[thrashej]

Quick Question:

We are trying to get my father to go inpatient at his hospice. Currently the nurse is visiting the home but for other reasons, he can no longer live with my brother. He, for whatever reason, does not want to live with me....So...... we tried to put him in one of the hospice houses and they said because he is still relatively mobile and wants to leave during the day that they could not take him! They said they have never had a pt that wanted to come and go as he pleased. They said that typically hospice inpt is short term--last two weeks of life (ok, how do they predict that anyway?). We told them that we would pay out of pocket for however long the stay ended up being and they still drug their feet.

Question is...is this uncommon? I mean, aren't there patients in inpatient settings that can leave for pete's sake? Dad wouldn't go in anyway if he thought he was going to be held prisoner! They wanted to bring a nurse into the home 8p-8a for when he had no competent caretaker but there is still a problem...he CANNOT continue living with my brother. So, basically, he has no home. I mean, what do homeless people do? If (this particular hospice) hospice is not for profit and provides services without regard to ability to pay, why can't he go in if we are saying no one can take care of him 8p-8a and he saying he has nowhere to live?

Thanks for any input!

[doodlemom]

Some hospices have "residential beds" that are privately paid for by the pt/family - or charity care. Many or possibly most hospice inpatient facilities have only acute beds which are to be used for their patients with acute care needs such as symptom management, actively dying pt's, and acute psycho-social needs. It is meant for short term (until the pt is stable, or until the actively dying pt dies, or while placement is found in a nursing home. Because of the staffing needs for an acute care facility, if they were to let your dad stay in one of these beds you would have to pay around 600/day to make up what Medicare or private insurance pays for acute care. Plus you would be taking a bed away from a pt with acute care needs. Our hospice does not have any residential beds and is certified only as an acute care facility. We could not let a residential patient stay there even if we wanted to because the beds are state certified as acute care. The hospice that you are speaking of probably is not allowed to just turn one of their beds into a residential bed. If they did it for your Dad then they would have to do it for everyone. Then the patients with acute needs would have nowhere to go. It is unfortunate and I know that your Dad really needs help, but most people in his situation have to go into a nursing home or pay for private duty care givers. In answer to your question, homeless people apply for medicaid and go into nursing homes,die in the hospital, or die in a homeless shelter.

[thrashej]

Ok, well, I guess that makes some sense. Guess we will all have to figure something out... Thanks for replying!

[APP]

Since he is relatively mobile, could he find a short-term apartment rental and continue to use visiting hospice? I realize insurance/medicare wouldn;t cover the rental expense, but it is an option if he can afford it.

[RnRatchet]

For what you would be willing to pay for him to stay at a hospice house (even though this particular one doesn't do residential) maybe you could look into a senior community of sorts? We visit several patient's in places where there is a LPN or RN who is the manager and helps set up med boxes and make Dr. appt's for residents. Most of them allow the pt to have their car is they have a valid driver's license and all allow the pt to come and go as they please. Most all include meals and cleaning services too.
Good luck in looking for a place for dad to call home.

[thrashej]

You know you all make really good suggestions but none of them will work, unfortunately. My Dad is so stubborn with EVERYTHING. He doesn't want to live with old people, feels funny in ANY house with other people, said the other day he "has no home". He can't even leave the house anymore, so why does he seem to care so much about leaving the house?? He can't drive.. It is just all too sad. He is poster child for not dealing with his death well. If he sees something on TV of a religious nature he gets white as a ghost... I saw him yesterday, he was worse. Pretty soon he will qualify for inpt hospice but I just found out yesterday that he never signed his POA form. He appointed people but won't sign. ???? what is up with that. He is barely in this world enough right now to make decisions for himself. He is so very confused I don't even know if he should be... So, hopefully today the HN can really, really, really talk him into going inpt atleast to get on methadone. He is so so so out of it and tremoring, itchy. Maybe methadone would work better for him?? Right now he just gazes off into nothing, his eyes look so empty...

[ktwlpn]

Originally Posted by thrashej

. My Dad is so stubborn with EVERYTHING...... He is barely in this world enough right now to make decisions for himself. He is so very confused I don't even know if he should be...... So, hopefully today the HN can really, really, really talk him into going inpt atleast to get on methadone. He is so so so out of it and tremoring, itchy. Maybe methadone would work better for him?? Right now he just gazes off into nothing, his eyes look so empty...

One option is to call an ambulance and take him to the ER-if he has a sudden increase in his confusion and tremors that's reason enough for a visit.Once he is there he's in the system and you won't be the bad guy-he'll have to go where ever they can place him..good luck