Well, hospice evaluated my mom while she was having delirium in the hospital. I believe it helped her qualify because staff noted severe dementia, which was actually moderate dementia worsened by delirium 
So the delirium helped her get services outside the hospital!
Dementia seems to be the most common diagnosis for hospice around here.
So glad that visitors will be allowed, even if one at a time.
Thatās so interesting @compmom , our local hospice will not/cannot approve on dementia alone unless it is the very end. They look for all the other, easier, boxes to tick. They turned my mother down a couple of times, including within 6 months of her death as she was not ābadā enough.
By the end of today my H had his head around hospice since testing indicated her kidney was no longer functional and her aortic valve was closed. We are in the comfort care stage and whether it is tonight, tomorrow or the day after, the end is near.
The hospital said they would allow one family member for one visit and two of his sisters have been feuding for hours. The eldest who hasnāt seen her mother in months and before that it was even longer and the next youngest daughter who spent every day at the hospital during previous admissions. My H said he would forego visiting since we had Facetimed her yesterday and had a window visit at the rehab center last week. Mind you, my H has taken care of all her needs, personal, financial, and medical for the last 5 years since FIL died. He spent at least two days a week with her. Anyway, the eldest showed up at the hospital demanding to be let in and the nursing staff called my H, since he is her medical proxy and POA. He said they had to wait until younger sister arrived (she also went without knowing whether theyād let her in) and to let them decide who would visit. Mind you, younger daughter is the substitute medical proxy and my H had emailed her a copy. Apparently, when she arrived she showād the proxy and they let her in - oldest sister was nowhere to be found. You canāt make this stuff up. In the end it will be Hās fault but thereās not much I can do about that.
Next crisis will be planning whatever kind of funeral is possible in Covid-times. Obviously there will be no shiva which, given the dysfunction of this family is probably better. H is with two of his kids and the third will come immediately. Weāve seen them and theyāve been SIP.
The CCRC will not allow visitors, but the hospital will. One per day. I get day 2, which is tomorrow. 600 round trip for a 3 hour visit. Canāt wait! 4 siblings are taking turns, so thatās nice. First time Iāve ever hoped she stayed in the hospital longer. Once she gets released to rehab we canāt see her.
I called the facility my mom started paying for but is not living in. They will not allow her to skip Juneās payment as she could in May. Ugh. I explained that thereās no way we want either or both of my parents to move into a facility ANY time soon, especially considering my dadās serious lung issues. The woman had forgotten that aspect of my dadās illness and said she will talk to the director to see if they can do anything. My sisterās point is that even if they donāt charge her for June, are things going to be any different in July, August, or September? And the fact that my dad thinks the unit is too small doesnāt help. I wish he could see it so he would know how nice it is, but of course thatās not going to happen.
What a perfect storm of events. My husband feels that maybe they should just keep paying for the unit - they were willing to put down a fortune (literally) for the facility they were originally going to move into before Dad got sick, so they do have the money.
The woman said if Mom were to move in now, she would have to quarantine for two weeks. A family member could join her, but that person wouldnāt be allowed to leave the room during that period, either. Who can do that?!?
Sheās going to call back tomorrow. I guess Iāll just gather information and then my sister and I will talk to my parents.
@runnersmom, can the eldest visit tomorrow if your mother in law is still alive? I hope her passing is as easy as possible
That would be up to the hospital and the rules are apparently quite rigid right now. I personally think they should allow short visits by all children in these circumstances, especially with things opening up here, but I donāt make the rules. Thankfully, one of the hospitalās chaplains is a rabbi from our synagogue who knows MIL and she will go sit with her tomorrow.
@runnersmom, Iām so sorry your DH is dealing with difficult sibs on top of his momās declining health. Would be nice if the older sister could step back and realize her behavior isnāt helpful.
@somemom, actually, to clarify, one of our local hospices is easy to qualify for (large organization that has been around a long time, well-staffed) and one is harder (smaller, newer, not up to speed yet). For the latter, just a diagnosis of dementia seemed to do it, and they used that to cover admissions requirements rather than congestive heart failure or colon issues (at the time we thought it was terminal cancer but it had not been confirmed by surgery so the hospice couldnāt use it).
I volunteered for them a few years back and all of my patients had dementia.
The hospice that didnāt accept my mother (and this was after the cancer diagnosis had been invalidated by a procedure) they did a dementia test and she passed as not having dementia. She has been diagnosed numerous times including an inpatient stay at a geriatric psych. facility, āmoderate.ā I noticed during their test that she looked at a calendar on the wall to answer about what day it was, and the newspaper was in front of her with the presidentās name. So she was sharp enough to use those!
Anywayā¦getting off track hereā¦main message is that qualifcations vary. Our large hospice organization is an empire! The smaller one is more personalized, but also admission is harder, based on resources and clout, I would think.
So shop around!
ps When my mother was not accepted, we did palliative care level care. The smaller hospice is associated with a hospital system that has three levels of home care, regular, palliative and hospice. Palliative got us nurses trained on end of life or chronic serious illness, but not aides. Only hospice provided aides. No chaplain, social worker or volunteer. But more flexibilty with medical procedures and imaging since Palliative does not put you on Hospice Medicare.
@runnersmom how can a hospital system pit siblings against one another in that way? And how could any of you determine which person would your MIL want to see most? I think it would be better to limit everyone to Facetime rather than allow just one out of three. Technically with primary proxy your husband has rights. He is certainly a nice person to resolve things the way he did.
@MaineLonghorn we had to pay for 4 months of my motherās expensive assisted living before she actually moved. But she wanted a particular apartment. What would happen if you cancelled the reservation? Would you be able to get another apartment there? (And if a resident leaves my motherās facility, notice has to be given before the first of the month and you have to pay for the next month.)
Qualification for hospice actually donāt vary. Medicare guidelines are very strict with who qualifies for hospice and who doesnāt. There are criteria a patient has to meet. It can be very straight forward for some diagnoses, and very complicated (and a bit more subjective) for others. My mom was stage 7 ALZ and still didnāt qualify for hospice because she was still ambulatory and eating enough to maintain her weight. She also was in her 70s with no secondary medical issues at all. She qualified at the end only after her seizure and head injury.
Some hospice programs are more willing to āstretchā than others but it also depends on a patientās primary physician to agree to a 6 month or less prognosis. (Also can be a sticking point).
The one ethical work around Iāve seen is some hospices have developed palliative care teams for those āpre-hospiceā patients that donāt qualify yet but have the need for palliative support.
And just a note, hospice benefits can run out and people have been discharged from the program if they become stable and no longer meet the 6 month or less criteria. The interdisciplinary team re-assess appropriateness for care regularly (as per Medicare guidelines).
@momofsenior1 glad you clarified that. The criteria donāt vary but interpretaton does. I felt that the large hospice has so much clout in our area that perhaps they could be looser.
In the training I did, it was frequently mentioned that people often improve with their services (their version, perhaps improvement would have happened without them!) and at the periodic assessment, go off hospice.
Our Palliative is called āBridge to Hospiceā
Regarding hospice choices, when my father was in the hospital I asked the nurses which hospice they would use if it was their parent. The couldnāt tell me officially of course, but unofficially I got some great leads. They hear all the stories and know which hospices are the most responsive.
Iām so sorry you get to the end of your life, then to be left without loved ones able to come oversee or love or make noise around you. Especially with dementia, thatās no comfort. It needs to be reevaluated. At least in part, not thriving them to let them be wharehoused. That blows my mind. Whoās it satisfying?
And now we wait - the doctor said MIL is comfortable and in no pain. She is barely conscious but unresponsive. She didnāt know that SIL was there last night but it meant a great deal to the sister who visited. Itās only a matter of time.
I visited my mom today, my sister visited yesterday. If you had a mask, could pass a temperature check, and knew her name, you could have visited. Shocking how lax the controls were, even though they are much stricter than 3 months ago. We canāt get into the CCRC but the hospital let us visit.
@runnersmom is your husband able to be there at all? Sounds like she is in the āactive dyingā phase but comfortable. I hope he can see her. This is so hard.
I had a window visit yesterday. Six feet away, both masked and with hearing issues it is tough. The person at the other window ( a mere 6 feet away) also had a hard of hearing mother. Rather than compete, I was mainly quiet while she talked to her mom at higher volume. When I did respond to my mother, the other visitor turned to me and said āCan you please keep your voice down, I am trying to talk to my mother.ā It just compounded a difficult situation. We need to be kind to one another! I remained quiet and left soon after that because I didnāt want a confrontation.The facility needs to set up windows with more distance between them!
My mother again asking to be taken out and during this lull in cases, I actually went on Zillow. I am incorrigeable. It is so daunting. Continuing as is.
@compmom - Thatās awful!! I wish you could have told her āI sympathize with you! Iām trying to talk to my mother, too! Sheās hard of hearing.ā
Iām never out so havenāt noticed the tension and anxiety and snarkiness from others, but Iāve heard stories. Itās so sad!
@compmom, yes that is how Iād describe it. No, he canāt be there but she is no long conscious and she is not in any pain. The hospital staff has been amazing, keeping him in the loop constantly and keeping her comfortable. This is just such a sad and difficult time for everyone dealing with these things, especially since we live in the hotspot area - rules are pretty rigid.
So my 91 year old mother has been in and out of the hospital the last two weeks. Sheās going home tomorrow. This time its severe head pain where she had Bellās palsy years ago. Also a minor stroke years, like 15, ago. They keep loading her up on meds and gave her a local block but nothing is really working expect for Dilaudid the last 2 days. Well , she canāt go home on that and they are trying some compound medicated creme.
The truly sad part is that her room is right next door to where my niece, her grand daughter is. She is bed bound with MS and young like 38. She hasnāt seen her in like a year due to both of them in and out of the hospital. Of course they wonāt let my mother see her since they both have strict restrictions. But my niece is going home soon and the paramedic will do the transport. So my mother is getting assistance to ātalk a walkā to hopefully cross paths in the hallway. My mother is very persistent It would be nice if they can just open the door so she could wave or somethingā¦