I don’t have time to read the whole caring for adults thread, unfortunately. Dad just got taken to the hospital by ambulance. 
My question is can hospice be used for long-term home health care? My mom can’t keep doing this herself, and she refuses to put him in a facility. What are the things I need to be asking? We’re all OK with hospice and palliative care, but I’m not sure that’s what my mom needs. She needs someone more hands on than is my impression of what hospice offers.
TIA
At this point…you want to work with the discharge people from the hospital. They should help you with a discharge plan…and this could include home health care, hospice, therapies, whatever.
In our experience, the Hospice agency we used was awesome, and was very willing to add services as needed. We started off with twice a week home health care…someone to do things like bathing, etc. that was very quickly increased to every other day, and eventually to daily. But this was not 24/7 care. It was about 2 hours a day max. But it sure was a huge huge help.
The hospice people have resources to connect you to…but so should your hospital discharge person.
You can also contact the council on aging in your community for a resource list.
For my mom, we actually hired someone privately for 8 hours a day, three days a week. Referral was word of mouth from friends. This woman was fabulous…cooked, cleaned, cared for mom, took her out sometimes. It was not inexpensive but so worth it.
Thank you, thumper. That’s why I encouraged them to take him to the hospital … I knew they would be clear-eyed about the appropriate options and point them in the right direction.
My mom is in terrific shape for 86, but it’s wearing on her. I was just there for six days, and he was great … still showered on his own and went to the bathroom on his own. Today, he’s a disaster, but I’m sure it’s not a temporary dip. It’s not going to get significantly better.
So sorry to hear about this. My experience with hospice(as you note) with both my mother and mother in law was that hospice benefits did not pay for daily, long term care. Someone coming in a couple of times a week to bathe someone, a nurse to check in , chaplain calling to see if we wanted services, etc. was more of what was offered. The hands on day to say stuff (which sounds like what you are interested in)was handled by family and a paid (out of pocket) aid. I’m sure others will chime in with their experiences with hospice and/or elder care. Good luck to you!
@“Youdon’tsay” Is some of what they’ll need within scope of VNA? I would also check with the hospital’s social worker.
Best wishes to your family. Take care of you.
I had to Google VNA. I’ll see if that works. Thanks!
My mom works for hospice and we were just talking about how limited the care is in terms of daily needs, just as
@thumper1 and @sevmom mentioned.
I was very involved in my grandparents’ care and dealing with the home health care agencies was sometimes frustrating because there was a big difference in quality of care with all the different aides that were sent in. I think if you could find someone privately, like @thumper1 talked about, it could be better and more affordable. I have friends who were stay-at-home moms who did work like that privately after their kids got older.
Sorry to read about your dad. Is he eligible for PACE (Program of All-Inclusive Care for the Elderly)? It’s in 31 states, and it focuses on serving people who are certified to need nursing home level care, but can remain at home with the proper support. PACE provides and coordinates medical care, nursing, therapies, medications, senior day centers, in-home aides, transportation, minor home modifications, and more.
It’s a godsend for aging caregivers. The problem is that there are only 250 or so PACE centers in those 31 states. If one is in your area, I hope you’ll check it out: https://www.npaonline.org/pace-you/pace-services
Thanks, @frazzled1 … there’s not one in their area.
Man, if I lived near them it would be easier to find someone privately. I’ll get my siblings on it.
They might want to start by calling the local senior center for recommendations. The county department of aging services can provide a list, which is helpful, but senior center staff often knows which care providers are more reliable than others. Good luck - hope you hear positive news about your dad soon.
Thank you. They’ve admitted him for the night.
Been through this.
First, the primary care physician has to issue an order for Hospice (usually not the hospital). The hospital will only issue orders for short term needs such as skilled nursing facility, short term home physical therapy, etc. these are usually covered by Medicare but only up to 30 or 60 days. Also, only if they see an improvement gained from the therapy, etc. but the hospitals do have a case manager/ social worker that can give great advice and referrals. However, be aware that the list they give you will be big agencies that are generally more expensive.
Medicare, health insurance and hospice do not cover general daily help. Long term care insurance will, if they have any. Hospice only comes for shower, etc twice a week. They do manage all the medications and take care of refills, etc. but they do not administer the daily medication. You are not supposed to be on Hospice unless primarily care physician determines you have less than 6 months to live and are terminally ill. They expect family members to take care of the 24/7 care giving, or you need to pay someone to help.
I think the best way to find home help is to get on Next Door or some other way to canvass your parent’s neighborhood and find helpers already working in the area. I found our care giver by calling everyone in my neighborhood who had aging parents and found a wonderful woman to come help with everything.
Sorry you are going through this. You don’t say why your Dad went to the hospital, but at this point it might be best if he stays there for three nights. If he is admitted for three nights for necessary treatment he can be sent to a rehab facility as @coralbrook mentioned. At rehab they can evaluate his needs and help find in home care if he ends up back home. We just went through this with my MIL and went through it several years ago with my Dad. My Dad ended up in a nursing home and my MIL is currently in an assisted living facility that she can only afford for another 6 months before family needs to contribute if she stays there. If it is determined your Dad can be admitted to assisted living, your Mother could live with him there. They will have their own apt, the facility provides 3 meals a day, there are activities they can choose to attend if interested and they can come and go as they please, including driving. They will also provide help with bathing, getting dressed. laundry, etc., if needed.
Speak to the social worker at the hospital to explain your mom’s refusal to put your dad into a facility. They may see the need for an outside facility and be able to influence your mom to change her mind.
Also, be sure the hospital doctor knows about your mom’s firm mindset. Doctors can be good or not so good in dealing with a stubborn caregiver.
Your mom is not going to listen to you. But she may listen to the medical folks. Good call to get them both to the hospital.
Hugs and good thoughts to you.
As already noted, hospice is not an alternative for long term care.
Get in touch with the discharge planner as soon as you can and see If your dad has a skilled nursing need that could qualify for Medicare services. It won’t be a permanent solution but will buy you time.
Also, be sure you and your mom understand what the hospice designation means. When my dad was on hospice they were very clear in explaining that, once on hospice, they do no more tests or prescriptions other than those required for comfort.
I just buried my mom after a LONG stint with Hospice Care, more than 6 months. There is a Requalification Requirement to extend Hospice Care.
We had both good and bad Hospice Care. There are multiple companies you can use for Hospice Care. Interview at least 2 companies to try to find a match for the kind of approach you want to use for your dad. We ended up firing one Hospice group that did not agree with our way of wanting to comfort my mom.
My mom had multiple UTIs, and we found a Hospice company that would treat with antibiotics. It was still a comfort approach for us, since UTI is so very painful.
Be open to listening to the hospital personnel, both doctors and nurses. They have seen and know how sick your dad is based on years of experience. Try to see your dad through their eyes. What HE needs may not match what your Mom THINKS he needs. And what your Mom thinks she can provide in terms of care may not be realistic going forward.
Palliative care is an option that provides pain relief, support services, and medical care at any stage of a serious illness; it doesn’t preclude pursuing a cure. @“Youdon’tsay”, your siblings will probably want to look for local palliative care providers, too. Again, a local senior center can be a great source of information.
There are also palliative care providers who have a seamless transfer to hospice care should that become more appropriate.
What shocked me was the level of detail that health care providers will ask if you want/don’t want. It is easy to say in theory, but the specifics needed by healthcare providers causes you to think hard. Is withholding antibiotics okay? Is withholding solid food when loved one can’t swallow okay? It is a very personal thing for each family, and you may have disagreements between siblings and parents about what care is right for a loved one.