Hospice while in Memory Care

rdc3

The medical director at my mom’s memory care facility reached out to me about putting my mom on hospice. I was surprised to hear this because when I hear hospice I think of someone on their deathbed, but my mom still has a number of years before she’s close to death. While she is in the moderate stages and her dementia is undoubtedly progressing, she is still very ambulatory and is otherwise physically healthy. 

The director explained that there are different levels of hospice care and this would simply be some extra personnel that come in periodically to help care for her. I expressed concerns about cost and was told it is 100% covered by Medicare. 

While I see no downsides to this, I’m wondering if anyone has experience with putting their loved on on hospice while living in memory care. Are there any caveats or concerns I should consider? Any surprise costs that could arise, or is it really fully covered?

M1

Makes me wonder if they are short staffed and looking for ways to fill the gaps? It does seem a bit odd. But i don't have any personal experience.

harshedbuzz

rdc-

It is not at all unusual for a MCF to request additional family-funded caregivers or bring in hospice when care needs ramp up for an individual patient. It's how they are able to allow their residents to age-in-place.

Your mom's general health might have less to do with her care than her behavior. If they are experiencing staff shortages, they may be looking to hospice for access to bath aides and a weekly nurse visit. 

Dementia is a terminal illness and many families regret not engaging hospice sooner as a well-chosen one can be a godsend. Normally, I am all for hospice and am one of those who regrets that dad died hours before his evaluation and mom didn't get any of the support they had to offer her around that time. That said, a transition to hospice impacts how and what medical services are delivered going forward and that should be examined before accepting this as right for your LO. 

HB

Beachfan

My DH is in a MCF since Nov., 2021.  He is severely compromised, stage 6, possibly beyond.  I chose this MCF because they serve only Alz/dementia patients, and residents can “age in place” (Die there).  I didn’t want DH transferred to a hospital, or SNF, to linger as he progressed.  Staff and I have discussed complications to his care (he is hand fed; recently I was told that it takes 2 staff to provide physical assistance).  I was assured that as progression worsened, Hospice would be involved.  

I am not sure how Hospice would be utilized in your mom’s case, but I would not turn down the offer.  If it is not an appropriate service, I would hope that the Hospice provider would indicate such and withdraw. In DH’s residence of 16, no one is receiving Hospice services at this point.  DH is the most compromised among the population.  Best of luck.  

zauberflote

My mom was in a smaller (about 40-45 residents when sh was there) age-in-place-in-your-same-room AL/MCF for 17 months. Almost half of that was on hospice, at my request. I was tired of beating hospitalists over the head to prevent unnecessary tests being done every time she wound up in the ER. Not to mention the nasty experience riding the ambulance must be for a 91 year old. I approached the DON at her facility, who told me that the best way to prevent those trips was to get her on hospice. I jumped all over that suggestion! In theory, in an emergency situation that is not covered by the DNR, the facility will call hospice first, which will advise plus show up as soon as they can. In practise, for Mom, this could have worked a bit more like what it was supposed to. I wish I had put a big ugly sign in her room saying "CALL HOSPICE FIRST!!!!"  

We had a RN case manager who visited 1-3 times/week, a social worker who visited occasionally, a wonderful bath aide who took over with bed baths when the shower room began to give Mom the screaming meemies, and would have had a chaplain if he hadn't just quit. The bath aide also delivered supplies such as briefs of the diaper variety, chux, desitin and other such medical supplies. There was also a 24/7 off-hours on-call nurse, who was very steady and calm. She talked me down off a couple of ledges, for which I am eternally grateful!

loveskitties

Medicare 100% covers hospice services and supplies.  

A representative from the hospice organization will come to evaluate your mother.  It would be good if you could attend so that you can ask your questions.  That person will determine if your mother meets their level of care needs to be accepted.  This can vary between hospice organizations even in the same city.

To be accepted by any of them you will need to agree to "comfort care" only, with no medical intervention for her dementia.  This means that hospice will be called, not 911, for a medical crisis.  You can terminate this agreement and hospice services at any time if you feel hospitalization/treatment is more appropriate.  Once terminated, it can be reinstated if you so desire and the organization agrees.  Hospitals will usually not treat patients who are on hospice.

Before proceeding you might want to meet with the medical director to discuss what issues are prompting this recommendation. 

Beauchene105

Medicare also covers palliative care. The group that administers my mom's palliative care is in fact a hospice organization. From what I am seeing, palliative care is sort of pre-hospice. The main difference I am seeing is that she is still being administered curative medicine, rather than strictly comfort medicine. It sounds like palliative care could be an option for you to investigate.

CarolynATL

After my dad spent a week in the hospital, hospice was recommended to me while transferring him back to memory care.  I am so grateful for their service.  A nurse visits him weekly, and they are the first call from staff in case of any medical change.  I was able to select the level of care that hospice will facilitate - full treatment with transfer to hospital down to comfort measures only.  When my dad has had a fall, a nurse is out within the hour to examine him.  I equate it to having an extra set of trained eyes on him.

Elshack

My DH has been in memory care since Aug 2022. In Dec. he went to the ER via ambulance 2 x with low oxygen levels and 10 min of being fairly non responsive. He is 92 and is at level 6.7 Alzheimer's . The ER Dr suggested hospice. He has been on Hospice since then and when he has these " spells " the facility calls hospice and the nurse comes out and examines him. 

I am all for hospice. The nurse checks him every week and another person comes out and bathes him 2 x a week and the facility then bathes him on Saturday. A social worker keeps in touch with me and the nurse keeps me up to date. A chaplain has visited him a couple of times every month. Now when he has a fall or moments of what looks like some kind of  TIA, there is no trip to the ER but hospice is called. My DH is still ambulatory but I am appreciative of extra eyes on him and weekly medical check ups. That nurse was the one who put him on pureed food for his meals which he eats in the dining room as he had developed difficulties chewing. 

I would say that you will be pleased with the hospice help. Also they now pay for all his diapers as he also has severe bathroom issues due to crohn's disease. That saves me at least $ 50.00 a month. Hospice is totally covered by Medicare. I don't look at it as end of life but extra help to keep him confortable.