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My uncle is 103 and until recently was living alone and doing reasonably well. But events last month led to brief hospitalization after a fall and then discharge to local nursing home for physical therapy to get him walking again. Without going into too much detail in this, or, please in answers, he is currently bed ridden but has begun PT to get walking again. He is taking various medications for heart and blood pressure, and isn't in any pain, and seems to need little "skilled nursing" that have observed in 12 hour a day bedside observation. In other words, this idea that he will served better in the hospice wing doesn't make sense.



The only thing that does make sense to me is that the facility will get to charge private pay rate for room and board instead of getting the
Medicare rate while he is rehabilitating. Or am I being too cynical?

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We've run into something a little bit similar this week. What type of medicare does your uncle have? My mother in law has medicare advantage, but it sucks when it comes to covering in-facility care. She was given 20 days, but because her orthopedic doctor has her on strict wheelchair only order (no walker, no walking) they deemed that she doesn't to stay at the facility anymore. No concern for the fact that she's wheelchair bound and my father in law can't lift her, she can't do the physical therapy at the level that medicare deems worthy of paying for, so they told her pay out of pocket or leave. If your uncle has medicare advantage, a hospice referral will get his continued care paid for without him having to decide between paying out of pocket or figuring out things at home. Hospice doesn't always equal giving up on someone. Sometimes it genuinely is the best way to get care paid for for the patient.
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My brother was put on hospice and they had him in much better shape than his skilled nursing home facility could have done. He was taken out of hospice care after 3 months. We knew that was a likely thing that could happen. He needed more intense care than the facility had workers had time to care for his needs at that time. The hospice workers cake to his nursing home facility, he didn’t have to move anywhere. The same thing happened with my friend’s father. It may be in his best interest. Definitely ask the Doctor his reasons.
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Hello, actually you are probably right about they will get more money. Hospital normally sends a person to a facility to receive Physical & Occupational Therapy like you mentioned. Medicare normally will pay 100 % for 100 days, as long as the
the person is benefiting from the Therapy. With those 100 days in mind that Medicare pays, whoever has the POA needs to call the Facility and tell them "NO".
Hospice is only for someone that is declining rapidly. I hope this helps
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Because he’s probably reached his highest potential and he’s near the end of his life. ASK them
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Once they move him to hospice they will stop PT. Don’t let them give up on your Uncle. They tried to give up on my mother in law many years ago at 97 when she broke her hip. They wanted to dismiss her, we were advocates and she did walk again.
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My experience with Hospice is that they are called in to get patients comfortable at the end of their life. Because of your Uncle’s age, and the staffs experience, they probably don’t feel that he will ever walk again because of his age and break. At his age it could take six months to a year to heal with physical therapy. Once elderly stop walking, it’s difficult for them to keep good circulation going. Their health seems to decline rapidly. If you really think that your Uncle has strong bones and his mind is good, advocate for him. I would have a heart to heart talk with the surgeon or his assistant in the operating room. I ran across a similar situation with a lady that I took care of. She was only 84. She was a drinker, smoker most of her life. Also her diet wasn’t always the best. She weighed only 63 pounds at her death. Her surgeon told me that her bones were so brittle that they actually sinking in her flesh. Therapy helped for a few months, but she never walked again. They can only give your Uncle physical therapy until he has reached he highest level of improvement and what his insurance will allow. My lady developed ulcers on her ankles and gangrene in her little toe, despite having stents put in her arteries on both sides. Her arteries were just too blocked. She had to have the toe removed and daily wound care for the ankle wounds. Eventually, she stopped eating and drinking. Maybe the facility staff see/know something that you do not. I would find out if you have that authority-medical directive or power of attorney. All the best to your Uncle. I hope he gets past this and lives on many more years.
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Ask the facility why.

At 103, things change rapidly and honestly, he would be blessed to go quickly if he is failing. A slow, long, painful death would be cruel for him.
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FoundryRat: Perhaps you should speak to the case manager to get a clearer picture of what you are describing.
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You can answer your own questions:

copy and paste: https://www.medicare.gov/coverage/hospice-care

I can only imagine how confusing it must feel to see the "Energizer Bunny" slow down and remember what he was previously capable of.

The cycle of life forces us to come to terms with the inevitable.
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I think you are being cynical and what they are suggesting is in the best interest of your uncle. My mother has been in hospice for almost a year, and the benefit is that she gets extra care. She was never going to become independent again and my only concern was to make her comfortable. Hospice provided a better environment, additional medical equipment and support. If you feel that your uncle will benefit from PT and will improve, then keep him where he is. But I would always keep his best interests in mind, even if it is a hard decision to make.
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When my mom was in nursing home after a fall and moved from rehab to private pay they suggested Hospice, but I declined it because I wanted her to continue physical therapy. I thought they hadn't given her enough of a chance. Then she did regain enough strength to become a one person assist from bed to chair or wheelchair, but she never actually walked on her own again, could only stand. The trying though, I thought, was good for her. She enjoyed being upright and moving around that way, even though someone was holding her up. When she could no longer stand on her own was when she went down hill fast. You might want to ask if he could continue physical therapy and not be on Hospice, but in a different wing from the rehab. You can also ask for another review to see if he can stay in rehab longer.
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We went through the same thing with my mother with a hospital doctor because she was 82, had Alzheimer's for 12 years, and was admitted for pneumonia (probably aspirated). We declined Hospice and she went to Rehab and stayed in their skilled nursing facility. She lived 2 more years! We thought the doctors wanted to give up on her because she had Alzheimer's. Advocate for you uncle! Hospice sends an end of life message to the elderly which can cause them to give up on life.
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KaleyBug avatar
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KaleyBug Nov 2022
We had a doctor 4 years before my mom passed at a hospital tell me to prepare my dad my mom was dying because she was in pain. Guess what it was a sprained ankle not that she was dying. I feel some doctors and rehabs give up on the elderly to quickly.
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I would speak directly to his physician. I don't want to sound negative here, but maybe the thought of rehabbing a 103 yr old is not reasonable. At 103 his body is going the other direction. Instead of making him "work" in this last season of his life, maybe the doctor thinks it is more humane and reasonable to make him comfortable....and that is what hospice does.

I don't think the doctor is worried about the room rate. I think he has your 103 yr old uncles best interest at heart.
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KaleyBug avatar
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KaleyBug Nov 2022
If I was 103 and lived by my self until just before this incident and everyone gave up on me I would be mad.
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Hospice is for the point in time where there is no chance of "cure"
In Hospice he will NOT get PT or OT
In many cases meds that he does not need will probably be stopped (although this is his choice or whoever is POA)
What is the REALISTIC chance that he will
Walk again?
Live on his own again?
Make a full recovery?
If he does actually qualify for Hospice I think those are not a realistic goal in the opinion of the medical staff. They can be wrong though.
If there is no money to pay for the "room and board" have the Social Worker help with the application for Medicaid.
You can have him transferred to another facility if you think that rehab is not doing enough to help him regain his pre hospitalization status. But honestly if they are encouraging Hospice I think that his recovery to the way he was before is remote.
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That's a very long time to be living, what's his secret?
Mom was put on hospice due to the fact of being bed ridden. Unable to get up and go to the bathroom requires extra care. There's a lot hospice can do and you can work with them on what you want done.
One thing I was told that hospice isn't permanent so don't cancel any any supplemental care packages. Keep your bases covered. Wish you well!
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Hospice referrals are made upon written physician order. Speak with his PCP ( Primary Care Physician) to obtain more specific information about why your uncle is being referred to hospice care. Hospice is also a " choice", not a mandate; in other words the patient or POA ( if pt cannot make own wishes known) can choose or decline hospice.

In general physicians refer patients to hospice services when the patient has 6 months or less of life expectancy. Perhaps the physician is receiving reports that your uncle is not responding to physical therapy or is unable to participate with the PT. Or, perhaps the staff and physician are seeing other S/ S ( signs symptoms) of decline.

Hospice care can be very helpful for the patient who is approaching EOL and, very helpful for the family members also toward accepting a pt. 's peaceful EOL, quality of life while living and family preparation toward pts EOL. The patient is also not subjected to therapies and treatments that are not beneficial and that the pt simply cannot do.

Practice good self care. Sitting at a bedside for 12 hours is not good self care. Get support for yourself so that you do not fall into caregiver exhaustion.

You asked for " few details" so I'll stop there.
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Age 103? God Bless your uncle for advanced longevity! Check with his doctors. Same age as my mother who was born in 1919 except she passed away in 2014 at age 95.
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It's possible they are in it for the money but it's more likely that they have your uncle's best in mind. Hospice is wonderful and provides services he would normally not receive. I was a hospice nurse years ago and had one patient who was in my care for four years before she passed. The doctor renewed her eligibility every six months. She had a weak heart and one could not foresee when her time was near. She lived to be 98 and enjoyed having nurses, nurse aides, volunteers, social workers and pastors visit and take care of her.
I currently work in a nursing home and we have residents on hospice that share a room. You may not have all the detailed medical information available. Why not speak to the administrator and get a clearer picture?
All the best to you.
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Honestly, for him, hospice would be like concierge care. He'll get plenty of attention, he's not required to die within the six month time frame, and there'll be no need to take him to doctors because they'll come to him.

He is not required to quit taking his meds if he has any, nor will he be "helped along" on his final journey, but the focus will now become his quality of life and that's the best thing if he's not going to ever return home.
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That's amazing that he was still living alone at 103!

As others say, I'd talk to someone at the facility to get the details on the costs and benefits of each choice. You might be a little cynical, but so am I so I see nothing wrong with that. LOL.

At his age, it would not be unreasonable to assume that he might die within the next months, just based simply on the odds of it happening. If he's motivated and does his PT and gets back on his feet, the facility may very well change their minds about how imminent his demise might be. Good luck.
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Doesn’t Medicare cover hospice?
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Isthisrealyreal avatar
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Isthisrealyreal Oct 2022
Not the room and board portion.
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Hospice care affords a 103 year old man a ton of extra services and supplies, all billed to Medicare. Comfort meds are only given if needed. Long term care costs, however, are not paid by Medicare so the monthly rent would be private pay or you'd apply for Medicaid to cover the costs. Medicare only covers rehab for 20 days, and at 103, your uncle may not be making the required progress for Medicare to continue paying.

You need to speak to the case manager for all the details and to get the facts here. At his age, I think it's unrealistic to expect him to become fully mobile again and/or to make the progress an 85 year old would make in rehab. Try not to be cynical but make choices that take his best interests to heart.

Unless you've witnessed "sleezy" actions to date on the part of this SNF, I wouldn't be jumping to unwarranted conclusions that that's what they are, a sleezy bunch of profiteers. If hospice and long term care is being recommended, I'm sure it's for a valid reason. A shared room is also an option for him.
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FoundryRat,

It's a miracle that he's done so well for so very long and, having outlived most all of his family and contemporaries, he's lucky to have you and other loving family members at his side to oversee his care. What an honor to have an uncle who has lived so long and lived through so much.

Because the Hospice 'wing' is still in the same facility, it's not unreasonable to look at this with some cynicism; I would. They may be involving your dear uncle in a transactional situation due to payment rates and this is where you can jump in and advocate for him. These places usually CYA well enough that appealing his being taken off of MC rehab would prove fruitless; they know what to document and appeals are difficult. That said, if he's trying to walk and making any progress, he should remain on rehab under MC. I would talk to your local Senior Ombudsman (they can take a few days to call back) or contact your state Aging Services - do this after asking the facility SW their rationale for the transfer and removal from Rehab services. Some of these places are rather sleezy so, read between the lines of what they're telling you and take notes, in fact, document everything you see of the care he receives.

What does your uncle want and who is empowered to oversee his cares, finances, and facilitate his wishes? Lots of cost and payment issues come into play in these situations and the DPOA needs to be closely involved.

As a retired RN, I can say that it is widely understood that whenever an aged person has significant changes in any 6 month period, it is likely that death will come in the ensuing months. At age 103 and having had some rather large recent changes, it may be that Hospice is appropriate and this may be why the facility is pushing for this move. However, if he is trying to achieve ambulatory status, he should be given that opportunity to recover to the fullest extent possible. He may then do well in a care facility that will allow him some independence and socialization for as long as he's able.

Given his extreme age and all of the associated muscle atrophy and all, he may very well be on his way out. Often, once an Elder loses their home and independence and esp after hospitalization and an NH stay, they can just give up and choose to make their exit.

I'm assuming that he's cognitive since severe dementia isn't mentioned in your post. In your place, I would do my level best to talk through this with him, openly and honestly. At age 103, he is staring at his mortality on a daily basis and may be more open to this discussion than you'd expect and it may be a relief to him. Once you know his wishes and intent, do your best to see that his wishes, as far as is realistically possible, are followed.

I wish you the best in all of this, it's both an honor and a burden to be overseeing the care of one so very aged, but if you're acting in his best interests and according to his wishes, that will ease his mind and your own.
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I agree with CM. How will this change effect his finances.

Medicare pays 100% the first 20 days, 21 to 100 days 50%. He can be discharged anytime in those 100 days. They are not guaranteed. Have they said that Medicare is discharging him for lack of progress. Or they feel he has plateaued? If he is being discharged, then you need to consider the options you have.

If he is considered 24/7 care, they cannot release him without proof that he will have 24/7 care at home. Maybe getting in home PT. If you can't care for him or he can't pay caregivers, he needs to stay in the NH. He will be private pay. If he has no money, them Medicaid will need to be applied for and his SS and any pension will go towards his care. Medicare pays for the Hospice care but not the facility.
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Ask the facility what the differences in care provision would be, and how the move would benefit your uncle. They may have satisfactory answers for you.
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If he goes into hospice care, it's not a death sentence. It's an assessment that he probably won't survive more than six months. He's 103 and it's reasonable to think that he may die within that time. Also, he's going to be evaluated regularly no matter where he is, hospice or skilled nursing. He may move back and forth between those as the evaluations change. My mother was in and out of hospice for 2.5 years! A new evaluator would come from hospice and decide she was too perky or something, and off hospice she'd go. Next evaluator, Mom wouldn't respond the whole time evaluator was there, so back on hospice. One time she hadn't spoken for months, the hospice evaluator came in and said Merry Christmas, and Mom said "Merry Christmas." So she was taken off hospice again. She finally died, age 95, after years of this. I'd take the nursing home's recommendation and get him into hospice. The care there may be better suited to his needs right now, and they may kick him out anyway if he improves significantly.
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At 103 his life expectancy is limited. They may have assessed he has little hope of being rehabilitated. I don’t think payment enters into it. Medicare will pay for his Hospice.
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JoAnn29 avatar
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JoAnn29 Oct 2022
Not for the bed though. Does not pay for facility care.
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