Usually when it is believed the patient has 6 mos or less to live. It can be extended for 6 month intervals. Go to search and type in Hospice. You will find many threads. Arms around, Susan
My wife, late stage 6, was put on hospice after she was hospitalized for pneumonia. She was "re-certified" at 90 days, meaning she had shown signs of "deterioration". At the end of the next 90 day period she was "discharged" because they could not satisfy the medicare requirements for "deterioration", even though everyone agreed she was worse. I don't know when she will get back on. Since one of the benefits of having our LO on hospice is the 5 day respite, I feel we should look into this sooner rather than later. I had checked with hospice 6 months before she was accepted. The pneumonia made the difference.
My wife is very clearly in stage seven. She cannot even walk reliably by herself. She does not speak except to jabber, she hasn't used my name in close to two years. She has no idea where she is, who she is, what day, month, season or year it is. There is only an hour or so each day when she even responds with a simple yes or no to questions like are you hungry or do you have to use the bathroom? She cannot feed herself. Dressing herself, even inappropriately, is ancient history. Yet... even the smartest doctor on earth could not accurately predict how long she will live. So who decides when "six months" is?
Sometime people are referred to Hospice by their physician who sees them in a decline of sorts. Whether it is a permanent or temporary decline, the physician recognizes that they will need a higher degree of care and Hospice can (and in our case, DID) provide that. Do NOT fear Hospice. It is NOT a death sentence or forewarning. They said that is one of the hardest things to convince people. Bringing in Hospice or NOT bringing in Hospice will not change the outcome of this disease. If they ARE going to die, they will, either way.
Hospice has been a wonderful asset for our lives in the last two months. To keep on it, the patient must chow a decline..lost weight, muscle mass loss, loss of appetite, etc. Marsh has said it right...decline is good ????? But that is how it works. It would be dreaful for both of us if he was not recertified after this period...ournurse says he will be as his decline is so evident..we'll see.
Thunder--We had Hospice and then were disenrolled when Medicare tightened the guidelines for qualifying. The ADLOs your wife cannot do are the ones my DH still can. He was enrolled under the condition "debility". When his deterioration continues to decline in the activities of daily living he'l go back on. A referral from your Dr. to the Hopice you want will start the ball rolling. Having help and a 24/7 call line for any help or information is wonderful. It sounds like it's time for help. Go for it.
My DH went on hospice a year ago by the recommendation of the doctor at the hospital where my DH went after psychotic behavior to have his meds stabilized. I think they clearly put him on hospice too soon but I'm grateful for it. Almost all of his medications are covered as well as briefs, wipes, and gloves. I say go on hospice as soon as they accept you.
What I have been gathering from everything I have read here is that dementia patients qualify much sooner than we think. I hope that will be the case in my DH because when I can't take care of him myself at home I don't think I am going to be able to afford a NH but I am going to cross that bridge when I come to it.
My husband has been on Hospice since July 2009. He keeps qualifying due to his rapid decline. He couldn't talk, dress himself alone, feed himself without assistance, or walk without assistance. Now he can't even sit up by himself and can't hold a fork or spoon in his hands. You don't have to be on your deathbed to get Hospice. Each Hospice has guidelines that they go with...and your doctor's recommendation carries weight as well. The case manager and nurse who come out to do the interview to "see" if they qualify are the ones who have to see them at their worst. It doesn't mean that they are going to die in 6 months.
When Hospice comes to your house, don't talk for your spouse or help the spouse in any way....let them struggle for words and everything else. Do explain to them what YOU have to do for your spouse; and the fact that they can't be left alone, and can't prepare food counts too in some states. I still can't believe that Marsh's wife was taken off Hospice. I still think it was a new nurse who couldn't see the decline in the last two months!
When we did have Hospice,our Nurse and CNA could see DH's declines, but they still had tro disenroll him because Medicare had tightened the guidelines odf decline that were the measure. Basically, DH was declining in cognition, languagfe, etc. but the measures for Hospice are still primarily along the lines of physical abilities. DH ws holding his own there. When he develops (progresses) in the skills they can count. he'll go back on.
As Mary says, each hospice has its own guidelines. And each state. And as Carol says, the Medicare guidelines are tightening up. If there's a co-morbidity, like serious heart trouble or maybe diabetes, then that would "help" too. My husband is currently about due for his six-months renewal. I doubt that he will qualify because, although almost totally bedridden, he has not shown decline and indeed is still putting on weight! Andrew our private CNA gives him so much "enrichment" that he's even more verbal than he's been for awhile, although he still has severe aphasia. As I said in another post, look at the pics I've put up on Facebook. He's happy.
What have we gotten out of Hospice? A nurse visiting and taking vitals every week, and prescribing ativan equivalent (not the rest of his meds). A social worker once and a chaplain once, who would have come more often if I'd needed them. A CNA who comes for less than an hour twice a week - I want my husband to be comfortable-ish with someone other than Andrew. However, the CNA is rushed and sometimes doesn't get here until 11 or 11:30. Our hospice did provide a hospital bed, and a geri chair. They did not and do not provide any supplies. They do not provide respite although they do aim you at some church charity that will help if you are at the medicaid level. I'm hoping that if he does get dis-qualified he can keep the nurse coming at least a couple of times a month. And the bed.
I called Hospice today. The person I spoke to asked me if Sharon met the following four criteria. Has she lost weight? ( she weighs 89 lbs) Has she had multiple hospitalizations? (not multiple but she was admitted a month ago for two days) Does she have difficulty swallowing? ( It is hard to get any liquid into her for fear of her choking, She has great difficulty swallowing most of the day) Is her vocabulary down to about 6 words? (she never speaks unless we prompt her to and it is rare to get an intelligible response... I am not sure if 6 is the exact number but it is close)
When Hospice called Sharon's doctor he said he didn't think she was "Hospice Ready"...?? The woman pressed the issue and he agreed to have Hospice visit and evaluate her. That is supposed to happen this weekend.
Sharon is so rigid and out of it it is near impossible to feed or bathe her. even though her doctor saw her only a few weeks ago I don't think he has any idea that she has declined this far.
Might be on the wrong thread here ... Today, I got on line and applied for hospice.. As some of you remember DH has been cleared for total knee replacement in a week.. With his cancer, heart issue, macular degeneration and dementia, I just got a little panicky when I read that there might be a waiting period or in some cases they are approved a day before they die... I am wearing out fast, mentally and if I am left to totally care for DH I will be used up...I want him to have care but I also want a life after... Selfish maybe, but I know it is entirely up to me to decide.. My question, > DID I do the right thing?? and where do I go from here... this disease gives us all a degree in so many phases of medicine.. I'm learning.. Thanks, all
peggy - I still do not know why, with all the other medical problems, you are putting him through the knee replacement surgery? From what others have said, there is the chance he will not recovery mentally to where he was before the surgery. Knee replacement is no 'walk in the park' for a healthy person, let alone one with numerous medical problems including terminal diseases (AD and Cancer).
wow my LO had knee replacement about three years ago just as Alzheimers was starting to make its appearence,after surgery the same day she got out of bed an said she had to get to school the kids were waiting for her in the classroom,five security people doctors ,nurses,chaplin,one of her sons an myself noone could control her,she was put in strait jacket an got out of it by biting the straps,then she bit a nurse,finally after about 8 hours they were able to drug her enough to calm her down,don't know if was all the stuff they gave her for operation but whatever she went bonkers,no way would I want to go thru that again,like Charlotte says no way to that operation,sounds to me like the doctors have a boat payment coming due
The morning after my husband's TKR he got up out of bed without assistance and was found wandering the halls. I had warned the staff to watch him. He wound up with a very good knee and loss of much brain function.
peggy--re hospice--I don't think there is a downside to applying. Our experience was that my hb was approved immediately--the day the intake nurse came to our home and interviewed me. After a couple of weeks on hospice, he was put into a geripsych unit for med adjustment,and I had to sign a paper to suspend hospice. Tomorrow is he supposed to be released and I will take him to an ALF to live. On Weds., I will call the hospice and tell them to reinstate him. So if your husband is approved prior to his surgery, I presume you would go through the same process--no big deal. (Of course, I'm sure there's a ton of Medicare paperwork coming my way, but I'll deal with it when it comes.)
Thanks, Marilyn I just had a wonderful call from hospice and they were sooooo very encouraging... DH has already been put in the system and they will access him .... All very easy...Yes, I expect lots of paper work and all that but, I'm getting use to questions and paperwork.. Hopefully, this will relieve his pain, maybe adding to his quality of life.. You've been very encouraging...
Peggy, I don't think anyone was trying to give you more guilt, they were just trying to tell you their experience with dementia & surgery. They were only thinking of the well-being of your husband & you. Regarding Hospice, my husband's doctor ordered Hospice. The first time he did not qualify, 3 weeks later he qualified.