So at 91, Mom with a broken kneecap from osteoporosis, wearing a brace for the rest of her life, confined to bed because she is not progressing in PT and refuses to get out of bed most days because the Hoyer lift causes her too much pain, severe arthritis, macular degeneration, usually only eats 1 meal a day and a few bites for lunch or dinner....this person cannot receive hospice care. What more has to happen to "limit" her lifespan. The doctor and staff of the nursing home called hospice but it seems she is not eligible. What now? Just let her lie there if she chooses, get mild pain meds that do not help, treat her aides, nurses, and family badly because she is so frustrated and in pain? Is there no other answer?
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Hospice care is covered by most insurance and Medicare, but the person must be deemed terminal with an approximation of six months or less to live. Of course, many people live longer than that on hospice care and some get better and go off. Your mother doesn't qualify because there's no terminal disease.
Keep tabs on your Mom and watch carefully. Also, keep in touch with the doctor. If your mom shows any signs of terminal disease then she would quality. Meanwhile, urge the doctor to go for quality of life management.
Take care,
Carol
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But a couple of years ago I tried to get her was evaluated for hospice when she was at her first NH - she had gone through a very bad patch, with back to back TIAs, persistent fever and more than 10% weight loss within 30 days - got evaluated and accepted by the hospice group. Then rallied, gained weight and got out of hospice within the 30 day window at the beginning of hospice. The hospice MD approved her but her NH MD didn’t… so no hospice. Most facilities have it such that both the medical director of the NH and the medical director of the hospice group BOTH have to approve for hospice.
There is a evaluation system for hospice. You should ask what in the evaluation kept mom from being accepted. Most NH & hospice providers use the FAST evaluation or a Mitchell score. Some use both.
Functional Assessment Staging Test (FAST)
Stages:
1. No difficulties;
2. Subjective forgetfulness;
3. Decreased job functioning and organizational capacity;
4. Difficulty with complex tasks and instrumental ADLs;
5. Requires supervision with ADLs;
6. Impaired ADLs, with incontinence;
7. A. Ability to speak limited to six words & B. Ability to speak limited to single word
& C. Loss of ambulation
& D. Inability to sit & E. Inability to smile &
F. Inability to hold head up
. Seems they have to be at a 7 to qualify.
Mortality Risk Index Score (Mitchell)
Points & Risk:
1.9 Complete dependence with ADLs;
1.9 Male gender;
1.7 Cancer;
1.6 Congestive heart failure; 1.5 Bowel incontinence;
1.6 O2 therapy needed w/in 14 days;
1.5 Shortness of breath;
1.5 less than 25% of food eaten at most meals;
1.5 Unstable medical condition; 1.5 Bedfast;
1.4 Age over 83 years;
1.4 Not awake most of the day
Risk estimate of death within 6 months
(Mitchell score):
Score Risk %
0 8.9
1-2 10.8
3-5 23.2
6-8 40.4
9-11 57.0
= 12 70.0
Mitchell seems to be used more. Dr Mitchell has done alot of studies and articles on dementia. Good luck, none of this is easy.
if they get better too.