The NH wants to put my mom on hospice. Her Dr said she (mom) is not considered to have a major illness that would result in her passing within 6 months and said she doesn't know how she would qualify for hospice? She also said hospice takes over as insurance. But if my mom falls and goes to the hospital, hospice won't cover it. I feel like I'm getting hosed. Her United Health Care Medicare advantage is a really good insurance.
Anyone with experience?
I'm also working 13 hour days and prepping her house for closing this month. 60 yrs of crap to clear out.
For me MAs are too confusing. Now Alva throws in the mix there are MA suppliments only. I have chosen to stay with straight Medicare. My husband's Union pays for his supplimental and I pay a small amount a month for my share.
1) In order for your mom to qualify for hospice, a doctor has to state that, given the nature of your mom's illness, if she refused any more life extending treatment, it is more likely than not that she will pass within 6 months. If a doctor makes that determination that is likely, and she doesn't pass, she is not "kicked out" of hospice - as long as hospice is seeing a continuing decline.
2) By agreeing to go into hospice, your mom is agreeing that she doesn't want to seek anymore life extending treatment - and here is the important part - for her current condition!
This was how hospice explained it to me: they are called in to give the patient the best quality of life they can for the time they have left. If my mom were to fall, for example, and break a bone, she could absolutely go to the hospital for treatment! My mom had CHF - so a broken bone had nothing to do with her condition. If she wanted to go to the hospital for IV diuretics, that would be a different conversation.
3) The patient can come off hospice at any time they want. If 2 months into it, they decide they want to try more life-extending treatment, they just end the hospice care and their care reverts back to their previous health care plan. And that doesn't knock them out of calling hospice again at a later time.
4) Medicare pays for hospice. Mom can keep her secondary insurance. My mom also had United Healthcare, and we continued to pay into it, and she continued to be covered by them. Some medications that she took weren't covered by hospice, so her United Healthcare picked those up.
As far as her doctor not wanting to "sign off" on hospice - I think it's hard for some doctors to be able to admit that there is nothing more they can do for their patient, especially if it's someone they have been seeing for a long time. My mom's cardiologist held off for longer than he probably should have; when I talked to him about it, he didn't want to seem to be "giving up on" my mom (those were his words). If you think mom is declining, you can ask the doctor why he thinks mom shouldn't be evaluated by hospice.
Also, not all hospices are created equal. Make some preliminary phone calls to different agencies and see what services they offer. Making the phone calls doesn't obligate you/mom in any way, shape or form.
I found hospice to be so helpful; the first time I called mom wasn't ready to qualify yet, but they gave me some really helpful information.
Good luck.
Have the NH call in a Hospice provider and evaluate Mom. You have this right. They will evaluate her to see if she qualifies for services. Medicare pays for Hospice and your MA needs to pay for what Medicare would.
Under Hospice Mom will not be allowed to go to the hospital. If she does, hospice will discharge her. Moms hospital stay would be covered by her MA. Any questions you have can be answered by the Hospice staff.