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When my mom died under Hospice care, the nurse came out and declared/called it, so I could then contact the cremation service. Since my mom's death last December, my dad's health is declining fast. He isn't in Hospice care and I don't know who I'd call if he gets his wish and dies at home in his sleep. Seems like calling 911, with all the folks they send out, isn't warranted if he's already gone. As an aside, he does have a DNR. Even with Google, I can't figure it out. Please advise and thanks.

Ricky, I think you said several times that you don't see the advantage of having hospice on board, but the big advantage is that there won't be any investigation of his death at home if he's a patient on hospice, even if hospice is only providing palliative (comfort, not treatment) care services.

It was great for mthr to have hospice to call first when she fell instead of rushing to the ER to see if she had a brain bleed. If we made the decision to keep her home on our own, and she had the brain bleed and died in her bed, then there would have been an examination, head trauma would have been noticed, an autopsy performed, and then an investigation into why she was not taken in (negligence on caregivers) or was there elder abuse (active abuse). Neither of those are what you want to face when you are grieving a loved one and want to get everything tied up.

Hospices can provide palliative care as well which has a cost - it is my understanding that Medicare covers hospice 100% but not palliative care. With hospice someone has to be at home with the patient at all times, but with palliative care, the rule differ.
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Pasa18 Feb 4, 2020
Good points to think about. My mother is on hospice but has improved over the past two months and I was thinking of revoking hospice services or waiting until the next evaluation. I will call medicare to find out coverage for palliative care. I think in CA it is covered under Plan B, so there will be co-pays for services.
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Ricky, since you apparently have already contacted a cremation service for your mother, are you using the same one for your father?  If not, have you identified a funeral home?

They could probably offer suggestions on how best to approach the situation, since they're familiar with your particular area.  

None of my family died at home, so I have no recent experience in this aspect of caregiving.

This is a sad situation, having lost your mother so recently, and now facing your father's apparent imminently close passing as well.  

I respect your attempt to honor his wishes; my father also planned to die at home, but his last illness was too intense for home care.    I was fortunate to find a compassionate multi-level facility where he spent his last days, warm, cared for well beyond any level I could handle, even with the nominal assistance of hospice. 

I still regret that I couldn't honor that last wish but I know in my heart that he couldn't possibly have gotten the care he got with a group of people trained to provide various levels of care.   Had I kept him at home, I know that I would still be battling recriminations for not providing the level of care I thought best for him.

Still, this is his wish, and you're considerate to try to honor it.
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My mom was on hospice for 2 years and I used them as a home clinic. They were useful continuing mom's regular home meds and I got labs done. I took her to the Emergency Room a lot which is your right while on hospice. When mom forgot how to eat and drink I revoked her hospice, took her to the hospital, they put a permanent feeding tube in her, then I restored her hospice on discharge. No problem! She was very comfortable after the feeding tube was put in and she lasted a long time with it. Ironcially she died of liver cancer and liver failure, and not Alzheimer's. But she died at home and she was really comfortable. yes old age and Alzheimer's disease is incurable--BUT I still continued to treat mom for dehydration, UTIs, and her regular meds under hospice!

You have total control on the treatment plan while on hospice. I just could not take mom to the doctor anymore so this is how I dealt with this, even though old age and Alzheimer's are terminal conditions.
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igloo572 Feb 5, 2020
Cetude, what an awesome plan & way to use mediCARE hospice benefit. Hospice as your partner to have a in home clinic. Really beyond awesome, you go girrrl! Out of curiosity & you don’t mind my asking, did you have a local, more small hospice or was this one of big nationwide players (Vitas, Compassus, Southern)? Did hospice nurse do the pulls for blood work or you did? How did you get vials processed... like you dropped off at a pick up site or you mailed them? Or could you still get her like to a Quest or other free standing labs co.?
Hospice as in home clinic, love it!
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I don't know about California but here it would be investigated by police as an unexplained death in the home, avoiding that is one of the benefits of being enrolled in Hospice. Is there a reason your father isn't with a Hospice provider? You don't have to accept their full services, just having the paperwork and a nurse on call if needed would be valuable for you.
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anonymous951699 Feb 4, 2020
Thanks for your response. He doesn't need to be on Hospice. He's not in pain, just old and winding down.
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My father died in his bed in California while not on hospice, and everything happened exactly as Cali says. Police, fire dept., and ambulance all came; ambulance whisked my dad off to the closest ER; and my mom had to answer the questions from the police. My dad was pronounced at the hospital. Had my dad been on hospice, the whole experience would have been less traumatic for my mom.
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anonymous951699 Feb 4, 2020
Aw crap. That sounds terrible. I've had enough freakin' stress, I don't need that.
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Ricky, they don't provide medical services per see, they offer support and oversight of the decline. So you can be assured that he will not get any pain meds daily, but you will have them in the refrigerator for the time he may need them.

He could be eligible for hospice or not, Medicare covers this service 100%. So he would not have any fees.

Can I recommend interviewing several hospice providers and find one that fits your needs and has a business model that you like, they are not all created equal. If you hire one and you decide that they are not a good fit, you can fire them and bring a different one in.

They helped all of us when my 52 year old sister was dying of cancer and refused any treatment. They helped us understand what was going on, what would most likely happen next and they treated her painful bedsores so she didn't suffer from those. She couldn't move because her back was broken from the cancer eating her spine away. I have been told that they are a sign of impending death and that they are painful when untreated.

I hope you find the perfect solution to your situation.
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anonymous951699 Feb 7, 2020
Thanks, I've been getting a lot of good advice. I suspect quite a number of people had the same question, and they're now helped as well!
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Ricky something else to think about. Does your city or county have crime watch or neighborhood watch Facebook groups? Or Facebook pages run by people who post police, fire and ambulance scanner traffic? Consider this......social media has turned us in to nosy neighbors. People see an ambulance at the neighbors house and go to their local Facebook group or page to find out what is going on. I personally find it intrusive. If I or my family member has a medical emergency, it is nobody’s business what happened. So consider this......should your dad pass at home without being on hospice, you will have the police, fire dept and paramedics at your house. Do you want the neighborhood or nosy passerby’s who want to know what happened, posting a picture of all the action on Facebook? Because that happens where I live frequently. And I personally would not be happy if that happened to me or my family. Would you want to open Facebook and see that reminder?

If your dad goes on hospice, which would be palliative care at this point, no one will know if and when he passes. The mortuary isn’t going to roll up to the house with a hearse. When my MIL passed, they came in a minivan that was backed in to the garage. Totally discreet and dignified.
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anonymous951699 Feb 4, 2020
You make a valid point about that kind of unsavory voyeuristic behavior. It is certainly the darker side of human nature to peep and post. I'm not on FB or any other social media sites, (other than this one).
While I am never stoked to have the cavalry come to my house, I live next door to a long term care facility and that side show occurs about once a week.
I appreciate all the great information and insights I've received so far, and think that in the foreseeable future, having Hospice come a couple times a week to just take vitals, is not a bad idea.
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While not in California (Maryland), my mom's doctor said you don't have to call 911. Call the family doctor - making sure he has a copy of the DNR and MOLST form in chart - and then you can just call the funeral home. Ask the family doctor what to do in that case, as I'm sure all states are different.
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anonymous951699 Feb 4, 2020
Thanks.
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Just call 911 & tell them you need to report a natural death of a family member. In most rural areas, the sheriff's dept. is also he coroner. The 911 dispatch operater will send a couple of deputies to confirm death. They may or may not send firefighter / emt.
When my father-in-law passed, only a deputy came out & then the funeral home was contacted ( it was the middle of the night) & they sent a couple of people to get the body. When my good friend passed, dispatch sent the EMTs ( in our area the firefighters are trained EMTs) & 2 deputies. One of the deputies called the morgue to come for her body.
In one of the larger cities I imagine it is still handled pretty much the same.
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Hello Friends,
Thanks to all of your great advice, I signed my dad up for Hospice today.
I appreciate the benefit of your collective wisdom, and the time you took to share it with me. Grateful and humbled,
R27
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NeedHelpWithMom Feb 14, 2020
I am very glad that you signed your dad up for hospice. Both of you will benefit from their services. Hospice will bring your dad and you comfort. If you or your dad wish to speak to the nurses, social worker or clergy, please do so. They were tremendously to our family when my brother was under their care in an end of life hospice facility.
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