LindainCT Asked July 2018

Medicaid pending; comfort care or move to hospice?

Hi everyone. I hope some of you can give me your thoughts or guidance.

My dad is 92. Nursing home since March. Now has aspiration pneumonia. He has lost his ability to eat/drink. Family meeting yesterday at NH. He has declined SO much in the last month. He is in bed now - can't walk, incontinent, last stage frontotemporal dementia. A decision was made for hospice/comfort care. : (

We are Medicaid pending. Application sent in May. But they are backlogged and could take up to 4 months for approval.

Medicare stops paying the Nursing Home as of July 31.

Nursing Home told us they can do Comfort Care until the Medicaid is approved (if he last that long). Hospice will not come to the Nursing Home while we are 'pending'. BUT... I found out (NH didn't tell me this) that we can move him to a beautiful Hospice Facility a couple towns over and that Medicare pays 100%. I didn't know that Medicare pays for Hospice.

SO.... the people at the nursing home are really nice and they really care about my dad. My dad is comfortable there and now knows all the staff and they know us. The staff is always popping in to see him. We are very happy with them.

BUT... August 1... he will have NO insurance paying for his stay there. I know when the Medicaid kicks in the NH will get their money... but it's so stressful knowing we will get the bill for his stay until the Medicaid goes through. And what IF we are denied??? (Lawyer says we won't, but who knows)

IF we move him to the Hospice facility... Medicare will pay 100% and that financial stress will be lifted. And then the Medicaid can take as long as it wants. But it will be traumatic for him to be moved.

I feel so selfish thinking about money when this is really about keeping my dad comfortable. : (

Any thoughts?

29 Answers

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Hi. You and your family need to make a big decision and soon. You can do medicare, hospice or nursing home care. I would not tell anyone what to do but I will tell you that I was in the same position with both parents at the same time. so I really feel for you. I was not lucky enough to have anyone to help me make the decision. son, and husband gave me there opinion as to what they thought but final was on my shoulders.
I did my homework and decided that hospice at home was the way to go. they wanted to go home. I couldn't afford anymore copays per month of close to 3500.00 each, nursing and care place. medicare leads you to believe they pay all and they do not. The Hospice care are wonderful. they pay everything. medicine, diapers, hospice beds, trips required elsewhere, doctor visits which they come to your home. etc. the worry of how am I going to pay the bills was no longer an issue. the best part of hospice is they treat the patients like they were their family. they are so wonderful and loving to their patients. they will be their 100 % for you and your family.
so I decided after speaking with hospice that their dignity
was not being taken away from my parents at the end of their lives.
they are their 24 hours a day for you.
It was painful to watch parents decline in life but they were treated with golden gloves and given everything they needed to be pain free and begin there new journey in life.
dad passed and mom passed three weeks later.
I am still in touch with hospice and they call me regularly to see if
I need anything. with hospice you cant go wrong...

Helpful Answer (8)

I see you’ve gotten quite a few answers. I just wanted to stress that you are not being selfish. Rather you are being practical. Keeping dad comfortable is actually a financial decision. Be gentle with yourself, you are doing the best you can. Hugs to you.

Helpful Answer (6)

What other insurance does your dad have? In Michigan, many people who worked for the autos, who have something called the “fifth level of care”. If a person is on hospice, this secondary blue cross (which provides this fifth level) will pay the nursing home room and board at 100%. Otherwise, I doubt Medicare actually pays room and board. Either way, I would encourage you to enroll your dad in hospice as soon as you can. There is so much benefit for him and you.

Helpful Answer (5)

Move him to where 100 percent will be paid by Medicare! They — the nursing home, don’t “care” about anything except $$$ & that is why they’re being “nice” so they can get paid privately. Move him ASAP!!!

Helpful Answer (5)

My FIL passed away last month. He was in the hospital when we found out he wouldn’t recover. Sepsis from a pressure sore he got while in the hospital. We made the decision to move him to hospice, but medically they could have kept him in the hospital. We were assured by the hospital discharge planner and the Hospice that Medicare would pay 100%. So far we haven’t gotten a bill. The care he got was AMAZING! Sometimes, you do have to think about money issues, even when death is staring you in the face. Money is one less thing to worry about, he can have visitors as long & often as he wants, and it’s a MUCH more peaceful environment.

Helpful Answer (4)

My husband has LBD and had to be hospitalized due to not eating and dehydration. The skilled nursing facilities he was in, did not seem to care if he ate or drank. I would see his food trays being returned untouched and his water not being touched. Instead of seeing improvement, all I saw was decline and extreme weight loss. I finally decided to bring my husband home with hospice. My husband is now eating, drinking and has gained 30 pounds that he had lost. He is also walking with and sometimes without a walker and using hand weights and ankle weights for excerise. Hospice is 100% covered by Medicare, they furnish everything the patient needs: hospital bed, shower chair, beside commode, wheel chair, walker, bedside feeding table, mattress pads, pull ups, gloves and prescriptions are delivered to your home. Depending on the patient needs, you will have a nurse that comes out, CNA's to shower patient atleast 3 times a week, social worker, chaplains, etc. They even have respite care for the patient and taken to a facility so you can have time for yourself. You can schedule respite care as many times as you need and they take care of picking them up from home and returning them back home. I understand there are many caregivers that do not have the luxury of being able to stay home and care for their loved ones, but for me, this worked out better than watching my husband decline when there wasn't a need to. God bless you on this journey, these journeys are not easy, but atleast I won't have any regrets, we can only do what we can.

Helpful Answer (4)

My understanding is that Medicare does NOT pay for Hospice room and board.

Helpful Answer (3)

I'm not understanding why " Medicaid pending" would be a problem for Hospice. Did they explain why?

Helpful Answer (3)

Because they won't get paid for the room and board until medicaid is approved.

(0)

Medicare does not pay for facility care while on hospice. Please check further. They will pay for nurse and attendant visits, medications, special beds and wheelchairs. If you find they do pay for the facility, let me know where you live.

Helpful Answer (3)

I want to echo Melissa's comment. You are not being selfish, in fact I would venture to guess that your dad would be very upset if he were aware enough to know you were thinking about stretching yourself thinner financially on his behalf. Both choices sound like ones that will be good situations for your dad's end of life, they each have their pluses and minuses and I don't think you can probably go wrong. You obviously love him very much and I'm sure he feels the same way about you so difficult transition or not I feel pretty sure that he would rather know you weren't overly stressed about money on his account if you don't have to be. That said sounds like there may be options to prevent that while keeping him where he is if that's what you really prefer. I don't think you can go wrong and you will make the right decision for everyone, one your dad would approve of because your leading with your heart but not ignoring your common sense. Let yourself off the hook here, you have nothing to feel guilty about. In fact your financial sensibility would probably make your dad very happy and proud.

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Medicaid pending; comfort care or move to hospice?

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