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My uncle is 103 and until recently was living alone and doing reasonably well. But events last month led to brief hospitalization after a fall and then discharge to local nursing home for physical therapy to get him walking again. Without going into too much detail in this, or, please in answers, he is currently bed ridden but has begun PT to get walking again. He is taking various medications for heart and blood pressure, and isn't in any pain, and seems to need little "skilled nursing" that have observed in 12 hour a day bedside observation. In other words, this idea that he will served better in the hospice wing doesn't make sense.



The only thing that does make sense to me is that the facility will get to charge private pay rate for room and board instead of getting the
Medicare rate while he is rehabilitating. Or am I being too cynical?

Hospice referrals are made upon written physician order. Speak with his PCP ( Primary Care Physician) to obtain more specific information about why your uncle is being referred to hospice care. Hospice is also a " choice", not a mandate; in other words the patient or POA ( if pt cannot make own wishes known) can choose or decline hospice.

In general physicians refer patients to hospice services when the patient has 6 months or less of life expectancy. Perhaps the physician is receiving reports that your uncle is not responding to physical therapy or is unable to participate with the PT. Or, perhaps the staff and physician are seeing other S/ S ( signs symptoms) of decline.

Hospice care can be very helpful for the patient who is approaching EOL and, very helpful for the family members also toward accepting a pt. 's peaceful EOL, quality of life while living and family preparation toward pts EOL. The patient is also not subjected to therapies and treatments that are not beneficial and that the pt simply cannot do.

Practice good self care. Sitting at a bedside for 12 hours is not good self care. Get support for yourself so that you do not fall into caregiver exhaustion.

You asked for " few details" so I'll stop there.
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Reply to janicemeyer18
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We went through the same thing with my mother with a hospital doctor because she was 82, had Alzheimer's for 12 years, and was admitted for pneumonia (probably aspirated). We declined Hospice and she went to Rehab and stayed in their skilled nursing facility. She lived 2 more years! We thought the doctors wanted to give up on her because she had Alzheimer's. Advocate for you uncle! Hospice sends an end of life message to the elderly which can cause them to give up on life.
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KaleyBug Nov 2, 2022
We had a doctor 4 years before my mom passed at a hospital tell me to prepare my dad my mom was dying because she was in pain. Guess what it was a sprained ankle not that she was dying. I feel some doctors and rehabs give up on the elderly to quickly.
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I would speak directly to his physician. I don't want to sound negative here, but maybe the thought of rehabbing a 103 yr old is not reasonable. At 103 his body is going the other direction. Instead of making him "work" in this last season of his life, maybe the doctor thinks it is more humane and reasonable to make him comfortable....and that is what hospice does.

I don't think the doctor is worried about the room rate. I think he has your 103 yr old uncles best interest at heart.
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KaleyBug Nov 2, 2022
If I was 103 and lived by my self until just before this incident and everyone gave up on me I would be mad.
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Ask the facility what the differences in care provision would be, and how the move would benefit your uncle. They may have satisfactory answers for you.
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FoundryRat,

It's a miracle that he's done so well for so very long and, having outlived most all of his family and contemporaries, he's lucky to have you and other loving family members at his side to oversee his care. What an honor to have an uncle who has lived so long and lived through so much.

Because the Hospice 'wing' is still in the same facility, it's not unreasonable to look at this with some cynicism; I would. They may be involving your dear uncle in a transactional situation due to payment rates and this is where you can jump in and advocate for him. These places usually CYA well enough that appealing his being taken off of MC rehab would prove fruitless; they know what to document and appeals are difficult. That said, if he's trying to walk and making any progress, he should remain on rehab under MC. I would talk to your local Senior Ombudsman (they can take a few days to call back) or contact your state Aging Services - do this after asking the facility SW their rationale for the transfer and removal from Rehab services. Some of these places are rather sleezy so, read between the lines of what they're telling you and take notes, in fact, document everything you see of the care he receives.

What does your uncle want and who is empowered to oversee his cares, finances, and facilitate his wishes? Lots of cost and payment issues come into play in these situations and the DPOA needs to be closely involved.

As a retired RN, I can say that it is widely understood that whenever an aged person has significant changes in any 6 month period, it is likely that death will come in the ensuing months. At age 103 and having had some rather large recent changes, it may be that Hospice is appropriate and this may be why the facility is pushing for this move. However, if he is trying to achieve ambulatory status, he should be given that opportunity to recover to the fullest extent possible. He may then do well in a care facility that will allow him some independence and socialization for as long as he's able.

Given his extreme age and all of the associated muscle atrophy and all, he may very well be on his way out. Often, once an Elder loses their home and independence and esp after hospitalization and an NH stay, they can just give up and choose to make their exit.

I'm assuming that he's cognitive since severe dementia isn't mentioned in your post. In your place, I would do my level best to talk through this with him, openly and honestly. At age 103, he is staring at his mortality on a daily basis and may be more open to this discussion than you'd expect and it may be a relief to him. Once you know his wishes and intent, do your best to see that his wishes, as far as is realistically possible, are followed.

I wish you the best in all of this, it's both an honor and a burden to be overseeing the care of one so very aged, but if you're acting in his best interests and according to his wishes, that will ease his mind and your own.
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Reply to Luta65
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At 103 his life expectancy is limited. They may have assessed he has little hope of being rehabilitated. I don’t think payment enters into it. Medicare will pay for his Hospice.
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JoAnn29 Oct 26, 2022
Not for the bed though. Does not pay for facility care.
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Hospice care affords a 103 year old man a ton of extra services and supplies, all billed to Medicare. Comfort meds are only given if needed. Long term care costs, however, are not paid by Medicare so the monthly rent would be private pay or you'd apply for Medicaid to cover the costs. Medicare only covers rehab for 20 days, and at 103, your uncle may not be making the required progress for Medicare to continue paying.

You need to speak to the case manager for all the details and to get the facts here. At his age, I think it's unrealistic to expect him to become fully mobile again and/or to make the progress an 85 year old would make in rehab. Try not to be cynical but make choices that take his best interests to heart.

Unless you've witnessed "sleezy" actions to date on the part of this SNF, I wouldn't be jumping to unwarranted conclusions that that's what they are, a sleezy bunch of profiteers. If hospice and long term care is being recommended, I'm sure it's for a valid reason. A shared room is also an option for him.
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Reply to lealonnie1
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It's possible they are in it for the money but it's more likely that they have your uncle's best in mind. Hospice is wonderful and provides services he would normally not receive. I was a hospice nurse years ago and had one patient who was in my care for four years before she passed. The doctor renewed her eligibility every six months. She had a weak heart and one could not foresee when her time was near. She lived to be 98 and enjoyed having nurses, nurse aides, volunteers, social workers and pastors visit and take care of her.
I currently work in a nursing home and we have residents on hospice that share a room. You may not have all the detailed medical information available. Why not speak to the administrator and get a clearer picture?
All the best to you.
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Reply to Juve424
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When my mom was in nursing home after a fall and moved from rehab to private pay they suggested Hospice, but I declined it because I wanted her to continue physical therapy. I thought they hadn't given her enough of a chance. Then she did regain enough strength to become a one person assist from bed to chair or wheelchair, but she never actually walked on her own again, could only stand. The trying though, I thought, was good for her. She enjoyed being upright and moving around that way, even though someone was holding her up. When she could no longer stand on her own was when she went down hill fast. You might want to ask if he could continue physical therapy and not be on Hospice, but in a different wing from the rehab. You can also ask for another review to see if he can stay in rehab longer.
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Bandy7 Nov 3, 2022
"When she could no longer stand on her own was when she went down hill fast"

I believe ArtistDaughter's statement is true for many if not most .

Yet, time and again, practitioners/facilites tried to give up on PT for my mom when she'd been down with extreme benign positional vertigo or BPV. I knew if they didn't help her through it and continue PT to rebuild strength after, it would change everything and be a downhill slide! It was amazing how hard I had to fight for that for her though.

I do not believe this would have been the case if she had been 20 years younger!! It's a shame that age comes into play but I firmly believe it does. No one would be so quick to relegate a younger person to not standing on their own or walking for the rest of their lives.
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Ask the facility why.

At 103, things change rapidly and honestly, he would be blessed to go quickly if he is failing. A slow, long, painful death would be cruel for him.
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