about hospice, they came to see my DH yesterday and when they did he still didn't qualify, even with the 20lb weight loss, loss of appetite and all of the other things wrong with him. I wasn't surprised about that yet because I knew he needed to lose another 20lbs before he would qualify. Then I was talking to a friend who use to work for the Movia(sp) program and she was saying that as of July the qualifications for hospice may have changed because of the medicare changes. Have you heard anything about it. It made me pretty depressed for a while because I was depending on them stepping in by the end of this year and now it feels like it will not happen for a lot longer. The nurse was saying he probably will be 130 lbs before they step in and qualify him.
Yes, at first I was told 20 % of his body weight. So if he was 199 when he started he would be 160 something when he qualifyed but anyway it sounds like it is not a fast rule anyway.
Deb, if you have more than one Hospice just check with them. We are a small town but we have 4 or more to chose from. Sometimes he may qualify with a different Hospice.
I guess in Texas the rules must be different. From what I have read off this site I fully expected them to tell me she did not qualify. They did weigh her and she has lost a little may 15 1bs at 155. In 5 minutes the nurse told me she was marginal, but would put her on for 90 days.
Failure to thrive is a favorite diagnosis for hospice. It was on the face sheet of my four patients. While they were all thin they didn't look like they were wasting away. Don't foget-hospice is a business like anything else. No patients-no billing.
bluedaze is exactly correct, sometimes it depends on their census. If it is low I think qualifications are a little more lax. I don't know if you contacted yourself or your doctor recommended Hospice, however, if it was the latter, you might try having the doctor request. My husband didn't qualify the first time he was evaluated. He couldn't speak, feed himself, was incontinent, couldn't not shower or dress himself, but, he could get out of a chair with one hand & walk. I still think it was his age of 60, that played a part. When he started having problems walking alone, I called them & he qualified that day. I am so grateful.
My dh can not dress-shower-is incontient most of the time-sometimes forgets how to eat-can still talk but does very little of it and he did not qualify.And if he walks any slower,the turtles will all pass him!!
Yes if census is low they will admitAn but if no decline may discHharge. Medicare guidelines have to be followed or medicare will make hospice pay them back.
nelle, that is just terrible!!!! I hate the fact that they are treating this like a business when it is our lives that I am talking about!!! The people that have come to evaluate him are so nice and thoughtful and almost apologetic when they have to tell me that he doesn't qualify yet. The man that came last was the first one to actually ask me about how I am coping with all of this and I got to tell him how it is affecting me. That was nice that he asked about me, he spent about an hour with us even though he didn't get paid for it.
bluedaze, I have heard the term failure to thrive a lot lately and in fact the director of hospice told me that I could probably get him qualified faster if that was actually used as the diagnosis(weird huh!)
Kadee, the doctor is the one who recommended hospice in the first place and that is why I think the doctor knows more than he is telling me(like how bad his dementia and parkinson's really is) We have had 3 evaluations total, the first one the doctor wanted and the second one the director wanted because she was concerned about my needing help considering my own medical issues and the third one was kind of a fluke. The director stopped by to see how we were beccause she couldn't get a hold of me on the phone and she asked a nurse to do the third one. I don't know what is up but it sounds like they are trying to help but just have their hands tied.
I am very thankful for the respite that Hospice has provided, but I think there is more going on here. I think the Hospice that I am working with is a for profit business and they have a blank check from Medicare. They seem to be wasteful. They are sending 2 Aides over each day to the nursing home to bath DW. That seems wasteful as they have staff at the NH to do that. I asked for the minium level of care from Hospice and the nurse told me she would check on DW twice per week. The nurse has been checking on her every day. I just think this is the problem with our health care system, they see the opportunity to make $$$ and they take it. There needs to be some incentive for providing the best care at the lowest cost.
moorsb, so do you think that they are evaluating him properly or are they doing it based on the cha ching method? I would hate to think that is what they are doing but it wouldn't surprise me in the least. I think that you are right though it come down to the health care system. Who knows I may end up doing this all by myself anyway! Uggggggggggggghhhhhhhhhhhh!!!!!!!!!!!!!!!
Our hospice is non-profit. I am pleased that we have aide that comes 7 days wk. However their census was los when accepted in feb., 7 months ago. During this time he had stroke and "severe" agitaion spells. He eats very well. Has had pneumonia. Dh is end stage. I keep looking for any sigbs of decline - none except for pressure spota due to care at their facility. Now their census is very high.I keep daily notebook that I record each days activity that may help us continue. Also, we have to use Hoyer Lift to get him in and out of bed.I can't tell if he has lost anu weight except upon returing from their facility for respite July 19. It has been that long we are trying to heal pressure sore area and he did gain weight back.
Once upon a time "hospice" meant a group of caring friends and volunteers who stayed with someone expected to die within a month or two. Not dementia patients. Over the years it's been turned into a business and apparently a lucrative one, as has "home health" in general. Once upon a time people stayed in the hospital until they could be safely cared for at home; now they are discharged to a "rehab" facility and often after that are prescribed visits by nurses and aides at home. One would expect that being cared for at home would be a lot cheaper than being cared for in any kind of facility, and it is. But 'tain't cheap.
My husband was referred for hospice by his PCP at the point at which he became essentially bedridden because of his physical problems as much as because of his dementia. He was on it for a year before he died. The medicare summary notices were sent, of course, and I've just looked at them to be able to describe their charges. RNs are billed at $652/hr; aides at $268/hr ($163 for 15 minutes of RN; $67 for 15 minutes of aide). I should note that both RN and aides spent a good bit more than 15 minutes each visit, and the aide in particular had to travel all over the state, at his expense, but 15 minutes a visit is all that was billed. Meanwhile there was an almost $2400 charge for "hospice in patient home" on top of this, so that the bill to medicare for two weeks was $2918. Which Medicare paid; my paper is one of those "THIS IS NOT A BILL" things. There's obviously a lot of back office support for everything, but reading these charges makes one realize why people think Medicare needs some reforming.
That said, they were great to have around!
So when you read that cuts are being looked at for Medicare, do realize that
Also, if you have another insurance plus your medicare they bill that insurance company first. When my dh had hospice last year, I thought it was a total fraud, I called our insurance company to complain and they didn't seem the least bit concerned.
At the time, my dh was totally mobile, could speak and carry on conversations. A VA doctor recommended the valuation by hospice because he has two terminal illness, COPD and ALZ. They purchased him a shower chair, which he didn't need. They rented oxygen for him which he didn't need. After about 4 weeks they discontinued the hospice service.
>>>>RNs are billed at $652/hr; aides at $268/hr>>.. how much of that do you think the RN and aide actually saw? The RN probably got more of their share than the aide who probably didn't get much more than minimum wage.
Yes, you get the feeling that it is all about the $$$ I was not at home when the RN shows up. The aide told the RN that she had noticed several bruises on DW comming from her stay at the NH. The RN did not even look at the bruises to see how bad.
I'm sure the RN and aide were paid MUCH less. Around here the going rate for aides through an agency (not Hospice) is about $18/hr. My invaluable Andrew (do a search) was paid about $10/hr; when he worked for me outside the agency - he did all the housekeeping for most of a year, and I MISS him! - I paid him $15 privately.
briegull, I agree that it is good to have them around. Even though he doesn't qualify yet they are very( or act like ) interested in helping me. They are calling me every 30 days and evaluate every 3 months and they say I can call them whenever there is a substantial change so they are not deserting me all together. I guess it is better than nothing.