Entering the 7th

I am saddened to hear Stewart, of your DW’s distress and the inevitable progression of her AD.

We have home hospice care for my DW. I talked with my DW’s nurse practitioner following a hospitalization and she agreed hospice might be appropriate and made the referral. This hospice organization is within the same healthcare system.

The hospice nurse makes weekly visits and, if medication adjustments are necessary, consults with the hospice doctor. All medications are covered by Medicare.

Whether it’s from hospice or not, your DW needs relief. Hopefully the MCF can provide palliative care. If not, then you do need assistance from hospice. I hope you and your DW get the support you need.

The sign-off by an MD for my mother's hospice was the same as @Vitruvius. The hospice doctor gave the approval, not the primary care doctor.

TBE - I am glad your pushing got assurances from the MCF that they will prioritize your concerns.

I'm with Vitruvius as one who has worked with 3 different hospices (2 for DH, 1 for a different family member) and the hospice evaluator (nurse) makes their assessment with the hospice's MD. I think the ad is just reassurance that protocols are followed to be sure hospice admissions follow regulations and are reviewed by an MD for the final decision.

Your initial concerns and instincts were right I believe - I don't think you were overreacting at all -- your DW has enough of the criteria that make her eligible for most hospices, in my view. At least based on our experience. I still don't understand the response of the MCF as if it creates more work for them if she's on hospice. Her care needs should be the priority and hospice brings extra support to your DW and to you, and in theory, to her facility. I'm with the rest of folks here who don't understand their resistance.