Dr. would not approve stated she was not bedridden. She has had Alzheimer’s for over seven years and is rapidly declining. She is eighty and I’m eighty two and I’m her only care giver no other relatives near by. From what I’ve read Home Health Care would not help much and I’ll not put her in a home. Any ideas on what I can do to get Hospice approved.
If she has another doctor you can ask that doctor to refer.
You could also contact a Hospice of your choice and ask if they could do an assessment because her doctor is refusing to refer.
It is not up to the doctor to say she is not eligible for Hospice, it is up to the Hospice to make that determination.
These are some of the things that can be documented for qualification.
*Unable to ambulate without assistance from someone
*Unable to dress without assistance
*Unable to bathe without assistance
*Urine or fecal incontinent either constant or intermittent
*No meaningful communication
And any of these in the past 12 months
*Aspiration pneumonia
*UTI's
*Pressure sores
*Weight loss
But as everyone has commented, home hospice is quite limited in what they offer. The hospice company we worked with also offered home health aides that you paid for by the hour (unlike the basic hospice services, which are covered by Medicare). And they had respite residential care (5 days) for free every so often, plus regular full time residential care that you had to pay for.
Home hospice was the right decision for my dad for sure. But it is limited.
Search the Internet for home hospice in your area or zip code. They can explain on the phone and also send you brochures on how to qualify and what is covered plus what else they offer. You might be able to get them to come make an evaluation on what she needs.
Life expectancy: They have a life expectancy of six months or less
Functional impairment: They are unable to walk, bathe, dress, or control their bladder or bowel functions without assistance
Communication: They are unable to speak or communicate effectively
Quality of life: They have symptoms that impact their quality of life"
And as pointed out, you do not need to be bedridden. Maybe years ago but not now. Criteria changed a while back. Dr needs to get up with the times. My neighbors sister, with Dementia, was on hospice and came to visit her everyday. Call a Hospice near you to have your wife evaluated. But do not expect much help.
You need help, you may need to hire it. Medicaid provides in home help but you can have no assets other than about 2k and a home.
I think you have a very skewed idea of what being under hospice care entails, as it isn't much and it sounds like your wife needs a lot more help now than just a nurse to come once a week(for about 20 minutes) to check on her vitals and their aides to come bathe your wife twice a week and then leave, leaving 99% of your wife's care to you still.
Sure you'll have access to the hospice social worker, chaplain and volunteers, but that doesn't help you much. yes, a volunteer may come once or twice a month to sit with your wife for an hour or 2, but again that's not going to help you much in her care.
You're either going to have to hire some part-time or full-time in-home help if you're wanting to keep your wife in your home, but please don't forget that you matter too in this equation.
If your wife's care gets to be too much for you please don't hesitate to have her placed in the appropriate facility, where you can get back to just being her loving husband and not her burned out overwhelmed caregiver.
My late husband was completely bedridden and under hospice care in our home for the last 22 months of his life, and hospice did very little to help other than the nurse coming once a week to start and the aides coming to bathe him twice a week. I had to hire an aide to come in the mornings, as 99% of my husbands care was still on me.
So please don't put all your hope in hospice to help care for your wife, as you'll be sadly disappointed. Instead hire some in-home help now to give you the real help that you need.
I wish you well as you take this very difficult journey with your wife.
It consists ONLY of two baths per week, one RN visit per week, some equipment such as hospital bed, commode, etc. and medications, as well as a call from clergy and social worker.
I myself, at this point, think that the enormous amount the government is paying for Hospice care would be better given to family caregivers to hire in some real help.
I am so sad to say this. Hospice wasn't around when I was a new RN and I saw people die in such agony before we got it, but it has been honed down to almost nothing but a little blue bottle of morphine.
It used to give much more individualized plans.
In order to receive Hospice care
1. MD must sign that the person has a disease which is expected to cause death within a six month period
2. Person declines further medical treatments for cure and wants comfort care only
Look to end of life care because care in home just won't give you the help you need whatsoever. If you cannot afford now to hire in some help, and it is too much for you, it is time to consider in-facility care. I am so very sorry.
No MD will guess at whether death is imminent within 6 months in the case of a patient with Alzheimer's.
I wish you the best. I am so sorry this is so tough.
Based on my recent experience with assessment, and what you're seeking to do, she will not qualify until she can't/won't eat, is too weak to function, is dropping weight or has another profound health issue that is "terminal" in the short term..
If you are overwhelmed by her care, why don't you go to Care.com and hire someone to come in and help you? Or, call social services for your county to see if she qualifies for any in-home assistance (and it won't be anything more than light housework, food prep, hygiene help, rides to appointments).
I have been advised recently that one may contact a Hospice agency directly to request an evaluation for a loved one with dementia. But, I agree about getting her approved by Hospice doesn’t mean around the clock care by their staff, unless she went to an inpatient Hospice facility.
My understanding is that if on Hospice, the patient receives 5 free days in a facility to provide the family respite time. I’m not sure how often the 5 free days in a facility that includes. If anyone knows, please chime in.
Key points about hospice eligibility:
Physician certification
A doctor must certify that the patient has a terminal illness with a life expectancy of six months or less if the disease runs its normal course.
Patient choice
The patient must elect to receive hospice care, meaning they choose comfort care over curative treatment for their terminal illness.
Regular re-evaluation
Even if a patient lives longer than six months, they can continue to receive hospice care as long as their prognosis remains terminal and is recertified by a hospice physician periodically."
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Having eliminated all the kinds of help that are available to her and to you, it looks like you’re stuck with being her caregiver until one of you dies.
On the other hand, should the scales fall from your eyes so that you see all the kindness, professionalism and variety of the services that you’ve closed your mind to, you might find what you both need. I wish you luck in hopes that you’ll change your mind.
You can call a hospice agency yourself, and they will come out and see if she qualifies. You can even call more than one hospice company.