I'm still banned from one nursing home down here. Seems I offered to pick up a social worker and throw his ass through a wall.
I went through three different hospice companies with my wife. I developed quite a reputation for firing people.
Hospice and Medicare
- Thread starter vic120
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I went through three different hospice companies with my wife. I developed quite a reputation for firing people.
On the other hand if they'd do their job there wouldn't be a problem. To expect us not to be upset when they don't is unreasonable. Especially when the kinds of problems they create are preventable and cause the patient and their family pain and anguish.
When mom was actively dying (blood starting to pool, irregular breathing, color changes, etc.) we called hospice and told them she had maybe an hour to live please come and bring the chaplin as mom wanted her to come. We left multiple messages with multiple people and on voicemail. They didn't show up until close to 2 hours after she died. Mom had arranged their chaplin would come before she died. That person never came at all in the end, even after mom died, even though we called her too. We finally tracked down the nursing home chaplin and she got there (she was off work that day and decided to come in - we didn't know that until after the fact so no complaints about her), although mom had already died.
The hospice company was responsible for dealing with what happened next after mom died too (she was donating her body). Since hospice didn't show up it was two nursing home aids who cleaned up mom, asked us what to dress her in, etc. One hospice worker who finally did come had the nerve to tell us they were "busy" earlier. Well someone then needed to tell us other patients had priority over someone actively dying and was in their last hour of life rather than just ignore the phone calls. Heck they could have sent out another available worker rather than one one assigned to mom since the other one was busy. I trashed them with specific examples on google and talked to their director about what went on. Like you, we would have fired them but mom died before we could. That leads to another question I'd ask before hiring. What do you do if the worker assigned is busy and you need someone now because the person is in the last hour of their life or in acute pain with nothing prescribed, etc.?
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Most hospice companies are with the patient when they die. Sounds like you were with a bunch of idiots.
Dealing with hospice is a learn as you go process. You didn't have as long to learn that stuff as I did.
What a sad and depressing thread . . . that should be read by everyone who has been through hospice with a loved one, expects to deal with hospice with a loved one, or has a client facing this kind of decision.
There is such a wealth of information in this forum if the members just take a few minutes to read threads like this.
I have been down this road with clients, family and friends. My hospice education came in the form of OJT which is not the best way to learn.
This information will appear in my next newsletter. Names will be changed to protect the innocent.
There is such a wealth of information in this forum if the members just take a few minutes to read threads like this.
I have been down this road with clients, family and friends. My hospice education came in the form of OJT which is not the best way to learn.
This information will appear in my next newsletter. Names will be changed to protect the innocent.
Probably best you don't mention my name.
Might be some outstanding warrants still out there.
No worries. You will be identified only as Carlos Danger or Ron Mexico
We had been told they'd be with us too and so would the chaplin (mom wanted her there before she died, the rest of us didn't care one way or another). In the end neither was and the chaplin got paid for doing nothing other than coming out when mom was first put in hospice since she never returned.
Here is some more we learned the hard way (that may or may not be relevant to what you want to write about):
For your article for things people need to consider (and someone needs to financially plan for if a family member can't do what is needed for the one needing hospice care):
In addition to what I have already said, we had a family member with my mom 24/7 for the last several days of her life as she was mostly being ignored by the nursing home staff (I"d imagine some of that is the emotional toll getting to know people who then die and having to deal with that over and over) and was incapable of pushing the call button. At that point in time we let the aide go we had hired about 6 weeks prior when she was incapable of using the call button, turning the TV on and off, answering the phone... (we needed her even when mom was in hospice as the visiting hospice aide/nurse came mostly only once a day) because it was clear she was going to die soon and with me there then too (I live 1000+ miles away) we could cover 24 hours (I covered 18 of those). That aide was not covered by long term care insurance nor was hospice, although the nursing home was covered. Had a family member not been able to cover the hours when we didn't have an aide earlier, we would have needed more aides.
People need to realize that hospice that isn't in an actual residential hospice center (and even there that might be an issue - depends on the hospice) means the family member in hospice is still left alone for hours on end. If they aren't capable of pushing a call button (and/or the call button isn't answered for long periods of time) then a separate aide (or family member) needs to be there to make sure the family member's needs are met.
In home hospice they come once or twice a day. At the nursing home mom was in they came once or twice a day. You need to ask about this in advance. With mom it was mostly once a day. We found out later some local companies are twice a day. It is worth knowing what kind of arrangements the hospice company has with the nursing home (or hospital) so that you can figure out which company(s) will require going through more red tape to get your family member's needs met (the pain med situation discussed in another post just as an example), how they handle when the person assigned can't come ASAP, etc. Ask the nursing home what kinds of PITA things go on with hospice they wish didn't and ask the aides and nurses on your family member's unit in the nursing home which companies they like best and why (but why may not be what is important to you and your family member though). You may not have time, like we didn't, to "fix" mistakes in whom you hire.
People need to think about getting long term care insurance while they still pass medical underwriting (as many require that you do so or have a several year waiting period) not to mention it is far cheaper if you get it when you are younger. They need to think about getting it for enough years too. Who knew mom would use up all 6.5 years she bought when she was 24 years old at her first job for herself and for dad (he used it for 4 months).
Generally nursing homes that aren't full of medicaid patients are "nicer" and somewhat better staffed (of course dual eligibles likely don't have long term care insurance and others that had money eventually may run out of money before they run out of life). Mom lived at a senior complex that had independent living (houses and apartments), assisted living, nursing home, and memory care).
She had the choice, when she moved in, to pay up front a fair bit of money for them to never kick her out if she ran out of money. As a result she had a place for life that also had a number of well to do people (so the facility was nicer). While she didn't need it in the end, she would have if she hadn't needed hospice when her long term care ran out. And when she was memory impaired she wouldn't have been forced into a different nursing home unit and room had she ended up with medicaid when she would have exhausted her assets on care. Staying put in the same room is far less stressful for most people as they age. They remodeled the bathrooms near the end of her life and the temporary move to a different room was very disorienting for her.
If someone qualifies for medicaid then they don't need long term care insurance (although then they won't have their social security dinged if they had it) but they need to realize that almost all of their social security will be taken by the hospice (or nursing home) and only a token amount (in some states less than $50 - the amount left is state by state determined) will be left for the patient to cover clothes, toiletries, etc., not to mention there is an asset limit. There is a look back for transferring assets to someone else. If I recall correctly it is 5 years. There are other rules if a spouse is involved.
Failure to plan ahead for "worst case" generally results in a financial crisis for the family if their choice is not to abandon their family member if/when worst case happens. Caring for someone at home who needs to be in a nursing home or hospice requires a lot of time. An aide would be extremely helpful if a family member needs a break and/or isn't able to change diapers, lift a patient out of bed, bath them, helping them use the toilet, etc. if the appropriate equipment isn't owned... Near the end it took 2 people to get my mom out of bed, to the toilet along with using a lift machine, All this is expensive. Buying long term insurance at 65 or older will cost way more (and they may no longer be able to buy it depending on the company and pre-existing conditions) than if someone buys it when they are younger.
We do not deal with death well in this country. I worry about what the medicaid cuts will do to end of life care for the people who will eventually need medicaid or already have it. And most people don't plan far enough ahead for this. In my opinion we need to educate our clients about this even if we only sell OM and MA.
This probably needs proof reading and I don't want to do that right now. Sorry.
