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My sister placed both my parents on hospice, other siblings put themselves on as contacts. My dad's physicians were not aware nor did they sign of to refer dad to hospice, is this legal?
Thanks, JoAnn. I am TRYing to be more diligent in looking at the dates. Looks like I messed up on THIS one. Actually I learned something. I thought that it is the patient's MD who makes the referral. But turns out when I researched that isn't always necessary. Who knew? Not me. I love AC. It teaches me something new every day.
Hospice requires physician referral. However, that MD need not be the MD of the patient. It can be any MD who has access to the patient's history and wishes for end of life care. So that it can be the recommendation of a hospitalist in the hospital. A rehab doctor. And from what I can research even the hospice MD themselves can review the case history and recommend Hospice. The only stipulation for Medicare coverage is that the expectation of life if 6 months or less. That the patient or patient's POA, MPOA or next of kin operating in the absence of parent's competency agrees with MD assessment and is familiar with the parent's wishes for comfort care at the end of life.
There is a POA involved here, I assume. Discuss with that POA.
If you suspect that your parents do not want hospice care, that your parents doctors are not aware that they have hospice care, and that someone in your family has ordered it in an attempt to usher them to an early death, then take your evidence of this to an attorney, is the only thing I can suggest.
If a Hospice is involved, and you are a family member, it is my experience that they will tell you which MDs approved your parents for hospice care.
When a parent dies who is being cared for by the health care proxy aka the oldest brother. Is the health care proxy required to notify all other family members of their mothers death?
A doctor needs to be involved to place anybody on hospice since there are general rules about hospice: 1 - the person is expected to live 6 months or less, 2 - the person agrees to shift from curing disease (or has an incurable disease) to maximizing comfort, 3 - the doctor will need to prescribe medications for comfort (usually pain medications), and 4 - the doctor will need to prescribe "hospice" for any hospice agency to send personnel to provide care (and get paid by insurance company).
Ask your siblings who the doctors are that are involved in your parents care. Try to contact these doctors and ask for a meeting with the family so information can be shared.
I noticed that several replies mention that the PCP was also Medical Director of a Hospice. FYI for those readers who may not know; Yes, practicing physicians can and are at their choice and agreement with a hospice also the Medical Director for a hospice. Hospice services seek out physicians with a " private practice" to be a Hospice Medical Director as this gives the Hospice a direct link to pt referrals at times. The physician serving as the Hospice Medical Director usually receives financial compensation from the hospice.
And, many patients entering into hospice services choose to make the hospice medical director ( MD) their physician of record directing their care from that point forward. Conferring with pts PCP or other physicians assoc with the pt is done at pt/ POA request to keep that physician informed if he/ she wants.
Hospice is an specialty care in the healthcare systems for or and family choice when aggressive treatment is no longer available or pt wants to discontinue such aggressive treatment. Hospice services should be viewed by the medical establishment and community as a specialty just like all other medical specialists such as cardiac, neurology, urology, oncology, orthopedic etc etc specialties.
Hospice is the specialty for compassionate care for pts with a life limiting illness who have exhausted all aggressive treatments or chosen to forgo aggressive treatments. Hospice cares for not only the PT but also the family with many specialty professionals on the Hospice team. Note that " hospice is care for life limiting illnesses" it is not about " dying"; it is about "quality of life" in the midst of a life limiting illness for pt. and family toward as a peaceful EOL . Everyone would do well to educate selves about hospice ; the learning curve is still very steep in communities.
You never need a physicians permission, you need a physician order however the hospice medical director can write the order, it does need the primary’s agreement.
The patient and/ or the POA for the pt. have " patient rights" which include the right to choose, to say yes or decline any medical care . PT and or POA have the right to request hospice care. Often some physicians are reluctant to offer or even make the pt and family aware that hospice is a choice; this is often at the detriment to the pt. Patients and families have the right to request and be admitted to hospice care if the hospice evaluation deems the pt. " Hospice appropriate".
The hospice clinical director and hospice medical director physicians work with the PT and or family POA and any other needed physicians and provide directions re communication with any necessary other physicians during the hospice assessment and admit and through out the hospice care.
In Massachusetts you don't need your GP's permission. Although my Mom was placed on hospice by her GP while still in the hospital (10 years ago). Me and my husband took primary care of her (my husband is a Paramedic) so in many cases that helped her and me to understand some of the stages she was experiencing. We had to pay to have a PCA come in for a hour each day just to give me a little downtime. I wish we could have been eligible for more help but we weren't because they said Mom made to much money 😕. Trust me she didn't make all that much SS and had little in the bank. Sorry I went off track there! I wish you blessings and prayers 🙏 it's very difficult being the caregiver but worth it, at least for me, I wouldn't have done it any other way however you must take care of yourself as well.
In NY this can be done. We did it with my mother. She had an appointment with her PCP last week. I told him that we did this, he said many people do this to get services that they would otherwise have to pay for. He did not need to provide authorization.
My mother is on hospice only because she is getting additional services that we would have had to pay for any other way. We now have another aide so that she now has 11 hours of coverage Monday thru Friday. The nurse comes once a week to check her out.
My mother had a UTI last month, I brought her to her doctor, there was no problem with doing this.
I met with the social worker last week, I had some concerns about hospital stays because we are trying to get my mother admitted to a nursing home. She told me you can drop out any time.
Thus far I view hospice positively. I am glad we have it in place. No complaints from me.
I don't see a way to edit my answer--I meant that my Mother's physician was the hospice physician too, not my Father's physician. My Father isn't quite at that stage yet.
Grandma1954 July 28, 2023 3:30pm Oreohun85, If you made the comment that Hospice was going to provide 12 hours a day of Nursing care that would not have been a service covered by Medicare, Medicaid or other Insurance it would have been something that would have had to come out of pocket as an expense. Hospice will not provide that type of care. It may have been a Home Care Agency affiliated with the Hospice but again that would have been an out of pocket expense.
I didn’t have your situation. I initially inquired about hospice care with my mom’s doctor. Mom started off with palliative care, then progressed into hospice.
Once a person reaches a certain point in their lives, hospice care makes the most sense. People who have progressive and incurable diseases like my mom had (Parkinson’s disease) are not going to improve. The best thing that we can do for them is to keep them comfortable.
Yes, it's legal. There comes a time when treatment needs to stop with elders. The indignity of being poked and prodded in useless trips to ERs where there is a 4 hour minimum stay, or worse yet, when they're admitted and come out in worse shape than when they went in, with hospital delirium and more issues than Newsweek. Elders of advanced age should be allowed to live in comfort and ease during their final days, weeks, months or even years of life left on Earth. Causing them trauma in a futile attempt to ward off the inevitable is not a great idea by most people's standards.
I discussed Hospice with the Head Doctor at Dana Faber and he saw my brother and agreed it was time to Bring Hospice in . Once the cancer went to his brain. I called Hospice and made an appointment . Then I Talked with the Head Psychiatrist at Brigham and Woman and Dana Faber - Dr. Peteet we spoke for a Hour . When It was time to administer Morphine this was discussed with the Nurses at Hospice and the social worker at the NH . I feel Its best to have back up and have expert Opinions .
Your sister did not need her parents PCP to agree or order Hospice. All Sis had to do is call a Hospice provider, have your parents evaluated and approved and the Doctor affiliated with the Hospice could sign off.
Even if dad is against it, and he was not aware he was signing himself into hospice care, and he was undergoing curative care.....thank you for your response truly appreciate the guidance
The Hospice doctor after reviewing medical records could confirm that the patient is Hospice eligible. When I stopped in at the Hospice I used for my Husband the admitting nurse made a phone call and that was pretty much it. If your siblings signed a release the Hospice could have obtained the information from the doctors office and not informed your parents doctor that they were going to be placed on Hospice. Simple reason for that is your sister had not yet signed the document that officially admitted them to Hospice.
Is your sister POA for your parents? If so then this would be acceptable. If not and your parents are not competent to sign for themselves then it might be a bit premature. If your sister is not POA (or any of the other siblings) this could be problematic. You, if you wanted to file for Guardianship.
All that said and because it is me replying...and I will say I am VERY pro Hospice. If your parents are eligible for Hospice I think there are many advantages to Hospice. If your parents are home there will be a Nurse that will come each week to check on them. There will be a CNA that will come 2 or 3 times a week to give them a bath or shower. All the medical supplies needed will be delivered to the house. Any medications will be delivered to the house. All the incontinent supplies including gloves, ointments, barrier creams, absorbent pads will be delivered. Any equipment commode, toilet seat risers, wheelchair, hospital beds, Sit-to-stand or Hoyer Lift will all be delivered. And each patient is eligible for about 1 week of Respite each year and your sister can request a Volunteer that can come in and sit with them or do some light housework if that is needed. Other members of the "team" are Social Worker, Chaplain and often there are other Therapies like art, music, pet that you can request. I honestly see no downside to having Hospice come in and provide service.
She also refused to give up her job as thier care giver which means additional help can't come to assist them, hospice was offering 12hours a day to provide nursing assistance, however she said no because that would mean she would have to quit the caregiver that only allows her to work 4 hours per day
In some but not all instances do you need a doctors recommendation for hospice care. Back in July 2018 I took it upon myself to call hospice for an evaluation for my husband without his doctors knowledge and they came out and did an evaluation in which at that time he only qualified for their palliative care, which I wasn't interested in. Ironically he went under hospice care in Nov. 2018 after almost dying from aspiration pneumonia and remained under their care until his death in 2020. If both your parents are now under hospice care it means that they both had to qualify for their care, which apparently they did, so be grateful that they now have extra sets of eyes on them and that they are being taken care of and kept comfortable. So to answer your question, yes someone can be placed under hospice care without physicians consent.
By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington.
Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services.
APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid.
We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour.
APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment.
You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints.
Please contact our Family Feedback Line at (866) 584-7340 or ConsumerFeedback@aplaceformom.com to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights.
APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.
I agree that:
A.
I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information").
B.
APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink.
C.
APFM may send all communications to me electronically via e-mail or by access to an APFM web site.
D.
If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records.
E.
This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year.
F.
You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
The only stipulation for Medicare coverage is that the expectation of life if 6 months or less. That the patient or patient's POA, MPOA or next of kin operating in the absence of parent's competency agrees with MD assessment and is familiar with the parent's wishes for comfort care at the end of life.
There is a POA involved here, I assume.
Discuss with that POA.
If you suspect that your parents do not want hospice care, that your parents doctors are not aware that they have hospice care, and that someone in your family has ordered it in an attempt to usher them to an early death, then take your evidence of this to an attorney, is the only thing I can suggest.
If a Hospice is involved, and you are a family member, it is my experience that they will tell you which MDs approved your parents for hospice care.
1 - the person is expected to live 6 months or less,
2 - the person agrees to shift from curing disease (or has an incurable disease) to maximizing comfort,
3 - the doctor will need to prescribe medications for comfort (usually pain medications), and
4 - the doctor will need to prescribe "hospice" for any hospice agency to send personnel to provide care (and get paid by insurance company).
Ask your siblings who the doctors are that are involved in your parents care. Try to contact these doctors and ask for a meeting with the family so information can be shared.
And, many patients entering into hospice services choose to make the hospice medical director ( MD) their physician of record directing their care from that point forward. Conferring with pts PCP or other physicians assoc with the pt is done at pt/ POA request to keep that physician informed if he/ she wants.
Hospice is an specialty care in the healthcare systems for or and family choice when aggressive treatment is no longer available or pt wants to discontinue such aggressive treatment. Hospice services should be viewed by the medical establishment and community as a specialty just like all other medical specialists such as cardiac, neurology, urology, oncology, orthopedic etc etc specialties.
Hospice is the specialty for compassionate care for pts with a life limiting illness who have exhausted all aggressive treatments or chosen to forgo aggressive treatments. Hospice cares for not only the PT but also the family with many specialty professionals on the Hospice team. Note that " hospice is care for life limiting illnesses" it is not about " dying"; it is about "quality of life" in the midst of a life limiting illness for pt. and family toward as a peaceful EOL . Everyone would do well to educate selves about hospice ; the learning curve is still very steep in communities.
The hospice clinical director and hospice medical director physicians work with the PT and or family POA and any other needed physicians and provide directions re communication with any necessary other physicians during the hospice assessment and admit and through out the hospice care.
My mom was put on hospice quite a few times for 3 years before she passed. I’m pretty sure it was the home health care team that ordered it for her
My mother had a UTI last month, I brought her to her doctor, there was no problem with doing this.
I met with the social worker last week, I had some concerns about hospital stays because we are trying to get my mother admitted to a nursing home. She told me you can drop out any time.
Thus far I view hospice positively. I am glad we have it in place. No complaints from me.
NHWM
Oreohun85,
If you made the comment that Hospice was going to provide 12 hours a day of Nursing care that would not have been a service covered by Medicare, Medicaid or other Insurance it would have been something that would have had to come out of pocket as an expense.
Hospice will not provide that type of care.
It may have been a Home Care Agency affiliated with the Hospice but again that would have been an out of pocket expense.
Once a person reaches a certain point in their lives, hospice care makes the most sense. People who have progressive and incurable diseases like my mom had (Parkinson’s disease) are not going to improve. The best thing that we can do for them is to keep them comfortable.
When I stopped in at the Hospice I used for my Husband the admitting nurse made a phone call and that was pretty much it.
If your siblings signed a release the Hospice could have obtained the information from the doctors office and not informed your parents doctor that they were going to be placed on Hospice. Simple reason for that is your sister had not yet signed the document that officially admitted them to Hospice.
Is your sister POA for your parents? If so then this would be acceptable.
If not and your parents are not competent to sign for themselves then it might be a bit premature.
If your sister is not POA (or any of the other siblings) this could be problematic. You, if you wanted to file for Guardianship.
All that said and because it is me replying...and I will say I am VERY pro Hospice.
If your parents are eligible for Hospice I think there are many advantages to Hospice.
If your parents are home there will be a Nurse that will come each week to check on them. There will be a CNA that will come 2 or 3 times a week to give them a bath or shower. All the medical supplies needed will be delivered to the house. Any medications will be delivered to the house. All the incontinent supplies including gloves, ointments, barrier creams, absorbent pads will be delivered. Any equipment commode, toilet seat risers, wheelchair, hospital beds, Sit-to-stand or Hoyer Lift will all be delivered. And each patient is eligible for about 1 week of Respite each year and your sister can request a Volunteer that can come in and sit with them or do some light housework if that is needed. Other members of the "team" are Social Worker, Chaplain and often there are other Therapies like art, music, pet that you can request.
I honestly see no downside to having Hospice come in and provide service.
Back in July 2018 I took it upon myself to call hospice for an evaluation for my husband without his doctors knowledge and they came out and did an evaluation in which at that time he only qualified for their palliative care, which I wasn't interested in.
Ironically he went under hospice care in Nov. 2018 after almost dying from aspiration pneumonia and remained under their care until his death in 2020.
If both your parents are now under hospice care it means that they both had to qualify for their care, which apparently they did, so be grateful that they now have extra sets of eyes on them and that they are being taken care of and kept comfortable.
So to answer your question, yes someone can be placed under hospice care without physicians consent.