My mom has been in long term care (since 8/2017) from a fall with a TBI. She has since been diagnosed with vascular dementia. She lost 48 pounds in first 8 months at original NH. I moved her and she is happier and weight loss has stabilized. She has begun falling down (13 falls in last 3 weeks) resulting in 3 hospitalizations. Nothing broken, but brusing, pain and more bumps to the head. She has been using a walker. Now the nursing home is trying to push me to move her to higher level of care. She is Medicare/Medicaid. There is no money for a memory type of care. I am POA and have been against any home change. Has anyone added Hospice or palliative care to allow a LO to remain where they currently live? As I have read, at this point she has most of the indicators that may point in this direction...frequent UTI's, VD, significant weight loss, can't dress or bathe herself and needs help toiletting. She still has most of her words, but now can't recall my daughter's name in the last 2 weeks. Her other underlying conditions are BP/run high, pace maker for Afib/low heart rate, life long depression.
Life limiting condition, with no chance for recovery and no continued course of treatment.
(personal opinion she probably would have been Hospice eligible in August of 2017)
Contact, or have Nursing home contact Hospice. (You can interview them as well, you can choose the Hospice you want) have her evaluated.
But
Hospice will not have someone there 24/7, Hospice will not prevent another fall if that is the concern. Your Mom will not be transported to the hospital when she falls again. Hospice becomes the 911, they will be contacted. If she requires hospitalization or is taken to the hospital she will go off Hospice. (Hospice can not bill while she is in the hospital and the Hospital can not bill if she is on Hospice) She can go back on Hospice once released from the hospital, if she goes into rehab she remains off Hospice.(again my personal opinion here but... to send someone to rehab with TBI/dementia is pointless for the most part. You have to be able to understand and participate in rehab. )
I think the call to hospice is a good one but the fact remains that if the facility where she is does not think they can keep her safe and that she needs more observation, more staff they can request that she be moved to a Memory Care facility. Unless you can provide a "sitter"
If your mom has no appetite you can convince her to eat, but sadly in many cases you might be causing stomach upset if her system is shutting down and only prolong her death and the ability to die with some degree of dignity.
God bless you for your loving care.
But personally I think their wanting her moved out as to shift her increasing care requirements & looming liability to another place. Plus you visit like every day, just about, don’t you? If it’s really “at least 5X a week”, I’d bet you visit sometimes 2x a day...... It may be that your pretty constant presence is problematic for staff and their ability to keep to a schedule as they have to work around you being there.
Her being gone = your gone too.
NH is 2.5 mi from your home, I get it, it’s super nearby & convenient for you so you visit & often. But I’d bet NH is beyond over you. If this could be a factor in them pressing on her moving to a MC, in addition to her fall-risk, they can find reasons to get her out...... if your getting written concerns or a 30 day notice on her care & this NH capabilities, she’s going to get moved out. Right now they want you to deal with doing this but if you don’t, then what can happen is when she has another fall, they will send her to the hospital and then refuse to take her back. Hospital discharge planner will have to find a spot for her or you take her into your home.
I’d suggest you request via the DONs office to have a care plan meeting ASAP to see what options are & if hospice added onto her care plan, can keep her at this NH, then please allow for a hospice evaluation to be done. NH MD/medical director will sign off for the evaluation to happen and then hospice group will send out team or maybe just hospice RN to do this. Hospice is a mediCARE benefit, so it’s technically self directed so your mom or you as her DPOA can select the vendor. Usually the NH as a few regular hospice groups coming into the NH already. It could be that the NH needs you to allow for hospice & perhaps pick a hospice in order for your mom.
If the hospice group doesn’t mesh well for whatever reasons, you as dpoa can change to another group. I did this with mom’s hospice, for me it was more about a matter of communication.... 2nd group could Skype and would call me from mom bedside in addition to email updates. I’ve got to tell you hospice was hand down absolutely a good decision. Hospice coming in 2-3 days a week added needed extra hands for my mom’s care plus brought in equipment (pneumatic bed, Geri bathing and day chairs, extra nutritionals, etc.) My Mom was on hospice 18 months before she died.
As far as I know, it was still covered by Medicaid.
My understanding of how all this works is in MT. Mom fell, broke her hip, had surgery. She was to be in a wheelchair. She forgot and got up only to fall and break the other hip. So, the Dr had to not only order the wheelchair, but also order a strap to go across her. Then is had to be a buckled best that she could undo. Because it was there, though, she cold not just get up and fall without someone noticing that she was struggling to get it undone. At the end, she thought it was the belt to hold up her pants. (She was wearing a dress).. Yes, the Dr. has to order the restraining strap.. God bless you on this journey!
Now we won’t have to move him if he gets worse as it is a step-up care that accepts Medicaid. Unless he becomes aggressive and is a danger to others.
I worked for 20+ years in SNF’s and did do speech language therapy for people that could not participate-whether right before Hospice or in the first few days of hospice.
It was to set up an environment for the best communication for staff and family with the patient, and for comfort eating. It is always short term-less than a week, but very beneficial to the patient and family.
I don’t know what higher level of care they mean...what do they suggest when you ask?