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Thread: End of life and Medicare

  1. #1
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    End of life and Medicare

    A friend told me that her stepfather, aged 89 and in rapidly declining health, has now qualified for hospice care according to the local hospice agency. However, it's in-home care only, meaning my friend's 89 year old mother has to do the day-to-day care. Since he's already practically bedridden and frequently incontinent, she's exhausted.

    Apparently, per Medicare guidelines, you are not eligible for a bed at a hospice unless you are within 2 weeks of death. (there are other criteria like, a minimal level of consciousness). My friend's stepparent has been given an expected range of 3 weeks to 6 months, so he is not close enough to dying to meet their criteria.

    I had always thought that if a medical doctor deemed you as being likely to die within 6 months then you were eligible to be transferred to a hospice; however, seems like Medicare will only pay for 2 weeks.
    Once again our medical system seems to fail those in need.

    (I should note my friend works full-time and they are in a city 120 miles away, so she's not available to help.)

  2. #2
    Senior Member iris lilies's Avatar
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    Quote Originally Posted by Lainey View Post
    A friend told me that her stepfather, aged 89 and in rapidly declining health, has now qualified for hospice care according to the local hospice agency. However, it's in-home care only, meaning my friend's 89 year old mother has to do the day-to-day care. Since he's already practically bedridden and frequently incontinent, she's exhausted.

    Apparently, per Medicare guidelines, you are not eligible for a bed at a hospice unless you are within 2 weeks of death. (there are other criteria like, a minimal level of consciousness). My friend's stepparent has been given an expected range of 3 weeks to 6 months, so he is not close enough to dying to meet their criteria.

    I had always thought that if a medical doctor deemed you as being likely to die within 6 months then you were eligible to be transferred to a hospice; however, seems like Medicare will only pay for 2 weeks.
    Once again our medical system seems to fail those in need.

    (I should note my friend works full-time and they are in a city 120 miles away, so she's not available to help.)
    That is a sad situation indeed.

    Isnt public healthcare grand?

  3. #3
    Senior Member iris lilies's Avatar
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    ...But realistically, we all have to understand that Medicare covers MEDICAL treatment, not living-our- life situations.

    Your friends have options through the publicly funded Medicaid program if they are without resources.

    If they have resources, they are expected by Nanny G to spend their own resources before Nanny takes over.

    This is not an argument just a comment: my mother was under hospice care for more than a year, but she was in a nursing home and was paying from her own resources, so of course Nanny G. Liked that situation. Hospice care is cheaper than agressive medical treatment.

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    Did this many years ago, with my grandmother. It becomes full family care. A friend recently passed after his diagnosis (his diagnosis to death was less then 21 days). He was in Hospice the last 5 days because no local family. No situation is the same and beds were certainly scarce.

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    I don’t see anything wrong with using your own money until you need Medicaid. My grandma did that. In the old days the surviving spouse was left impoverished but the laws have changed and that’s not the case anymore. He needs to go into a home. That poor woman will end up dying from the strain.

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    She should call a social worker in the department of aging in their town and ask for advice.

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    Senior Member catherine's Avatar
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    Ugh.. New Jersey just passed assisted dying, and if I'm compos mentis at that stage, I'll sign up and save my family months of cost and hassle.
    "Do any human beings ever realize life while they live it--every, every minute?" Emily Webb, Our Town
    www.silententry.wordpress.com

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    C, you won’t be in New Jersey.

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    Senior Member SteveinMN's Avatar
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    Quote Originally Posted by iris lilies View Post
    Isnt public healthcare grand?
    Private is absolutely no better. A friend of DWs was discharged from the hospital to hospice at home with terminal cancer. They expected two weeks. She lasted for six, aiding herself by eventually withdrawing from food and water. There was some outside help for daily cares, but the rest of it was up to family and interested friends. It did take a toll on everyone. Private insurance.

    Quote Originally Posted by Teacher Terry
    She should call a social worker in the department of aging in their town and ask for advice.
    Indeed. Possibly was assigned one in the hospital to make discharge go more easily. The hospital also might be a resource.
    Success is to be measured not so much by the position that one has reached in life as by the obstacles which he has overcome. - Booker T. Washington

  10. #10
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    Perhaps Lainey's friend needs to carefully review how Medicare eligibility is determined for a case like her stepfather.

    As I understand it, a physician determines that the patient is terminally ill, with prognosis of less than 6 months to live, assuming that the illness runs its usual course.

    The hospice benefit is 2 90-day periods followed by an unlimited number of 60-day periods. If 6 months of hospice care elapse, I believe the physician would need to recertify that patient.

    I would have questions about the home health and hospice provider's capability. I may be nave, but I would assume that to be licensed, a hospice service provider would need to demonstrate capability to deliver all levels of hospice care. Medicare recognizes 4 Levels of hospice care:
    Level 1: Routine Home Care. The Home Health Care Aide provides specific cares and then goes away. At any point it may be determined that a higher level of care is needed.
    Level 2: Continuous Home Care. The Home Health Care Aide(s) is present with the patient at home for 8 to 24 hours per day. The need for Continuous Care is re-evaluated every 24 hours.
    Level 3: Inpatient. Circumstances (such as intractable pain, continuous vomiting, etc) may require the patient to be transferred to an inpatient hospice facility.
    Level 4: Respite (for the caregiver). The patient is transferred to an inpatient hospice facility for period of up to 5 days to enable the caregiver to meet her own personal needs.
    Last edited by dado potato; 4-17-19 at 2:02pm.

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