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-   -   When can Hospice start? (http://www.healthboards.com/boards/alzheimers-disease-dementia/864079-when-can-hospice-start.html)

ninamarc 08-13-2011 09:44 AM

When can Hospice start?
 
Deb, you mentioned that you started hospice with your Mom.

what are the conditions that are required so one can start it? Do you have to wait for the doctors to say that? Can you start it without the doctor's request? How does the hospice co. approve it? What are they looking for?
Terminal and what stage?

I am just wondering. My FIL wants to be treated as much as possible, unlike your Mom, he does not mind short-term catheter in principle.
Of course, surgery is out of question. ER is still the option.
How do you tell people no ER and etc.? What if my FIL wants to go to the ER? He still knows about doctors and the ER. He can still say that he wants to see the doctor because he feels bad.

I checked the website and I found some 5 conditions that meet medicare requirement and also he needs to have some serious disease - he has congestive heart failure.
I just don't understand how people bring it up. Usually it is told by the doctor.

Thanks,
Nina

Gabriel 08-13-2011 11:27 PM

Re: When can Hospice start?
 
For both my Mom and my Dad I requested a Hospice evaluation. Yes, it had to be approved by the doctor first but it was my request. You don't have to wait on the doctor to suggest it... The doctor just has to sign off on the evaluation. Then Hospice came in and did their evaluation. They were the ones that determined acceptance. Once they accepted Mom, they notified her doctor. I had opted to use the Hospice doctor so her previous doctor sent all the records to Hospice.

If there is a reason for a medical consult the Hospice nurse comes and evaluates. If necessary the Hospice doctor will come out as well. It is then up to them to determine treatment. Mom's Hospice nurse visits with her twice a week on a regular basis. So Mom actually sees more medical personnel now than she did before... she just doesn't have to go to the ER to see a nurse or doctor :)

Love, deb

ninamarc 08-14-2011 10:43 AM

Re: When can Hospice start?
 
[QUOTE=Gabriel;4822346]For both my Mom and my Dad I requested a Hospice evaluation. Yes, it had to be approved by the doctor first but it was my request. You don't have to wait on the doctor to suggest it... The doctor just has to sign off on the evaluation. Then Hospice came in and did their evaluation. They were the ones that determined acceptance. Once they accepted Mom, they notified her doctor. I had opted to use the Hospice doctor so her previous doctor sent all the records to Hospice.

If there is a reason for a medical consult the Hospice nurse comes and evaluates. If necessary the Hospice doctor will come out as well. It is then up to them to determine treatment. Mom's Hospice nurse visits with her twice a week on a regular basis. So Mom actually sees more medical personnel now than she did before... she just doesn't have to go to the ER to see a nurse or doctor :)

Love, deb[/QUOTE]

Deb, thanks for the reply.

So far my FIL can still walk a little bit and he talks when he wants to talk although he does talk less and less this spring/summer. He does not understand the surroundings but he likes where he is. He is not in a wheelchair. The UTI has started but it is the first time in the home after 1 year.
I suspect starting next year, he will be in that shape when he cannot walk or talk well. Then we will think about hospice.
The other thing is, if you mention hospice too early, sometimes the people in the home may think you want him to die... But it is not my intention whatsoever. You know, how people misinterpret your motive?

Hugs,
Nina

Gabriel 08-14-2011 11:27 AM

Re: When can Hospice start?
 
Nina, as I have said my Mom still walks and feed herself with cues. Her ability to communicate is limited but it has been that way for over 2 years now. Yet she qualifies for Hospice. The Nurse and Social Worker frequently walk with her in the court yard to do their evaluations :)

Hospice has nothing to do with wanting a loved one to die. It doesn't even mean that they are going to die imminently. It means that they have a terminal condition and you have opted for palliative care rather than aggressive medical treatment because they are not going to return to their previous healthy state of being. It is about getting them the addition medical attention that is appropriate for where they are in the moment.
When I took Mom to her regular doctor for blood in her urine they wanted extensive test to determine the source of the blood. Is it a tumor or obstruction. They want to rule out the worse case. The Hospice nurse will order a short run of antibiotics for potential cystitis and forgo those extensive test because we are not going to treat those more invasive problems if they exist. You don't have to argue with a specialist that there is no need for what he thinks is necessary. Most of the medical profession is geared to find the worst if it exist and aggressively treat the underlying problem. Palliative care treats the symptoms to make the patient more comfortable.

My Mom is in the later stages of Alzheimer's. I am not going to aggressively treat a cancer if she should have one. I am not going to treat her as if she was a health 60 year old with many good years ahead of her. The Hospice philosophy gives you the support and guidance to make the decisions that need to be made to make your loved one as comfortable as possible without unnecessary procedures. Yes, it does take accepting that your loved one has a terminal illness. It also takes a decision that you are not going to aggressively search and treat other conditions but instead attempt to keep your loved one comfortable and pain free.

Love, deb

PS... as for what others might think :) I do what is best for me and my Mom and they can think what they want to :p


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