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<p>Let me preface this all by saying that hospice can never be used only for respite care. For someone to sign on for hospice, a physician must certify that, given a normal trajectory of a disease, that person has approximately six months or less to live. Not to say people haven’t been on hospice services for longer (they often are), but someone can’t just choose hospice because they want respice services. The Medicare hospice benefit (and most insurance companies) will provide up to seven days of respite care for family/caregiver breakdown, but that care must take place in a skilled nursing facility.</p>
<p>That being said, if he’s on hospice, there’s an assigned social worker. Sometimes it takes a week or so for that social worker to get out for an assessment visit, depending on scheduling, but in the meantime, they have to have made contact by phone. Social workers are particularly cognizant of family breakdown, and know when to step in and intervene if the situation is a health risk to either the patient or caregiver. I do know that, often, during their assessments, social workers will ask about support systems for the caregivers. If it seems they have little support, the social workers (and even other team members) might suggest the caregivers reach out to friends if possible. I can very easily see that kind of suggestion being given to the wife, and her taking it to mean she must get help from friends… after all, you said she has bi-polar disorder - you’re only hearing one side of the story, and you have to consider the lens through which the wife is hearing the suggestions from hospice. </p>
<p>While their are ‘adult’ children within close proximity, it is important for people to understand that that can mean absolutely nothing when it comes to taking responsibility and helping out. My bet is that if the son is just out of prison, he’s got some serious issues himself. Just because there are grown children (even living under the same roof), it doesn’t mean that those children are helpful in any way. It’s sad, but true in so many cases. Usually it involves some sort of estrangement, somewhere on a continuum; I suspect he’s using them as room and board until he can get on his feet, and is emotionally already out the door. It just plain stinks, but many times friends become more involved in care than adult children do. I see it often.</p>
<p>Next issues, while he initially hired her to help care for him, he probably was more independent then, and didn’t need help with personal grooming and hygiene needs. So it was different in that context than it is now. Hospice benefits include twice-weekly (minimum) visits from certified nurses assistants, but not all families choose to utilize that part of our services (usually they have a paid caregiver living in the house). However, I would say that if we have a patient without a paid caregiver living in the house, and they refuse CNA visits, I would bet that the patient is a male 90% of the time. Men have a much harder time accepting the kind of personal, intimate care that is often needed by the time they are on hospice. I could tell you story upon story of men who fought tooth and nail before even agreeing to meet with one of our aides. Most the time our aides win them over, starting slowly, if given a chance to meet with them. </p>
<p>However, this in no way excuses the unrealistic expectations this woman has placed on people. I can see how forces joined together could easily create a situation where someone won’t agree to bring in a paid caregiver due to modesty, distrust, and a fear of the unknown. As I mentioned earlier, the kind of care he most likely needs now is much more personal than what the wife provided him when they first met. I can also say that if this woman is at her wits end, and cannot handle his care alone, hospice will insist they either hire a caregiver or put him in a skilled facility. If she cannot handle it (meaning she can’t cope with the day-to-day tasks of keeping up a household, including meals, cleaning, and his care), they will eventually tell her she has to hire someone or put him in a residence. If she chooses not to, the hospice has the right to discharge him from their services. They will not be part of any situation that involves safety risks and/or possible neglect. It becomes a liability for them, i.e., what if she’s trying to help him up to the bathroom (and it is known by all that she should not do so due to her own health problems, and has been told not to) and he falls on top of her. Families must be compliant with hospice rules to be part of hospice.</p>
<p>Many hospices also offer volunteer services where a volunteer is assigned to a family, and makes weekly visits. Often the caregiver uses that time to either run errands, catch up on some sleep, go to their own doctor’s appointments, etc. What strikes me so odd about this situation is that this woman is so resistant to what I know are other more professional resources available to her. Granted, she may not be telling the hospice team the whole story and may be pretending that she can handle it all fine; if that’s the case, they have know way of providing some sort of intervention if they don’t know. Literally, we’ve had to have interventions with family members who are totally dysfunctional. </p>
<p>This has gone on way too long, but I just wanted to reiterate that there is likely much more to the story than you’re being told. It doesn’t mean you don’t have a right to feel annoyed and irritated by her demands, and I wouldn’t change how you’re handling it. But just remember that there’s a hell of a lot more going on in that house, and she’s obviously in chaos mode. Really, this doesn’t even come close to some of the situations I’ve encountered. My favorite one this year was the situation with the adult children of one of our patients, who was in a nursing home (relationships between the patient and children was not great). They scheduled the funeral before he even died. Literally, I was called out to see them when he was alive on a Sunday night, and they already had the funeral scheduled for Wednesday; needless to say, they were frustrated that he wouldn’t die so that they could keep to their schedule. The staff at the nursing home told me this, and we’re absolutely appalled. It created quite a rift between the staff (who was quite angered at the family) and the adult children. So yea, don’t even assume adult children always mean well.</p>