In my mom’s case, she could have self-paid for the two weeks at the CCRC, but it seemed unreasonable that the secondary insurer didn’t want to pay for something that seemed likely to (and did) make it possible for her to return to living at home alone. Penny-wise, pound foolish.
Once we get to the point where we are convinced that my mother cannot get better or more independent we’ll all agree that less intervention is better. But stepping down to the nursing home now when IL or AL are in reach with more rehab is not in the cards.
I agree with @surfcity about being realistic on what the senior person can do, is willing to do, what means QOL to them. Of course if they are depressed, some medications can help. Sometimes they just don’t want to push themselves with therapy, and one needs to look at their situation as being capable at the level they are at.
Resident/senior can always refuse meds. I have a resident that gets two pills at night, and picks out the antidepressant and refuses to take it. Of course the resident which has medications mixed in apple sauce or crushed, they usually are compliant in taking their medications.
Emotional/physical/situational. Some have more tenacity and inner strengths to cope well Some don’t. Try to show them the love no matter how frustrated/angry anyone gets.It always also helps to have compassionate staff who stay friendly and work through various situations with the resident and their family.
@MomofJandL good for you being a fierce advocate for your mom! I often think of myself as a mama bear when it comes to my parents. A trait I see with so many on this thread and my protective instincts seem more fierce than they were with my kids. I think it’s because we have less protections for the elderly in our society.
It is now very clear that FIL and MIL (who both are in the hospital now) will need to go to rehab and then skilled care. The two geographically close sons are handling things. MIL I believe is too weak to have any resistance. FIL likes to be waited on, so he will go with the flow.
Hospice came to visit us last week, it’s apparently really tough to get approved for hospice for dementia! This is the 3rd time I’ve spoken with them in less than a year. They agreed to come out this week and recheck her, but got snowed out, hopefully next week will be a hospice intake. I swear to you, I don’t know if I should hope she rallies and gets better or stays bad so she qualifies!
I’ve had the same experience @somemom. Hospice has been out twice but my mom isn’t “bad enough.” I would definitely would like to have extra help and support.
Table 1
Medicare Hospice Benefit Eligibility Criteria for Dementia
Patients will be considered to be in the terminal stage of dementia (life expectancy of 6 months or less) if they meet the
following criteria. The medical record of the patients with dementia should show all of the following characteristics:
- Stage seven or beyond according to FAST;a
- Unable to ambulate without assistance;
- Unable to dress without assistance;
- Unable to bathe without assistance;
- Urinary and fecal incontinence, intermittent or constant; and
- No consistently meaningful verbal communication: stereotypical phrases only or the ability to speak is limited to six or fewer
intelligible words.
Patients should have had one of the following within the past 12 months: - Aspiration pneumonia;
- Pyelonephritis or other upper urinary tract infection;
- Septicemia;
- Decubitus ulcers, multiple, stages 3 and 4;
- Fever, recurrent after antibiotics; and/or
- Inability to maintain sufficient fluid and calorie intake with 10% weight loss during the previous six months or serum
albumin <2.5 gm/dl.
a
Functional Assessment Staging Test. Stage 7a is unable to ambulate without assistance.
Sad to say, I am glad she has lost 10% of her body weight or she would not have hit anything on the bottom list and she still can talk, that is a rough list!
My mom can still ambulate but that’s it of the first 6 on the list, and she’s had recurrent infections, falls, and multiple hospitalizations. We’ve been told that the fact that she’s still eating well is what’s keeping her out of hospice.
My former MIL has been on hospice care twice as a result of Alzheimer’s disease. She continues to have everything on the first list and item 6 on the second list. Still alive and holding steady at age 92. Sigh.
I wonder how much the area in which you are located affects the hospice willingness to risk Medicare punishment for people outliving the first 6 months. Both my MIL & FIL were on hospice, I signed the paperwork and I was surprised each of them died within the first 180 days. Each of them had Dx other than dementia which could cause the hospice people to be able to justify intake, but they were both stronger when I signed them on than my mother is now!
This will be the 3rd hospice intake I’ve signed in 38 months, I’m tired. 
Hmm… my mom is 2,3,4,5 on the first list and has lost about 20 this past year. But otherwise healthy as a horse and still verbal. It’s such a struggle to get her out of bed every day. She would never get up, get changed, eat, drink, or do anything without massive prompting and urging. It’s so sad.
Wow, that is a rough list. For my mom, hospice will be there on Thursday. Hope she qualifies. She meets all the criteria on the first list and has lost <10% of her weight (89 pounds now). The one possible dis qualifier: I think she does have more than 6 words but barely talks. It will be really difficult to do this all over again.
It looks like my dad is a 6 on the FAST scale. He is still able to ambulate and has more than 6 words. I told him his birthday was coming up and he had no idea when it was.
The six words is crazy hard to meet. Hospice will be coming out Monday, assuming snowpocalyse does not prevent it again, they cancelled this week as we are snowed in, which also means no PT, no shower aide, no daughter and GKs, no sister, no neighbor, no visitors. She is so bored!
This recent discussion about hospice has raised a question for me, so I figure I will ask even though I’m not in your situation. Many of my friends have elderly parents and I want to be informed.
I’m confused because it sounds like each of you is having to get approval from the hospice agency itself for your demented parent. But when my (cognitively alert) dad went on hospice, it was by doctor’s order, at which point we had a choice of a variety of hospice agencies to choose from. From my understanding, Medicare would be delighted to have people go on hospice because so much money is saved because there are no more hospitalizations or extraordinary measures.
Is it different when someone has a form of dementia? Does a doctor order not suffice? Or does this perhaps vary by state? (I’m in California.)
I don’t know if there is a difference between hospice guidelines for dementia and hospice guidelines for other ailments. But if there is, here are some things about dementia that might explain the difference. These are based on my observations of my ex-husband’s family’s experience with his mom, who is 92 and has Alzheimer’s disease.
- A person with Alzheimer’s disease can live for many years at a very low functioning level. It can be very difficult to predict how close a person with Alzheimer’s is to death.
- A person with Alzheimer’s disease is likely not receiving extraordinary measures. And a person with Alzheimer’s disease might very well not be receiving any medical care, or at least medical care of the kind that Medicare would pay for. My ex’s mom doesn’t take any medications, as far as I know, and no longer is seen by a physician. She doesn’t receive any medical treatment of the type only a physician or nurse can legally provide.
- The $260 per day the hospice agency billed Medicare to provide some care for my ex-husband’s mom was much MORE money than is spent on her when she’s not receiving hospice care. When she’s not receiving hospice services, Medicare and the secondary insurer are spending 0$ on her.
Hospice, like other government programs, has rules and must go by the rules, not common sense. Hospice is for people who are terminal, I believe it was designed with cancer initially. Dementia is rough to quantify and does not easily fit the tick boxes required.
For me, one of the best things about hospice coming in would be having expert eyes on my mother every week, gleaning ideas from experienced people would help me do a better job.
My understanding is hospice currently is for folks expected to live 6 months of less. It can be extended. Some people with COPD opt for hospice. They are given comfort care and Rx with no charge to them. For their comfort.
Some condition, including dementia and COPD, it’s a judgment call as to when a person is within 6 months of death.