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?
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.
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.
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.
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.
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.
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.
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.
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!
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.
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.
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.
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.
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