Skilled-care or hospice?

Medicare allows hospice for stage 7 of Alzheimer's patients. It is a little complicated. After 90 days if the person is  still alive, there is prequalified period again.

I didn't know this rule. I thought people with AD can have hospice only if they cannot swallow and need feeding tube.

Nina

Even if the rule allows hospice, I would say it is up to the family decide when to go in the hospice program, medicare or not. In reality, stage 7 of AD takes 1 to 3 years. Not just 6 months as hospice dictates. Maybe for most people, they cannot live long in stage 7 but there are some cases when the elders can sustain this stage for 3 years or so. I understand these people are by now living in a horrible vaccum and would not have any meaning for life. But in pro-life point of view, the hospice can always start much later when the person cannot swallow and etc. At least when the person stops talking, he can still watch with his eyes. When the person stops feeding himself, the caregiver can feed him unless he does not accept that. I know this stage is a hard stage for caregiving and the elder would be violent when he receives caregiving or help.

Drawing a fine line between hospice and skilled nursing care is important. It is not proper to think of hospice right away just because this person stops talking or walking or feeding himself.

Nina

Hi Nina,  It is my understanding that Hospice doesn't function to expedite an end to life, but rather to make that end more comfortable.  Usually, nursing home staff will approach the family with information about Hospice care before the "need" arises.  In this case "need" is a subjective term, as some will decline this optional level of care for many different reasons.  For some, Hospice is an admission of giving up or losing hope.  It isn't unusual for family members facing these circumstances, to remain in denial long after the futility of continued medical care becomes obvious.  The continuation of life by artificial means may seem necessary to some, whereas allowing someone to die without such intervention, may seem more humane to others. 

A terminal illness, by its very definition suggests that skilled-care (nursing) will only be useful for a while.  At some point, the decision to "let go" and make the person comfortable may be the best idea.  It's not so much a decision to let someone die, as it is, to allow someone to, when it's going to happen anyway.  I think that dying in comfort is certainly preferable to dying in a room connected to machines prolonging the inevitable.  People should let conscience be their guide in deciding this process, not emotion.  Acceptance of the reality that a loved one's life is ending, may be helpful in reaching a good decision.  This is not a case of getting it right or getting it wrong, as much as it is, doing what feels right and appropriate for the loved one. 

Anyone interested in Hospice should explore www.hospicenet.org for more information.  It's a great web page with a lot of useful information.  Best Wishes -- Joe