When do you know to call in Hospice?

Aprons - as others have said, you will need for your mom's MD to write the orders for an evaluation for hospice to happen. Now as far as which hospice, you should call around to see what is available. Hospice is a Medicare paid benefit, and as such it is "self-directed" so your mom (or you) can select the provider. Also since it is self-directed Medicare benefit, you can fire or change hospice group. I did this for my mom and it was done within the first 90 day hospice period. Took 3 days for the change over as I had already spoken to the replacement hospice which did their interview with her and let I the NH know in writing of the change. BTW Medicare pays hospice about $ 4,500 a mo. My mom is now totally bedfast and or her hospice is RN once a week, an hospice aide 3X a week with 2 of those visits involving bathing, social worker twice a month and on-site MD evaluation every 60 days. They also got mom a geri bath chair, a geri sitting chair, a "breathing" mattress with specialized bed plus all her diapers, specialized drink (TWOCAL HN with FOS) - all cover by Medicare. Now all the equipment was there within a day too. Some smaller hospice may not have the cash flow to do all this right now, so ask about what the delivery schedule is for any equipment that your mom may need. You don't want to have to wait for a geri bathing chair if you can help it.

Some hospice - like VITAS & Compassus - are larger national networks and then some are just a single location with super small staff. I have dealt with Vitas & Compassus and both were just fine with great staff. Both were very short time hospice placement. One thing about the bigger groups is that if your family member needs pretty serious med's - like Class 3 or 4 pain meds - they have it; most smaller hospice just do not have staff that carries this on them. They have to request that another person come to give the shot as they aren't certified for Class 4 drugs or have the insurance needed to travel with Class 4 in their car. Also the bigger hospice often have a free-standing in patient unit for the very "end" end of life. In my mom's city, VITAS has this @ an old women's & children's hospital. My aunt went to it as she was in immense pain which was well managed as she was in-patient. Now my mom - on hospice since June - will stay in her NH and never go to in-patient hospice as she likely will just pass away @ her NH. Both in-patient units I've been at seem to have a younger patient group end of life from major cancers or major trauma rather than the elderly dementia patient.

Not all hospice are the same, it;s like finding a NH that is the right "fit" you have to call about, ask ? and make a well-informed decision. And you can change to another facility or another hospice provider if it just doesn't work out.Good Luck.

You Mother is getting tired and is ready for next world. Religion was always comforted me. My Mother had dementia. She was much younger. But, age doesn't mean anything if there is no quality of life. My Mother had dementia for 12 years. My sister was my Mother's POA. But, I was my Mother's Health Care Proxy. When it comes to siblings. One sibling should not have full control. There are things we can disagree on but, it is protective for a parent. I worked in a Long term facility for 32 years on the units. I saw many people like your Mother. The last 17 years I spent working in Geriatric Research. My major was Pallative Care. But, getting back to my Mother. I moved in with my Mother the last 8 years. I was working. My husband worked nights and always slept with one eye opened. My Mother adored my husband. My Mother was a Sundowner come 5 pm. I had to be home at 5p. I did have an hour to my self to exercise. Then I would pick my daughter from aftercare. I got up at 4:30a to have quiet time for myself. In 2008 I had a serious work related accident. I tried to work for 2 years. But, on June 30, 2010. I walked out and never looked back. I am on Social Security. But, I believe everything happens for a reason. The following Fall, I saw my mother getting weaker and weaker. But, she was stubborn and knew how to push herself. In January 2011. My Mother was walking upstairs and feel and cracked her head open and was admitted to the trauma unit. After two days, I decided it was time to call Hospice. This Hospice was the first in the country and they where excellent. From the fall my Mother became bed bound. Which was quite difficult for her. Money wise if you can have no more than $2000.00 in a bank account in her name. You are also allowed money for burial. Call a nursing homecare agency. They will help you fill out a Medicaid form. This is not Nusing Home Medicaid and is not attached to property in her name. Because my mother was bed bound. I had a aide for 40 hours a week. I lucked out. She was the best. You have 16 hrs of Hospice care. I used them to cover my regular aide days off. I knew they could keep her safe. I had time to care for my daughter and to shop etc. I aso had respite time. My 3 siblings never helped. Hospice will give you a smal box and tell you how to use it. Hospice are on call 24/7. My mother asked to have all four of her children visit together. We did and all stood around her bed. The last two weeks she started to let go. The Thursday before she died. This is very common. My old Mother was there no dementia for a few minutes. She said to me "Mary I've had enough let me go" which was like taking a big weight off my shoulders. My Mother was in control of her on density. Friday, my Mother developed rapid pulse and a temp. The hospice nurse told me. If this continues your Mother won't make it through the weekend. Saturday she had some discomfort. I gave her Morphine as needed. You can never give to much morphine in moderation and calling the nurse to agree with dose. By Saturday night all four of her children where with her. I got into bed with my mother and held her hand. My sister and I gave Morphine every hour and had to go up in doses of Morphine for comfort. Comfort measures are Morphine, Ativan every 4 hours and oxygen. It was Sunday, my Mother was on 18 mg of Morphine every hour. I have seen others suffer and Morphine didn't help. Then you start with suppositories and a pump of pain meds. My Mother was comfortable on the dose that was given. 2p I gave my mother her last dose of Morphine. I could quickly see her failing I told my family it won't be long now. My Mother passed at 2:20p very quietly, peacefully. It was July 17, 2011. She was 79. My Mother died with dignity in her own home. I never regretted what I did for my mother. When people stop eating walking and sleeping a lot. They are giving up. The term is called Failure to Thrive. The worst thing you can do is put in a feeding tube. It just prolongs death. This is the first time I told my story. I hopes it helps. Hospice can come if they don't feel a patient is going to die before 6 months. It is always nice to meet the family and see the patient before they need Hospice. Your Mother at 90 has probably had a good life. Now it is time to let her die with dignity. There are Hospice facilities that are quite nice. They cost the same a month as a Nursing Home. It is cover totally by Medicare. If you are in a facility it is part Medicare and Medicaid. My Mother was totally Comfort Care. From the time of her diagnosis. I wish you the best of luck. Do what is best for your Mother.

Giving injections is not comfort care. There is Morphine is given by drawing up the dose in a dropper and slowing put a little on both sides of
Inside there mouth and under their tongue it is absorbed quickly. Ativan come in liquid form too. But, if you have pills. You can put one under there tongue it is tasteless and is absorbed quickly.

I see changes in my mom, she's slumping over, lose a lot of weight, tries to feed herself but now I help her more with feeding, she can eat finger food without being too messy, she drools but still able to walk some with help with a rolling walker. She eats at the table with her, I don't isolate her, she's in a room with family at all times, what hurts is that she doesn't call me by name now but she still recognizes me. I just can't see her not eating or walking, I know I am a little pushy but that's what kept her going. We like to have lost her in 2005 but I didn't give up, she had to start all over with eating, walking (oh my God !),bed mobility, the whole works. Oh by the way she has Parkinson too. Thank God she is still hear but I tell you I get soooo tired sometimes until I don't think I can may it. God gives me the strength and I look back and say , I made it through this day. I can't just let her stay stay still, she would deteriorate sho nuff. I 'm not having it ! As tired as I am now but when it 's all over with......I can truly truly say , I've done my part, without a doubt I've done my part.

OOPS ! I meant to say she lost a lot of weight, and eats at the table with US !

"As tired as I am now but when it 's all over with......I can truly truly say , I've done my part, without a doubt I've done my part."

Please....never forget that. You deserve the credit.