Hospice assessment

Quilting brings calm · August 8

On Monday I asked the nurse at Mom’s AL if she thought Mom was ready for hospice. She jumped right on that. The account rep stopped by an hour later and took the initial info. She really didn’t seem that hopeful but she started the process. The PCP’s office called me Tuesday and wanted to know what diagnosis they should put on the orders. I was shocked- isn’t that their department? I wasn’t very hopeful after that phone call.

Today the hospice nurse did her assessment. She hadn’t received a lot of info from the doctor. She did her thing, went out to her car and called the hospice doctor. The result- mom wasn’t declining enough at this time. However we should have her re-assessed in 4 to 6 WEEKS. I walked out with the nurse and asked about that timeframe. It seems the hospice doctor thinks her ability to do ADLs will decline in that timeframe. Nothing to do with her physical prognosis. That’s an interesting take by someone who hadn’t seen her after a 45 minute assessment by a nurse.

The nurse called me back almost two hours later( around 4pm). She had received a lot more information from Mom’s doctor ( or doctors). She wanted to go back to mom and ask her to attempt to do a couple things. I told her to go ahead, but just know I wasn’t there. I haven’t heard any more.

It’s not that I expect Mom to pass away in 6 months. However I think she is declining, looks frailer, is on oxygen, has mobility issues, uses a lot of depends ( at least 4 28 count bags a month), is even more cognitively challenged lately, and is extremely needy. I thought she could benefit from the extra attention

Thoughts, anyone?

M1 · August 8

I bet she'll qualify...if not now then shortly. Doesn't sound like they had enough information to start with. Glad you went ahead with it.

ButterflyWings · August 8

They need to take her current Stage into account, and her worst day. Has she had any infections, falls / fall risk, weight loss or other decline lately?

I think you are right on time to press this issue. The lack of knowledge that some (many?) medical personnel have, regarding the real limitations of dementia is scary.

M1 is probably right, that the nurse didn’t have enough info at first, and likely overestimated your mom’s capacity.

Here’s hoping she receives that support sooner than later.

Iris L. · August 8

Is she losing weight? "Failure to thrive" is a criteria for admission to hospice.

Iris

Quilting brings calm · August 8

@Iris L. She’s not losing weight. That is probably one of the reasons they said No today.

@ButterflyWings She’s had 3 falls in the past year. Two of which fell just outside of the last six month range that they inquired about. She’s likely to fall again soon. She has a habit of walking away from her walker while in her apartment. The nurse saw her doing that today. Mom will then hold onto the furniture and the walls to move about. Add in the oxygen tubing from the stationary machine that snakes across the floor.

forbarbara · August 8

Just another fun roller coaster in the dementia theme park. Hospice has been helpful for my MIL - extra eyes and good advice. MIL has been on and off hospice twice now, and currently is off. She’s on a plateau doing pretty well, gained enough weight to no longer qualify for “failure to thrive”. (I think the part of her brain that tells her when to stop eating no longer functions. )

I’m particularly grateful that our local hospice will answer my questions even when she’s not in their care. Had to do this twice in the past 18 months.

I hope this works out for you and your mother. You are a good advocate.

harshedbuzz · August 8

I hope you can make this happen soon. You could use the extra help and support, and your mom could certainly use another layer of attention.

Quilting brings calm · August 8

—Just another fun roller coaster in the dementia theme park. —

Isn’t that the truth? I bet we could come up with dementia themed names for many amusement park rides.

fmb · August 8

The website below contains links to hospice evaluation criteria for various diseases. These criteria are set by Medicare.

https://www.vitas.com/for-healthcare-professionals/hospice-and-palliative-care-eligibility-guidelines/hospice-eligibility-guidelines

@Quilting brings calm Did her doctor's office provide all of her diagnoses? While she may not currently meet the criteria for admission based just on Alzheimer's, being on O2 implies a comorbidity that, when combined with Alzheimer's, may meet the criteria.

It is standard for an intake nurse to perform the assessment and report their findings to the hospice doctor for determination. The nurse probably has more practical experience in these situations and knows exactly what to look for.

Another thing to consider is that if this first hospice provider will not certify her for admission yet, another one might. I'm hoping for your sake that now that this first provider has more information, they will be able to certify her quickly.

Cosmic · August 9

Sounds familiar. Hospice came to do an evaluation and said LO was not ready, three days later I asked for another eval. She had declined so rapidly that hospice started immediately. Two days later she was bed-bound and Less than 4 weeks later LO of 64 years passed. Hospice is not an exact science and things change almost daily so if you see changes that concern you by all means have a re-evaluation.

starwood · August 10

This is my first post since I joined this group months ago after hubby was diagnosed and I’d really like input from others who have had similar experiences. Over the last 4-5 months he’s had a rapid decline physically. For a month or so, the decline was both cognitive and physical, but he had some improvement cognitively after some medications changes. However, he is now totally dependent in all self-care areas except eating, but needs some assistance with that. He’s developed a very severe lean to the side when in his chair, making transfer to bed/toilet, etc. very difficult He still has fairly good long-term memory, but is beginning to have more issues with knowing where he is. He has become wheelchair dependent, lost 15 pounds in 3 months, and despite medication to stimulate appetite, he is barely maintaining his weight. Neurologist has done diagnostic lumbar puncture for normal pressure hydrocephalus but his symptoms have not changed as one would hope if the diagnosis was positive. So, I’m wondering at what point hospice might come into play. I know every case is different, but am curious if anyone has experienced something similar and been approved for hospice.

Quilting brings calm · August 10

https://alzconnected.org/discussion/comment/218699#Comment_218699

You will get better answers if you start your own discussion. Just copy what you wrote and click on the plus sign to start a new discussion.

M1 · August 10

Hi Starwood, im sorry your husband is declining. Absolutely, ask for a hospice evaluation.

fesk · August 10

Starwood, you mentioned several times there were medication changes and that the decline has been rapid. I'd look at all changes and see if you can track any of the new symptoms to those changes. Overmedication or side effects sometimes could result in the symptoms you mention - lean, difficulty standing, etc. In addition to a hospice evaluation, I'd look into the possibility some medications may be contributing. Wish you the best.

Hospice assessment

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