Should we consider hospice?

kitten0509 · May 7, 2007

Hi there! Sorry to hear about your grandfather. I have a link that might help you to explore your options. Generally, hospice is for patients that are diagnosed with less than 6 months to live, and they can remain on hospice as long as every 6 months, they continue to have that diagnosis. I did hospice as part of my psych clinical rotation and it was a wonderful experience. There is usually a team of caregivers including a nurse, an MD, a social worker, a chaplain (non-denominational), home health aides and volunteers. I provided this link because although you may not be located in Massachusetts, this is a wonderful company and I'm sure you will find the answers to some of your questions on their website. http://www.hns.org/

Jolie, BSN · May 7, 2007

My thoughts and prayers are with you and your family. It is so hard to see a loved-one decline.

Your dad's physician can help answer your questions as to whether or not your dad mets the criteria for Hospice care. There may also be important considerations regarding Medicare/Insurance coverage of services that a social worker could help you sort out.

We placed a family member on Hospice care this year, and she passed away about a week later. I am glad we made the decision that we did. However, it was important for us to understand that the room and board portion of her skilled nursing care (in a LTC facility) would be our responsibility, as Medicare would not pay for both skilled nursing care and hospice.

Best of luck to you as you make these difficult decisions.

wonderbee, BSN, RN · May 8, 2007

End stage Alzheimers disease is a qualifying diagnosis. You can ask your doctor for a referral to hospice. The hospice team will come out and evaluate his readiness and talk with you and your family about what hospice service is and what it is not. You can then make an informed decision.

Facilities often have contracts with selected hospice agencies and automatically use those. Doctors as well use their preferred agencies. That doesn't mean though that the patient and family can't override and choose their own. In my area, the really big name agencies aren't necessarily the ones I'd choose. The medium and smaller sized ones seem to generate more patient/family satisfaction.

These are difficult decisions.

shleynic · May 8, 2007

Thank you guys so much for your input. It has been very helpful and I have a better idea of what steps to take.

debblynn13 · May 8, 2007

I agree with RNKittyKat.

Go ahead and get a referal and talk to several hospice places. Let them assess where your grandfather is and whether he qualifies. Some doctors are not aware of the qualifications or may be reluctant to refer. It might take a bit of persuasion on your part to get a referral.

It is best if we can get people into hospice early enough to get to know the family and their wishes and concerns. I have had two patients in the last 2 weeks that were admitted and passed within 2 days. Not nearly enough time to build trust and to fully utilize what hospice has to offer.

Deb

aimeee, BSN, RN · May 8, 2007

Dementia is not something that always follows a linear path. General indicators are a loss of the ability to walk without assistance, loss of ability to communicate meaningfully, inability to perform own ADL's, loss of awareness of one's own needs. Weight loss of greater than 10% of one's bodyweight within the past 6 months, swallowing difficulties, repeated hospitalizations over the past year, and additional major health problems would also be contributing factors. If you are seeing any or all of the above, you may want to ask for an evaluation.

KellieNurse06 · May 8, 2007

I personally would look at meds 1st before anything else......is your grandfather on any new meds????? Some people are extremely sensitive to medications......Just an idea. Look up all the meds he is on ...and you can go on a site like drugs.com and list all the meds & their interactions and whatnot will come up..................I always suspect meds 1st if there are any rapid changes in a patient and even moreso if they are older in age.

A friend of my bf had a problem with his father a couple of years ago...he was on meds that were new and he ended up sleeping like 18-20 hours a day and sometimes he would recognize people and sometimes not........I told him check the meds & sure enough after investigating further it ended up being the problem. and today he is perfectly fine..........I always think meds if something changes drastically out of the norm for a person......good luck & sorry to hear of this going on....

Rnmomajmj · May 9, 2007

I agree with KellieNurse06 in checking out medications. I have a father-in-law that I ended up taking him to the ER one night because he was dozing off quite often, confused, and very unsteady on his feet. All of this happening within one week. Took him to the ER, tried to give the ER staff his medication list but they kept telling me that they did not need it. After about 7 hours in the ER getting a Cat Scan, ABG's, UA, and who knows what else they diagnosed him with Chronic Confusion, discharged him, and told him to contact his physician the next day. The next day I finally looked at his med list myself, since he couldn't get an appointment with his doc, and found that he had been taking 3300 mg of Guafenesin, 2400 mg/day from his primary Dr, and 900mg/day from an allergy doc. Once he dropped back down to his normal dose he was fine in a few days.

shleynic · May 9, 2007

The nursing home he is at is sending him to a mental health facility for three weeks so that his meds can be adjusted. However, I'm trying to push our family to bring in someone from the outside to evaluate him as well.

KellieNurse06 · May 10, 2007

Well at least something is getting looked into shleynic........the reason why I say meds is think about it logically......how many patients are in the facility, how many meds get passed by the nurses....and if they passed lots of meds...chances are pretty much on the money some meds have interactions that are given together and sadly to many patients. The reason I say this...and I know you probably know already ..is because if they had to pass out all the meds at different times they'd never get med passes done.....and usually it's a time consuming process as is..... all the meds usually get passed together that are within a few hours of each other for time saving measures....... I remember my daughter going into respite care for a week every so often...she takes phenobarb, dilantin, synthroid, clonopin, all within 4 hours of each other....so they gave them all at the same time.. 8am to save time........ and it says you can't give dilantin with many other drugs at the same time....and I believe if I recall correctly all of these have some type of reaction if given together at the same time. She used to end up with toxic dilantin levels alot due to this...and she'd be sleeping alot, and just not herself.......luckily this was a very short time frame because if it was a normal thing well let's just say it wouldn't be very pretty.............

anywho.....I am glad someone is doing something anyway..that way if it is indeed for absolute certainty the alzheimers then you know you did everything you could to try to help him & you won't have any regrets with should of, could of & would of's..................I wish your grandfather well & please update on this..I am very interested ! Good Luck!...oh p.s ..I just had a thought.........has he been checked for a UTI?????? I remember the incontinent issue you mentioned just now...duh!!!! sorry! I know elderly people can have some really bizarre stuff happen with UTI's...and mental status changes was one of the 1st things I remember about this......... good luck!

a21chdchic · May 10, 2007

5-9-2007

Your grandfather will have to have a prognosis of 6 months or less to live in order to qualify for Hospice. The prognosis comes from the PCP, although he/she may get an opinion from Hospice &/or a Palliative Care Professional. You should ask the PCP for a Hospice referral. Based on both the prognosis and other co-morbidities, a Hospice Professional can tell you if your grandfather will qualify for Hospice or not. However, if the patient has an expected life expectancy of greater than 6 months, you can still be followed by a Palliative Care Specialist. These two fields are very similar, their goals are the same. There are no aggressive treatments or testing with the goal of finding a 'cure'. The goal is to do testing and/or treatments only to keep the patient comfortable. For example, sometimes radiation is done on a patient as a means of pain control, not to cure the disease. In that case, radiation may be something that a patient may opt for.

The main difference between Palliative care and Hospice care is - Hospice requires a life expectancy of 6 months or less, and Palliative care does not have that requirement, but the goals are to treat a patient to keep them comfortable not to cure their disease state.

In the event your grandfather qualifies and opts for Hospice care, your best bet is to find a Hospice that is Non-Profit because the bottom line is this, they will put proceeds back into the Hospice Program to improve the services already offered, and the proceeds of a For-Profit will be lining someone's pockets,therefore, the RN's will have a heavier caseload and less time for individual patients and their families.

The services that you want to have available to you through your chosen Hospice organization will include: Home visits by: MD, RN, CNA, Social Worker, Chaplain, Homemakers, Volunteers, and of course don't forget about the importance of Bereavement Services after the loss of your loved one. Without a doubt, a Non-Profit Organization is the way to go for outstanding service and care.

a21chdchic in AZ - Hospice RN Case Manager