At the end of June my dad, who has Alzheimer disease, was hospitalized with pneumonia and dehydration. After the hospital he was sent to an acute rehab facility. While there he acquired C-diff. Also, he is not eating for at least the past month. The C-diff was cleared and now he is ill again and extremely weak. He cannot get Medicaid. Is it time for Hospice?
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About hospice, since it is a Medicare benefit, it is self-directed. That means that the Medicare recipient can select the hospice group. If you are his MPOA, then you can do this. I agree with the others that he may be best off with hospice at this point in time - he will qualify. But back to the "self-directed" details, you can shop around for the hospice group. There are many big national ones - VITAS & Compassus - and then local smaller ones that seem to do more in home hospice services. My mom is with Southern Hospice group which is in several states (she's in TX); they are her second hospice group. I basically removed the first group within the 2nd month as they just flat would not communicate in a timely manner with me. My point is that if the hospice provider doesn't seem to be a good fit, you can change the provider. Simple easy paperwork too.
For my mom, being on hospice is something the NH really loves as it provides so much more staffing for care. She has gotten so much more detailed attention since on hospice. Initially it was RN once a week, aides 3X a week, social worker & chaplin once a month plus specialized equipment. Now it is RN twice a week and aides 5X a week, weekly social worker and chaplin as she is very end of life. My mom's NH works well with hospice, there are like 8 different ones with patients there and the NH provides for a hospice desk at the nurses station for them.
Some NH who might not be all so excited about dad as a regular resident will be more welcoming if he is also coming in on hospice.
For the smaller hospice groups, the equipment and stronger pain meds can be an issue. They may not have the funds or credit lines to get the special beds, geri chairs, geri bath chair, breathing mattress, O2 units, etc. delivered within 24 hours.
If it looks like dad will be needing serious pain management, being on at home hospice can be an issue. For serious pain meds, the smaller hospice companies may not have enough RN's who routinely carry them (the aides don't) so you have to wait till the 1 RN who can do schedule 1 or 2 drugs to get to the dad's bedside. Or the MD /medical director with the smaller hospice are not that 24/7, (they have their own private practice and do the hospice on the side) so you have to wait to get orders changed or drugs added. For NH hospice pain management won't be an issue as they will have the serious drugs on premises or get regular formulary delivery if dad needs something unique.
Has anyone spoken with you about C Diff reoccurring? For men,it seems to be a revolving door of NH, C Diff, then back to hospital, then discharge back to NH. The upside of this is that each time he goes to the hospital - it he is there for the usual week to clear & stabilized - it usually starts a new clock on being on post-hospitalization rehab which is covered by Medicare.
None of this is easy or simple. Good luck and try to keep a sense of humor going amidst all this.
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Hospice is a wonderful program, if he is ready for it. If not, it sounds like he needs a skilled nursing home. Where was he living before being hospitalized?
I am so sorry that your family is dealing with the difficult situation.
If he's not a vet, try the New York City Chapter of the Alzheimer's Association (http://www.alznyc.org). There are social workers on hand to help you figure out next steps. Their number is 1-800-272-3900.
Other resources:
National Association of Area Agencies on Aging - www.n4a.gov
Eldercare Locator - www.eldercare.gov/eldercare.NET/Public/index.aspx
These may crisscross and route you back and forth and round again but mercifully you'll find the right person to give you clear direction.
If he was a wartime vet, you could call the VA.
If he can't get Medicaid, then he pays from his assets until they are spent down. If he gave away assets, you get them back.
Since you are in NY, even life estates can be attached by MERP since 2011.
Many parents gift away money and houses with the unwritten understanding that their kids will take care of them right to the end. The kids unwittingly agree to do this, because they think they can do all the care. More often than not they can't, nor can they pay back.
Hospice will not cover the cost of the Nursing Home. So at the end of Sept you bring him home on Hospice, because you have no other options.
Here's more information: http://www.medicareadvocacy.org/News/Archives/Hospice_HospiceInNursingHomes.htm