hospice

I need some advice! My mothers doctor will not order hospice for her even
though he has told us several times in the past that she needed it. She is
currently in the hospital and will be released in a couple of days, and he
wants to send her to a nursing home instead of hospice. Everyone that has
been involved in her care has said she needed inpatient hospice, but without
her doctors order we have no other option, do we? I have tried to contact
other doctors in her area,but I can't see putting her through more
evaluations and exams at this point.There has to be something I can do that I
haven't thought of. Any suggestions would be wonderful!

sode wrote:
> I need some advice! My mothers doctor will not order hospice for her even
> though he has told us several times in the past that she needed it. She is
> currently in the hospital and will be released in a couple of days, and he
> wants to send her to a nursing home instead of hospice. Everyone that has
> been involved in her care has said she needed inpatient hospice, but without
> her doctors order we have no other option, do we? I have tried to contact
> other doctors in her area,but I can't see putting her through more
> evaluations and exams at this point.There has to be something I can do that I
> haven't thought of. Any suggestions would be wonderful!
>

I suggest you contact a hospice in your area and explain the situation.
Perhaps the hospice will do an assessment to see if your mom is hospice
appropriate.

Hope this helps.

Russ

"sode" <u34621@uwe> wrote in message news:72ecdc35d50cf@uwe...
>I need some advice! My mothers doctor will not order hospice for her even
> though he has told us several times in the past that she needed it. She is
> currently in the hospital and will be released in a couple of days, and he
> wants to send her to a nursing home instead of hospice. Everyone that has
> been involved in her care has said she needed inpatient hospice, but
> without
> her doctors order we have no other option, do we? I have tried to contact
> other doctors in her area,but I can't see putting her through more
> evaluations and exams at this point.There has to be something I can do
> that I
> haven't thought of. Any suggestions would be wonderful!
>


I am basing this on you and your mother living in the USA, otherwise this
information will not be useful.
Call a hospice yourself, first of all depending on where you live there may
not be any inpatient hospice. Ask for a hospice evaluation. Many hospices
will see patients in a nursing home, providing home hospice ( since the
nursing home is the patient's home). Your mother if admitted to inpatient
hospice will not have any tests and the medical director would do the
evaluation..

Also unless your mother is actively dying ( death is days away) or required
inpatient care your mother will have to pay the "Board charges" which will
be about $200/day. How about taking you mother home with hospice care? That
could be hard if you have other family commitments.
Good luck, Alex

Russ is correct. Check with a local hospice. The intake nurse may be
able to intercede with the doctor to make the hospice admission. Many
hospice nurses have run into this situation with doctors---many times it
is due to a lack of *knowledge* of what hospice is and what it can/can't
do.

>I need some advice! My mothers doctor will not order hospice for her even
> though he has told us several times in the past that she needed it. She is
> currently in the hospital and will be released in a couple of days, and he
> wants to send her to a nursing home instead of hospice. Everyone that has
> been involved in her care has said she needed inpatient hospice, but
> without
> her doctors order we have no other option, do we? I have tried to contact
> other doctors in her area,but I can't see putting her through more
> evaluations and exams at this point.There has to be something I can do
> that I
> haven't thought of. Any suggestions would be wonderful!

Hospice is appropriate for people with a terminal illness but it is not
appropriate for long term care (more than about 2-3 weeks). Longer term care
is more appropriate in a nursing home and many have staff with an interest
and / or experience in palliative care.
MIKE

"Mike Radcliffe" <mikeradcliffenospam@iinet.net.au> wrote in
news:465d04c0$0$17968$5a62ac22@per-qv1-newsreader-01.iinet.net.au:

>>I need some advice! My mothers doctor will not order hospice for her
>>even
>> though he has told us several times in the past that she needed it.
>> She is currently in the hospital and will be released in a couple of
>> days, and he wants to send her to a nursing home instead of hospice.
>> Everyone that has been involved in her care has said she needed
>> inpatient hospice, but without
>> her doctors order we have no other option, do we? I have tried to
>> contact other doctors in her area,but I can't see putting her through
>> more evaluations and exams at this point.There has to be something I
>> can do that I
>> haven't thought of. Any suggestions would be wonderful!
>
> Hospice is appropriate for people with a terminal illness but it is
> not appropriate for long term care (more than about 2-3 weeks). Longer
> term care is more appropriate in a nursing home and many have staff
> with an interest and / or experience in palliative care.
> MIKE
>
>
Mike,

I think this varies. Here the guideline is 1 year or less of expected
survival for hospice care, & the patient cannot be seeking curative
treatments. Hospice can deliver different pain medications than are
gernerally used outside along with support for the patient & family.
Hospice services are also delivered without any co-pay by many insurance
companies.

But, if hospice is delivered in a nursing home, my insurance company
considers this 2 different things & will pay for only 100 days of nursing
home care, but that may be enough.

Fig

"sode" <u34621@uwe> wrote in news:72ecdc35d50cf@uwe:

> I need some advice! My mothers doctor will not order hospice for her
> even though he has told us several times in the past that she needed
> it. She is currently in the hospital and will be released in a couple
> of days, and he wants to send her to a nursing home instead of
> hospice. Everyone that has been involved in her care has said she
> needed inpatient hospice, but without her doctors order we have no
> other option, do we? I have tried to contact other doctors in her
> area,but I can't see putting her through more evaluations and exams at
> this point.There has to be something I can do that I haven't thought
> of. Any suggestions would be wonderful!
>

Hello,

Does he give you a reason? I wonder if there could be a misunderstanding
of terms. Sometimes hospice services are delivered in a nursing home
setting, sometimes at home & other times in a bricks & mortar hospice
(which are becoming rare where I live).

Could he be telling you she needs round-the-clock nursing care maybe in
addition to hospice services?

You might want to check any medical insurance to determine what her
coverage is for each. If she is not seeking curative treatment, which
sounds like the case, hospice can help with pain issues, nutrition,
personal/religious issues & support her & your family emotionally. You
can often get services coordinated easier than you cound arrage them
yourself. There is often a cost advantage as many insurance companies
charge nothing except your normal premium for hospice. The nursing home
adds another dimension, so you'll want to check her policy closely & ask
what you would be required to pay for that & any maximum number of days'
coverage.

Should you opt for home hospice (maybe your home), hospice can send
helpers for bathing as well as nurses & social workers & chaplains. They
can sometimes give the caregiver a break (called respite). But caring
for a dying person, especially if pain or other medications need to be
administered around the clock can be more taxing than it may sound.

I am sorry this is happening to you & your mother & I hope you find easy
resolution. There are many here who have traveled this road, myself
included, so feel free to stay with us. We support caregivers as well as
people living with cancer.

Fig

>> Hospice is appropriate for people with a terminal illness but it is
>> not appropriate for long term care (more than about 2-3 weeks). Longer
>> term care is more appropriate in a nursing home and many have staff
>> with an interest and / or experience in palliative care.
>> MIKE

>
> I think this varies. Here the guideline is 1 year or less of expected
> survival for hospice care, & the patient cannot be seeking curative
> treatments. Hospice can deliver different pain medications than are
> gernerally used outside along with support for the patient & family.
> Hospice services are also delivered without any co-pay by many insurance
> companies.
>
> But, if hospice is delivered in a nursing home, my insurance company
> considers this 2 different things & will pay for only 100 days of nursing
> home care, but that may be enough.
>
> Fig

In Western Australia our criteria for admittance to an inpatient hospice is
that you have advanced terminal disease.
Funding is for two weeks respite to give carers a break, unlimited for
symptom control and two weeks for terminal care this last item is flexible,
of course but beds are limited and some judgement has to be made about
moving to longer term care options if the patient has 'plateaued' and no
longer seems imminently close to death'. They can't afford to have beds
'blocked' by relatively stable patients for months as this would deny
others in more acute need the care they need. I know this happens in other
countries and can only assume ,as in the UK, that home hospice services are
inadequate.
Acceptance into 'home hospice' where I work is based on a patient having a
terminal disease and symptoms needing control and a life expectancy of 3-6
months. Patients are usually looked after their oncologist until this stage
is reached but those with difficult symptoms still have access to pain
management and palliative care teams in hospitals.
Many nursing homes have palliative care trained staff and nursing homes can
request hospice input from my service to advise on symptom management. Many
of their residents have been with them for years and don't want to go to a
hospice and likewise the staff form attachments to their residents. The
drugs and equipment are available to all wherever they are.
About 50% of our patients die as inpatients either through choice or
circumstance. Most would choose to die at home if they could.
Medicare covers all the costs. Although some 'exotic' drugs not approved
have to be paid for by the patients there are often ways around this.
MIKE