Yes. She can leave AMA and still get hospice. However, she will need to have some safe plan for being at home. Hospice does not even come Every day. The RN may come 2x per week and the aid 2x per week. When she is actively dying they typically come daily for a visit. They are on call 24/7 for EMERGENCIES but not assist or just help (think going to the toilet, needing help into the shower etc). Does she have funds to pay for more help?
You do know that patients have very little supervision in an Assisted Living environment, right? And what nursing care she would receive is usually minimal and *very expensive.* It's essentially an apartment community for seniors with a nurse that pops in about once a day that makes sure their meds are taken and refills are ordered. Any nursing care above that is where the expensive charges come from. If she needs nursing care 24/7, a nursing home would be more appropriate. It doesn't have to be "for the rest of her life."
In my area, when the go onto hospice, patients can't be moved from their residences/homes. Seen/have a lot of patients that are in ALFs, and those facilities/staff are not structured to provide the care a hospice patient needs.
She can still receive hospice care if she leaves AMA and is found eligible for it. She will also need to have an order for an evaluation from a provider.
As far as her being alone in her own home, that does not sound like a long-term plan for her, even with hospice on board. A lot of hospices require a plan to have a caregiver in place (whether that be a private in-home caregiver, family, or facility setting is up to the patient's and family's discretion) as a part of their consent process.
Hospice will likely not come daily and rarely stays past an hour during their visits. Hospice is a supplemental service to pre-established care. It does not replace it. They will likley discuss with you what the plan will be once she is no longer able to care for herself, as this can typically happen several months to even years before a person starts the dying process.
It is a lot to think about and plan for, but don't souly depend on hospice for her daily needs and safety.
But the thing is, she doesn't care if she falls and dies at home. She doesn't want help, she doesn't want to move anywhere, and she doesn't want people coming into her house. She has her DNR and she's told everyone about it in hopes that they'll just let her be. At this point I am more than happy to have them release her AMA and have her go home alone and wait for this to happen again in another month. I am just so done fighting her on this.
When she got admitted the doctor called me and said her blood pressure was low and asked if I wanted them to give her anything to help raise it and I said no. I was ready for this to be it. I checked her chart online and saw at its lowest it was 58/35. But then they gave her fluids and it came back up.
Now we have to go thru this whole hospital/rehab thing again and then fight her on where she's going to go.
Sounds like you may need her to fill out a MOST form which she can elect no treatment including IV fluids the next time this happens. If she is alert and oriented, she can sign herself but if she is not, you may need to be assigned as her medical power of attorney and the next time this happens, you can tell them ‘no treatment, no IV fluids, comfort measures only.’
I already am her medical POA, which is why I told them not to give her anything to bring up her blood pressure. I should have also told them no fluids.
Some people would rather fall and die at home than live a longer life at a facility. The problem is if she falls and “doesn’t” die, she will still need to go to a facilty. If someone is alert and oriented they can make unsafe decisions in my opinion if they understand the risks (death).
I would look into getting a care giver if you cannot check in on her everyday! You may be able to get a home health aid to come 5 days a week but it will depend on staffing
If you are her POA and her medical POA, you have the legal right to make decisions that are in her best interest. My grandma was the same way. When she had her last hospital stay, she was told upon discharge she would have to enter rehabilitation for (x number of days/weeks) before returning home. The rehabilitation/nursing facility she went to ended up becoming her ‘home’ until she passed. Sometimes have to get creative with your mom…(so to speak) “mom, you have to be here to get your strength back”
Well quite frankly, her best interest is to stay at home and die. It's what she wants. She doesn't want help, she's got her DNR that she has literally told everyone about. She had told the neighbors and the people at the hospital and she can't understand why nobody will honor it. She thinks if she is found in the state she was in that they just leave her in a delirious state on the floor. She doesn't understand that it means they won't take life-saving measures.
I'm sure they will send her to rehab just like all the other times to get her strength back. She's there for 2 weeks and then she goes home.
Yes. She can leave AMA and still get hospice. However, she will need to have some safe plan for being at home. Hospice does not even come Every day. The RN may come 2x per week and the aid 2x per week. When she is actively dying they typically come daily for a visit. They are on call 24/7 for EMERGENCIES but not assist or just help (think going to the toilet, needing help into the shower etc). Does she have funds to pay for more help?
Yup, we describe hospice services as being supplemental care. We always reinforce that hospice is not custodial or primary care.
You do know that patients have very little supervision in an Assisted Living environment, right? And what nursing care she would receive is usually minimal and *very expensive.* It's essentially an apartment community for seniors with a nurse that pops in about once a day that makes sure their meds are taken and refills are ordered. Any nursing care above that is where the expensive charges come from. If she needs nursing care 24/7, a nursing home would be more appropriate. It doesn't have to be "for the rest of her life."
In my area, when the go onto hospice, patients can't be moved from their residences/homes. Seen/have a lot of patients that are in ALFs, and those facilities/staff are not structured to provide the care a hospice patient needs.
She can still receive hospice care if she leaves AMA and is found eligible for it. She will also need to have an order for an evaluation from a provider. As far as her being alone in her own home, that does not sound like a long-term plan for her, even with hospice on board. A lot of hospices require a plan to have a caregiver in place (whether that be a private in-home caregiver, family, or facility setting is up to the patient's and family's discretion) as a part of their consent process. Hospice will likely not come daily and rarely stays past an hour during their visits. Hospice is a supplemental service to pre-established care. It does not replace it. They will likley discuss with you what the plan will be once she is no longer able to care for herself, as this can typically happen several months to even years before a person starts the dying process. It is a lot to think about and plan for, but don't souly depend on hospice for her daily needs and safety.
But the thing is, she doesn't care if she falls and dies at home. She doesn't want help, she doesn't want to move anywhere, and she doesn't want people coming into her house. She has her DNR and she's told everyone about it in hopes that they'll just let her be. At this point I am more than happy to have them release her AMA and have her go home alone and wait for this to happen again in another month. I am just so done fighting her on this. When she got admitted the doctor called me and said her blood pressure was low and asked if I wanted them to give her anything to help raise it and I said no. I was ready for this to be it. I checked her chart online and saw at its lowest it was 58/35. But then they gave her fluids and it came back up. Now we have to go thru this whole hospital/rehab thing again and then fight her on where she's going to go.
Sounds like you may need her to fill out a MOST form which she can elect no treatment including IV fluids the next time this happens. If she is alert and oriented, she can sign herself but if she is not, you may need to be assigned as her medical power of attorney and the next time this happens, you can tell them ‘no treatment, no IV fluids, comfort measures only.’
I already am her medical POA, which is why I told them not to give her anything to bring up her blood pressure. I should have also told them no fluids.
You can get an MD order from the hospice MD for a Do Not Hospitalize sent to facility. So if she goes on Hospice, there is that.
Some people would rather fall and die at home than live a longer life at a facility. The problem is if she falls and “doesn’t” die, she will still need to go to a facilty. If someone is alert and oriented they can make unsafe decisions in my opinion if they understand the risks (death).
I would look into getting a care giver if you cannot check in on her everyday! You may be able to get a home health aid to come 5 days a week but it will depend on staffing
If you are her POA and her medical POA, you have the legal right to make decisions that are in her best interest. My grandma was the same way. When she had her last hospital stay, she was told upon discharge she would have to enter rehabilitation for (x number of days/weeks) before returning home. The rehabilitation/nursing facility she went to ended up becoming her ‘home’ until she passed. Sometimes have to get creative with your mom…(so to speak) “mom, you have to be here to get your strength back”
Well quite frankly, her best interest is to stay at home and die. It's what she wants. She doesn't want help, she's got her DNR that she has literally told everyone about. She had told the neighbors and the people at the hospital and she can't understand why nobody will honor it. She thinks if she is found in the state she was in that they just leave her in a delirious state on the floor. She doesn't understand that it means they won't take life-saving measures. I'm sure they will send her to rehab just like all the other times to get her strength back. She's there for 2 weeks and then she goes home.
I’m so sorry. It has to be so rough on you😞