Hospice Assessment in MC?

ARIL · January 10

What is involved in an assessment for hospice care? Is there any reason NOT to have an assessment for a person around late stage 6? Does Medicare pay for hospice entirely?

Yesterday my father fainted in MC and was sent to the ER. I was called at work and went to the hospital within an hour. Fortunately the ER doctor was a reasonable person and let us take him back to MC after a battery of tests. But it does seem increasingly the case that medical interventions aren’t accomplishing much, and they are traumatic for him.

I plan to talk to his PCP, but I am interested in knowing from this community what the process is like. Thank you.

SDianeL · January 10

you just contact hospice and they will do the evaluation for you. Yes Medicare pays for it. You must agree to no medical intervention. Hospice is wonderful. They usually approve anyone with late stage dementia. They reevaluate them every 6 months. Don’t hesitate to call them. There usually are multiple hospice organizations so if for some reason you're not happy you can contact another one.

AmandaF · January 10

I would not hesitate to ask, though you might talk to the MC staff in addition to the PCP, since they could have specific hospice agencies they know to be good. For my mom it was dementia plus a bad injury that led to her qualifying. The MCF put me in touch with the hospice director, who explained everything and answered my questions, and then sent a nurse over to meet me and my mom and do the evaluation. For us they reevaluate every two months, and I really hope she will continue to qualify, as they have been an amazing help.

And yes Medicare covers it entirely, it’s wild, almost like we live in a society or something! Good luck.

ARIL · January 10

Thank you both. I spoke to MC staff, who told me that there are three hospices that they work with regularly but that my dad’s PCP has a strong preference for one of them. I emailed the PCP a little while ago to get this conversation started.

@AmandaF Thanks for making me smile with that “it’s wild” remark. From a cost standpoint, I can see why Medicare would pay for hospice in preference to multiple fruitless hospitalizations, but I can’t say I’m used to feeling as though there’s much of a social support network in place. Except maybe on this forum!

Anonymousjpl123 · January 10

Aril,

It’s actually really good. Hospice seems like one of the things we have that really really helps. Medicare covers it in full. Similar to you, my mom’s MC connected us to hospice after a very bad fall and weight loss. It has only been amazing. So many extra services. Not just extra supplies and stuff, but the chaplain and social worker visit regularly, she gets excellent care, and they have people visit. She even got lavender reiki!

I think it’s also great you and the MC are coordinating with your mom’s PCP.

I have found it to be an incredible resource for my mom and me. Which as you said, is rare!

CaliforniaGirl-1 · January 11

We get reevaluated every 60 days. Our doctor said that sometimes patients do so well on hospice that they "graduate" and the families are sorry they will stop getting all the services but they can go back on anytime and ask for another evaluation. Some people are on and off for a few years.

After reading here about communication issues between facilities and hospice we used a hospice service which was one of 3 recommended by our MC. The best thing was that my LO's physician, who we love also sees hospice patients for them so we have had continuity of care which has been great.

Having a doctor or nurse on call 24/7 has been very helpful and the hospice service has been very supportive of my LO's quality of life.

psg712 · January 11

I appreciate everyone's comments on this topic, as I've been considering hospice for my mom too. Up till this point, the health director at her MC has said she's not ready yet. Probably because most of the residents there who use hospice services are wheelchair or bedbound, completely dependent for all ADLs.

My mom still walks with a walker, is partially continent, feeds herself though needs increased prompting and eats much less than she used to. Needs step by step guidance with ADLs. Her communication skills are rapidly diminishing. You have all heard my frustration with antibiotic treatment for what appears to be progression of dementia and "so that she doesn't have to go to the hospital". Avoiding ER visits is one of my primary motives for hospice care. But does she actually qualify? I'll be meeting with the health director again next week and this is on my list for our discussion. Open to all input!

CaliforniaGirl-1 · January 11

The hospice will evaluate and decide what the condition is. If they decline, and it happens you can pursue an evaluation with another hospice provider or ask to have your mom re-asessed. You can also refuse to let them send your mom to the ER and ask for hospice instead.

In our case it was the ER doctors who said to me, its time and offered to start the process then and there. I declined and said, I would speak to my LO's physician,

Quilting brings calm · January 11

@psg712

You’ve described my mom at the point she went on hospice. Because she needed help with her ADL’s ( being directed in the shower, help picking out clothing, was partially incontinent), used a walker, and was on oxygen. Although she did die a few weeks later, that was unexpected when she was evaluated. The first evaluation, we had the wrong staff member helping me talk to the evaluator. That staff member implied mom was more independent than she was. The hospice evaluator came back 60 days later ( they put her on a schedule) and re-evaluated her. I had a staff member that I knew understood mom’s limitations present with me for that evaluation. She was accepted.

ARIL · January 11

I appreciate these insights. My dad is ambulatory (but with more and more balance issues), partially continent, and needs lots of cuing and increasing support with ADLs. He is sleeping more and more, eating less, losing weight, and so on. He is still verbal. He was in the ER after fainting this week. It does appear that hospice could be a helpful next step.

For those of you who have gone through an evaluation, what is that like? Is there a physical exam? A conversation with MC staff? The POA? The PCP? All of that? Who conducts it?

Quilting brings calm · January 13

In the cases of both my mom and step-dad, the process worked like this: The AL nurse suggested to me that it was time for hospice. I agreed. She called the doctor and requested a referral to hospice to the agency normally coming to the AL. An evaluation was scheduled. I attended the one for my mom. It’s a mini physical exam and questions about their medical situation, how they function, can they do ADLs independently, etc The evaluator got some info directly from the doctor and submitted everything to the hospice doctor. Who made the decision. In Mom’s case she didn’t qualify and they put her on a schedule to ge re-evaluated two months later. She qualified that time.
Medicare began picking up the cost of her depends and wipes, hospice arranged for a hospital bed, visits from the hospice nurse, social worker, chaplain, aid. Because she was on hospice, the AL allowed her to stay until death even as her care needs greatly increased.
It was the same for my step-dad.

terei · January 13

My mom’s companion who saw her at least once a week suggested to me that we should call a hospice. I was initially shocked, perhaps because I was seeing her only a several days a month because of my distance to her MC. Mom had been non verbal for about 8 months + was aggressively refusing meds. I told the staff to try ONCE to get her to take them and if she refused to STOP. It was only serving to agitate her twice a day. We never saw any change when we stopped the meds. She was sleeping more and more…sometimes would even fall asleep at meals and was losing weight. She was accepted to hospice immediately about 6 months before her death from ALZ.

Hospice Assessment in MC?

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