Why was Hospice care denied?

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harrah Asked June 2013

Why was Hospice care denied?

My Mom is 92, living in a private home that gives elder care. She has dementia, is unable to walk, even with a walker, is incontinent. She has times when she gets very combative and abusive; slides out of her chair to the floor, crawls around, screams, hits, refuses to eat or drink or take meds. She is on Ativan, so when she gets like this, the fact that she won't eat or drink only makes the craziness worse. The aides at the home can't do anything with her at these times. We're afraid they're going to kick her out, and we have absolutely no other options for her (have been on a waiting list for the only decent local nursing home for over a year).

The owner of the care home suggested that we call our Dr. and ask him to write a prescription for Hospice Care, which he did. Someone came and evaluated Mom. We got a phone call on Friday that she will not be accepted for care-- she doesn't qualify. This is heartbreaking for us-- the help that they said they could give (regulating meds, seeing that she gets out to the porch or out for a wheelchair walk, chaplain visits, help with Medicaid (we're almost out of money for Mom's care), keeping her calm--) all sounded like the answer to our prayers. Now we're back at square one. Or rather square one hundred. We were told that she needed two "qualifiers"-- we thought the dementia and her weight loss (she's down to 127 from about 160) would be enough. But the hospice woman said that since she was eating (the day she saw her), the weight loss doesn't apply. Any suggestions? Thanks.

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score 0 · Answer 1

Usually there is more than one hospice in an area. Those who have gotten in trouble for their dementia case numbers are less likely to take in new ones, as dementia as the primary illness is notoriously hard to predict death 6 mos out. The first hospice we called thought that mthr's primary problem was dementia, because I talked about it so much - and they had been in trouble with Medicare for keeping dementia patients on service for too long. She was denied.

The second company correctly saw colon cancer was her main issue, and she even had a new palpable lump in her gut. Dementia is a secondary diagnosis with them, and she was accepted.

My advice is to have her evaluated by a second hospice. If there is some diagnosis besides dementia that can be her primary diagnosis, that is the way to approach it.

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score 0 · Answer 2

booklady, if a doctor says that the 95 year old isn't going to be dying within 6 months, that person will not go onto Hospice.

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score 0 · Answer 3

If a 95 year old person has had two bad falls, can hardly walk, cannot hear, and has excruciating back pain that is not eliminated by Tylenol or Vicodan why cant that individual received hospice Care? He has a living will which indicates no invasive procedurs just pain management.

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score 0 · Answer 4

hiker, if the patient does not want to give up the medical device, it is their right to refuse the Hospice services. What device?

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score 0 · Answer 5

This person is within 6 months of dying and has cancer. The issue is a hospice denied putting her on hospice, claiming a certain medical device (which would NOT prolong life but provides comfort) was reason for her not "qualifying".
It made no sense. Her daughter would like to "APPEAL"THIS DENIAL. But how and to whom??

That is my question. She lives in another state and asked me to research in CA who to describe this to and to state how it is medically INCORRECT.

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score 0 · Answer 6

hiker, Hospice is a Medicare program. First, they need an MD to say the patient will likely die in 6 months, with tests that prove it. Dementia is not a qualifier. Second, Hospice benefits do not cover the nursing home cost. They supply meds and a visiting nurse.

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score 0 · Answer 7

if someone is denied hospice services and you think your loved one DOES qualify, what is the governing body one can appeal to in California?

thank you

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score 0 · Answer 8

harrah,
My heart really goes out to you!! My father was admitted to a rehab facility and we were told that "patients with Dementia getting over an infection have no reason being back in the ALZHEIMER'S and Dementia Ward... He was not even there 24 hours before they put him in the ALZHEIMER'S and Dementia ward locked down. I was not happy... He was sick, he didn't need to be there....
The Nursing Homes we visited were ok ; however, the wards were locked and the nurses were young and did not communicate with patients unless they had to!! Not impressed!

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score 0 · Answer 9

A nursing home, just like assisted living facilities, they have some, or units within that specialize in "memory loss". These have higher vigilance and security and can deal with the increasing complexities of people who are not bed bound but are combative or flight risks.

If I understood what you meant by a private care, I think these are small facilities, and they likely do not want to deal with a complicated case.

Best of luck

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score 0 · Answer 10

Ismiami-- what is an NH? Thanks.

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score 1 · Answer 11

When my dad went into hospice, I was told it required a 6 month life expectancy. Someone can outlive that and they would reevaluate and extend if appropirate. I was also told that albeit rare some people improve and leave hospice. My dad passed within 4 weeks.

Hospice is helpful, they provide patient comfort and pallative care, but it is intended as an end stage.

Your mom may not be there yet, physically. A NH for dementia may be a better fit for your mom. Hospices tend to be staffed for more near end, less combative patients.

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score 0 · Answer 12

My mother was on hospice for 18 months. The diagnosis "Failure to thrive" She was 93 with severe dementia and bed bound.
Keep asking. Talk to the Dr's nurse or case manager they may be more helpful and understanding than the doc.

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score 0 · Answer 13

I am so sorry. That happened to my mother, Hospice declined her in December and she passed in March, with the assistance of Hospice. Hospice told my family that the patient needed to be within 6 months of passing. Mom had ALS and they turned her down until Social Services got involved after a hospital stay.

It didn't sound like you are battling any life threatening illnesses? Maybe see if the Dr would call and give a better description to the Hospice facility. If not, try...try again. : )

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score 0 · Answer 14

Thanks, Sonswife (sad name, huh?). I appreciate your input. I doubt that our Dr. or his office will be especially helpful, but that is certainly something we can look into. I knew about the six months thing-- it's hard to know, I guess, how long anyone will live, so I surely can't say one way or the other that my Mother qualifies in that way. As far as the life she's enduring now, I very much hope it doesn't last longer than six months, and I know she feels the same way.

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score 2 · Answer 15

I am so sorry that you are faced with this situation. As far as the Hospice denial - I am familiar with one qualifier for a Medicare Certified Hospice - having a disease that will cause the person's death in the next 6 month. Please contact your doctor for his input, he may have additional information that could influence Hospice's decision. Also, he may know of other resources you could access. Does his office have a Case Manager, usually a nurse or social worker? A Case Manager could be helpful in connecting you with help for the Medicaid application and connecting to other resources.

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Why was Hospice care denied?

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