Hospice denial / appeal

angeladporter

Hi there. My name is Angela and we are caring for my father in law who is in the late stages of Alzheimer’s. He is on a level 7e on the FAST scale. He is 100% bed ridden, doesn’t talk, sleeps 15-19 hours a day, in a diaper 24/7, cannot feed himself and starting to having some troubles swallowing. He has been on hospice that provides an aide twice a day. Recently he had a new nurse and she advised that they are discontinue his care / aides “since he is doing so well” and no change since being in hospice. When in actuality there has been a change in his health and he isn’t doing well but my mother in law is a retired RN and takes excellent care of him. He is losing weight, getting more agitated when they try to turn him or touch him most likely due to the pain of laying in a bed 24/7, sleeping a lot, having issues going to the bathroom, swallowing issues, etc.

They told us that we can file an appeal.

Has anyone been in a similar situation and successfully won a hospice appeal in the state of Delaware? Looking for any advice or guidance on what to include for the appeal to justify hospice care.

In doing research it sounds like being at a level 7F isn’t sufficient and he would need at least one comorbid or secondary condition that affects his expected survival. He has lost weight but they don’t weigh him do it is hard to prove. They just measure his bicep which still has a good amount of muscle since he holds onto the bed rails / fights when being changed.

“To be eligible for hospice care for a primary diagnosis of dementia, the patient should have a FAST score greater than or equal to 7 and should have specific comorbid or secondary conditions that adversely affect the patient's expected survival.”

• Delirium

• Dysphagia

• Pneumonia

• Pressure ulcers
• Weight loss (10% over the previous six
months) or other evidence of diminished nutritional status)

• Recurrent fevers or infections nutritional status (e.g., bypoalbuminemia)

Thank you so much.
Angela

Jeanne C.

Angela, my husband is on hospice care in Delaware. He's fully through stage 6 with a toe in 7. There was no issue recertifying him after 90 days due to continued weight loss and an increase in falls. Have you considered another agency? We're using AccentCare (through Christiana Care Health). I know a couple of people using Delaware Hospice. I haven't heard of anyone in late stage getting dropped. I highly recommend AccentCare for everything except respite (we didn't have a good experience with inpatient respite care, though you may have different results - they didn't seem to be equipped to handle someone who is still as mobile as my husband). His social worker, nurse, and CNA have been amazing.

terei

Call and check with a different hospice if your appeal is not accepted. I am shocked they are considering dropping him in his condition