How to increase hospice care

Lynne D

After a TIA and two bd falls, my husband was taken by ambulance to the hospital this morning. There are no injuries, no brain bleed. However he is diminished cognitively and not ambulatory (he walked a mile on Monday).

He got here because he cannot be redirected. Last night he had (under a hospice nurse’s supervision) Zyprexa, Halidol and lorazepam (two doses). He STILL got up, wandered at night, and fell. 

I am obviously incapable of keeping him safe at home as things are at present (however he is currently non-ambulatory so should not wander tonight). What more do I need to say to hospice? What kind of services can I ask for? Ideally, I would like someone to watch him at night. I did read that a criteria for “continuous home care” is available for an “out of control” patient. Sounds like us. 

The social worker is allegedly looking at placement options. Has been for about a month…

Thanks in advance for your help and support!

Joydean

Lynne, I have no helpful information. Just wanted to let you know I’m thinking of you and your dh and praying you get the help you need.

M1

Lynne I'm so sorry.  I'm glad he's in the hospital.  Is there an inpatient Hospice option near you?  Sounds like it may be time, if there is one.  Otherwise it may be time for a nursing facility with hospice support.  I just don't see how you can continue to manage him at home.  Please keep us posted, I am sure you are grieving.

dayn2nite2

I'm sorry you're in this situation.  I think what hospice services are available depends on the hospice.  Generally, home hospice is fairly limited, offering equipment, bathing assistance, nursing visits and sometimes when one is available there is a volunteer that will sit with someone.  I don't know how much more would be available at home. If the patient is imminently dying, then there may be help during that process, not sure.

As was suggested, check to see if inpatient hospice is available.  I think for assistance watching him at night, you're probably looking at placement.  Do you have a couple of facilities to give to the social worker at the hospital?

And of course, you are going to have to do the "he's not safe with only me at home" mantra and do NOT take him home if you feel he isn't safe.  Being a current inpatient in a hospice would make him a higher priority than waiting for placement at home but you may need to be flexible in location if there are no beds available.

toolbeltexpert

Lynne I can't give any advice, but I too want you to know that I am praying for you.

MaryG123

I’m sorry for the decline Lynne.  Hugs to you.  O

Jo C.

This is a difficult one, Lynne.  Some Hospices are more beneficent than others, but they must all abide by the federal CMS laws/rules. 

Here is a link that describes such care and it is pretty stringent.  Such care coverage would go under the Continuous Care rules which requires a minimum of eight hours being necessary BUT the bulk of the hours must be from a licensed nurse and it is considered "temporary" and the ongoing need must be assessed on a daily basis.  Here is a link:

Continuous Home Care in the Medicare Hospice Benefit - NHPCO

(Weird outcome from trying to place link.  Seems to be that a better link somehow put itself in place after my signature and it will not let me move it.  Strange.)

Though not usual, the Hospice may have a special program or special services that they provide in certain circumstances; you can ask.  They may offer the five day Respite Care at a NH.  Though your husband can no longer ambulate does not mean that he will not keep trying to get out of bed which certainly is a high risk behavior that is dangerous and may lead to a severe outcome and you are trying to keep him at home.   Most of these sorts of circumstances are most often expected to be cared for at a SNF with Hospice coming in to oversee and manage care plans.  Still; one can try.

As for inpatient Hospice settings; most of them are also for temporary stays and most often to manage uncontrolled pain and other extreme issues that have been difficult to manage in the home setting.  Sometimes, if the patient is in such a situation and death is imminent, the stay may be a little longer, but it is difficult to find such care settings and to have them accommodate situations such as the one you are dealing with as it is a behavioral issue rather than a physical clinical issue.

Give it a big try, Lynne; read the criteria and then let them know that it is a patient care issue of significant need due to the danger aspect and see where they go with it.  With any luck, they may be willing to assist in some way.    

Hoping for a good outcome for you,

J.

https://www.nhpco.org › CHC_Compliance_guide

jmlarue

It's these catastrophic twists and turns in this disease that really destroys us. I surely hope an in-patient hospice placement can be found for him. It really is beyond time for him to no longer be in your home. It hasn't been safe for either one of you for a long time now. Surely, he would qualify for skilled nursing at this point - with hospice. Am I wrong to assume that Medicare will cover the cost for at least 100 days? No way to be sure, of course, but given that he's had a significant TIA and bad falls in rapid succession, it would be hard to deny the idea that his life is growing short. You may need to look as far away as Boise for a SNF and that would probably mean a different hospice organization. Still, that would be preferable to the alternative of keeping him home and you having to go it alone caring for him overnight. I wouldn't last a week doing that. Holding you close through this awful time.

(So much heartache and hopeless desperation for so many of us recently. It's not easy holding one another up when we're falling apart ourselves.)