now.

Many parts of your story are mine. Mom 95, Alzheimer's, macular degeneration, virtually deaf. In memory care 2 1/2 yrs. Had constant UTI's - antibiotics merry-go-round, until an angel nurse suggested no more antibiotics. (Mom's wishes for no measures are clearly spelled out, signed and posted). I worried about pain, angel nurse suggested hospice. I called dr, she was evaluated and on service within 24 hours. That was 19 months ago. They supply equipment, supplies like depends, gloves, etc- medications, shower aid 2 times per week, social worker, chaplain and more. At first they were part of my team, then in March (covid) they became my EVERYTHING! I have not seen her in person even tho she is 5 miles from me. At first even the hospice nurse had to do virtual, but now she is my eyes and ears inside. The bath aid still can not go in, so the facility aids do that but they are not charging me for it. Different companies may be different in their service, you can ask. Usually more than one company offers hospice care.
Because of hospice, I do not need to take her out to Dr appointments, the nurse checks her every week. I have a team of caring people who check on ME and how I am doing in addition to Mom. She has a "comfort care kit" at the facility with any drugs she might need for pain and will not go to the hospital. They will let me know when she is nearing the end of her life, be with her and me if I can be there, make the final call, notify the mortuary etc. And provide counseling for me and my siblings who live far away for a year. All of this is paid for directly from Medicare, you will never see a bill ( and it is not cheap). You are not signing her death certificate, you are bringing life boats along side of you to support you through what is inevitable, death and the loss of your Mom. Please do not wait, my heart hurts for you, I share your pain.

I agree with all who suggest at least a consult with hospice. Going through this with my mother now! I guess the question is why would you refuse additional support or services at this time? Hospice is a great option for comfort care and support (and relief) for patients and their Loved Ones!

Dear MJ, this is so difficult to write. My mother's funeral was yesterday and I want to share with you what I have seen. My mother entered hospice 4 years ago. She stayed in for a year; I have never seen anyone work so hard to get her better. She graduated after really hard work. I too, have had Mom sitting on a bed in hallway of emergency room for 10 hours, and in an emergency room for 24 hrs twice. It's horrible. And this was before co-vid. About 5 months ago my mother at 95 entered Hospice again. She had shingles and it just knocked her down. I got her family doctor to sign off on it and called the same hospice as before. I refused to take her to the hospital. She got to have her same chaplain as before and it was just like family, the nurse became her best confidant. Call them now. They will take care of her and help you. All are not alike but you cannot lose. Ask them to be with you when your mother passes; they can answer questions about her not being in pain and other thoughts that will go through your head. Beware intruding relatives and let them know you are in charge and you are taking care of her. It's amazing what people will come up with. You need to be with your mother. Bless you and and your sweet mother in this time of pain.

My husband has dementia and is 65 years old. He is not able to do anything for himself and I can not get him into the car to go to the Dr, In our area my PCP told me about a HOMECARE Dr group that visit pts at home. When I had this Dr come to see him the first time, he suggested to me to put him in hospice. I held off for a month or so then agreed to do hospice. He is still on hospice and it is 3 years now. All staff visiting us must wear a mask and usually gloves, with them getting covid checks weekly. Maybe your Dr can suggest if she is ready for hospice. Hospice does go to nursing homes too I found out. It is so hard. God help you through this difficult time.

Mom was on hospice with dementia before she passed  the nurse also treated a wound on her ankle that took forever to go away. Before hospice she was in the hospital a few times, she fell at the assisted living and broke both her wrists and then fell  out of bed once. She never did good  at the hospital, she would not  sleep and they had to knock her out so she wouldn't try to get up. I was told dementia patients never do good in hospitals. Watch for uti's also those can make big differences in older people who can't tell you anything  I just don't think they ever drink enough water  so they always get them