Hospice, Nursing Home & Medicare

I thought I would share my experiences yesterday with the final phase of Dad’s cancer.

My Dad has reached the stage where no further aggressive treatment will benefit him, and has chosen to focus on quality of life in his last weeks or months. His doctor ordered hospice services yesterday. I had taken that to mean inpatient hospice care, either at the nursing home he is confined to or at the local hospice inpatient center. The hospice nurse came to the nursing home yesterday to evaluate him, and said he does not yet qualify for inpatient hospice. Even though he has no strength to lift himself out of bed, has fallen trying to get himself up, and is mentally confused and disoriented, hospice determined that he can still be transferred to a wheelchair, can feed himself, and has no pain – therefore, he is not eligible for inpatient care. However, he is eligible to be placed on the hospice program with a nurses and assistants coming in twice a week to monitor his progress.

Because the doctor discharged him from treatment, and transferred him to hospice, Medicare downgraded him from Skilled Nursing to custodial care. Therefore, Medicare is no longer paying his room and board at the nursing home, though they will pay for his “part-time” hospice care. In order to get him back on Skilled Nursing, he would need to be receiving PT or OT, but be dropped from hospice, as Medicare does not allow both at the same time. PT and OT was stopped at the nursing home because he was making little to no progress.

He can’t afford 24-hour help at home, so that’s not an option.

He has too much money to qualify for Medicaid.

So until he gets sick to the point of requiring inpatient hospice, he will be paying out of pocket for his room and board at the nursing home.

Hospice seems like a wonderful program, but I feel that if he deteriorates as quickly as the doctors have said, then he won’t get the full benefit of the program until it’s too late. Although I am happy with the care he is getting from the nursing home, I would prefer that he be treated at the hospice inpatient center when the time comes, but at the point when he’s finally qualified to go there, he’ll probably be too sick to be moved.

It just seems so complicated, and my head is about to explode!

Any thoughts?

Jan