When my mom died under Hospice care, the nurse came out and declared/called it, so I could then contact the cremation service. Since my mom's death last December, my dad's health is declining fast. He isn't in Hospice care and I don't know who I'd call if he gets his wish and dies at home in his sleep. Seems like calling 911, with all the folks they send out, isn't warranted if he's already gone. As an aside, he does have a DNR. Even with Google, I can't figure it out. Please advise and thanks.
I'm in PA so maybe CA is different; now is a good time for you to call your dad's doctor and ask them exactly what you should do.
If you die in my state, not under hospice or a physician's care, it is an unattended death and there is an investigation. That can be simple, but they are always looking to determine if foul play was involved, so it could be unpleasant to go through at the same time as losing your dad.
Hospice will keep him comfortable and pain free, they can help bathe him, change his bedding and it is a phone call when he passes.
You need to be considered in this situation as well, hopefully you can convince him that you need him to be on hospice.
He could be eligible for hospice or not, Medicare covers this service 100%. So he would not have any fees.
Can I recommend interviewing several hospice providers and find one that fits your needs and has a business model that you like, they are not all created equal. If you hire one and you decide that they are not a good fit, you can fire them and bring a different one in.
They helped all of us when my 52 year old sister was dying of cancer and refused any treatment. They helped us understand what was going on, what would most likely happen next and they treated her painful bedsores so she didn't suffer from those. She couldn't move because her back was broken from the cancer eating her spine away. I have been told that they are a sign of impending death and that they are painful when untreated.
I hope you find the perfect solution to your situation.
It was great for mthr to have hospice to call first when she fell instead of rushing to the ER to see if she had a brain bleed. If we made the decision to keep her home on our own, and she had the brain bleed and died in her bed, then there would have been an examination, head trauma would have been noticed, an autopsy performed, and then an investigation into why she was not taken in (negligence on caregivers) or was there elder abuse (active abuse). Neither of those are what you want to face when you are grieving a loved one and want to get everything tied up.
Hospices can provide palliative care as well which has a cost - it is my understanding that Medicare covers hospice 100% but not palliative care. With hospice someone has to be at home with the patient at all times, but with palliative care, the rule differ.
If your dad goes on hospice, which would be palliative care at this point, no one will know if and when he passes. The mortuary isn’t going to roll up to the house with a hearse. When my MIL passed, they came in a minivan that was backed in to the garage. Totally discreet and dignified.
While I am never stoked to have the cavalry come to my house, I live next door to a long term care facility and that side show occurs about once a week.
I appreciate all the great information and insights I've received so far, and think that in the foreseeable future, having Hospice come a couple times a week to just take vitals, is not a bad idea.
I don't understand what service Hospice would provide, other than being on-call for pronouncing his death.
Please enlighten me.
The OPs dad is old and it doesn’t even sound like dad is interested in curative treatment at all. It sounds like palliative care is appropriate.
They could probably offer suggestions on how best to approach the situation, since they're familiar with your particular area.
None of my family died at home, so I have no recent experience in this aspect of caregiving.
This is a sad situation, having lost your mother so recently, and now facing your father's apparent imminently close passing as well.
I respect your attempt to honor his wishes; my father also planned to die at home, but his last illness was too intense for home care. I was fortunate to find a compassionate multi-level facility where he spent his last days, warm, cared for well beyond any level I could handle, even with the nominal assistance of hospice.
I still regret that I couldn't honor that last wish but I know in my heart that he couldn't possibly have gotten the care he got with a group of people trained to provide various levels of care. Had I kept him at home, I know that I would still be battling recriminations for not providing the level of care I thought best for him.
Still, this is his wish, and you're considerate to try to honor it.
Medicare hospice status is granted after his MD determines that he likely has 6 months or less to live. That is a medical determination, not something a caregiver "decides." And hospice status can be renewed again and again.
When on Medicare hospice status, all medical support, including help with ADLs if needed, are 100% paid by Medicare. You and your dad will receive no bills. The hospice service determines what services the patient needs and then provides them. The service is seamless and very worthwhile (based on two cases in my immediate family.)
It's up to you and your dad to bring up hospice with his MD. That MD can explain what it means in his case. It sounds like, if your dad is "declining fast," hospice may be helpful to furnish some services, including nurse visits to the home, and they handle notification of the correct persons when a death occurs. For all these reasons, talk to the primary care MD about the advantages and disadvantages (seems like none in this case,) of Medicare hospice status.
Great post with lots of information. (2/5/20). You mentioned about M/care Hospice pays for all ADL's if needed. That is only if hospice is coming to the home, correct? My MIL is in a NH, and on private pay, we are working on Medicaid application with an attorney.
If she were moved back to a house, and stayed on Hospice, what type of care do you think she would get, paid for, if needs 24/7? She has Parkinsons, and can only eat pureed food now, and cannot do anything (transfer) without help, and also is incontinent.
Do you know if hospice would loan her a bed in the NH, just like they would at a house?
thank you
My grandma died at home, alone, NOT on Hospice and when my uncle found her, he simply called her dr. He came out, pronounced her gone and called the mortuary. She had recently had hip surgery and was not doing well.
We've had deaths in our neighborhood and having the whole fire dept along with the police come--it's awful. Kind of terrifying for little kids who witness all this...Hospice does things so gently IMHO, just having them on board, even if they are NOT providing day to day care, would be a boon to you. Takes away that possible drama.
Dad's hospice team was catered to HIS needs, toward the end they did provide a lot of support, Your dad could easily go from not needing much help to being very needy in a few days. I'd look in to it, just checking it out cannot hurt.
You have total control on the treatment plan while on hospice. I just could not take mom to the doctor anymore so this is how I dealt with this, even though old age and Alzheimer's are terminal conditions.
Hospice as in home clinic, love it!
I hope he remains not in pain, but hospice handles much more than pain meds so I would implement that to assist you and him... in my opinion.
I can see how this is weighing heavily on your mind. I called up Council on Aging in my area to ask this very question. They informed me to call 911 and explain that my mother had died. They take care of it from there.
Many years my grandma died while visiting at my parent’s home. Her heart just gave out. Daddy called grandma’s doctor. An ambulance came and took her body to the morgue. Arrangements were then made for grandma’s wake, funeral Mass and burial.
When my father-in-law passed, only a deputy came out & then the funeral home was contacted ( it was the middle of the night) & they sent a couple of people to get the body. When my good friend passed, dispatch sent the EMTs ( in our area the firefighters are trained EMTs) & 2 deputies. One of the deputies called the morgue to come for her body.
In one of the larger cities I imagine it is still handled pretty much the same.
My gram died in the car on her way to a doctor's appointment. My mom drove her to her doctor. The doctor said, "Yes, she passed." Mom had to take Gram to a hospital to get a death certificate completed and store the body until the funeral service could arrive.
Given what everyone has said about avoiding the hoopla involved with an at home death, I would definitely look into it and sign up if possible! My mother is in a MC facility. Don't know what they do, but it won't impact me (no fire, emt, police, ambulance at my house!)