How does palliative care and/or hospice work? Do patients never see a doctor again?

A doctor should be a part of the palliative care team. It appears the nurse didn't think your father needed to be seen by the doctor for this infection. I have found that when a tooth is involved, doctors do make a referral to a dentist because that is their field. This doesn't seem unusual.

Here's what I learned about how Hospice works that few folks understand, I know I certainly didn't. When your family member becomes a Hospice patient, all of your Medicare A&B coverage is diverted to the Hospice facility as an ongoing daily charge pretty close to what an inpatient daily hospital bill would be, whether or not you actually have any billable activities that day provided by the Hospice facility.

If you were to take your person to the hospital or the doctor, without clearing it for approval by the Hospice facility, your person will have NO insurance coverage for any outside medical care. The Hospice facility has to reverse the person's coverage, or to be willing to cover any outside charges if they deem it medically necessary.

A dental bill is usually not something covered by regular Medicare, so if your person needs dental care, and is ambulatory enough for you to get them there, it will not affect their Medicare insurance. The question you have to ask yourself is how will this affect your family member in the larger picture? It is assumed they have 6 months or less to live if on Hospice, so letting dental work go untreated may accelerate their passing. Did they ask that no heroics or procedures be done to prolong their life if it is determined that they are on the way out anyway?

What are your person's wishes regarding end of life care? Is all this written down?

You will have to find a dentist that will be willing to treat a person with very fragile medical needs. Giving them an Rx for an infection is one thing, but extracting a tooth is something that perhaps only an oral surgeon might be willing to do, again, depending on what other comorbidities your person has going on. They aren't going to be willing to face a malpractice suit because the procedure caused complications that caused death.

Here's the rough part of the discussion, is this something that will be an easier passing than letting the rest of their comorbidities run their natural courses?

I'm super conflicted on situations like this because I lived it in a scenario that didn't go well.

My mother developed a simple bladder infection. Hospice would NOT order antibiotics. I could not take her anywhere even if I could have moved her. She had fallen 6 weeks previously and broken her femur, and had mid-late stage Alz, so they sent her home from the ER with a referral to Hospice and said she wasn't a surgical candidate. Nothing else was wrong with her.

When she got the UTI I begged for at least one round of antibiotics so her bladder infection didn't become a kidney infection. Nope. They wouldn't do it. Kidney infection, then kidney failure, is what killed her because they wouldn't approve an $8 prescription. Yes, she was dying anyway, but I had just hoped that she would just fall asleep and not wake up instead of thrashing and moaning from a raging fever as her body was going septic.

Hospice was no help for my mom. I handled all this alone. Sure they came and brought diapers and taught me how to change her and the sheets, but they weren't there every day and certainly not for any amount of time. They were paid handsomely for running errands for me. Oh, and kept encouraging me to give her their morphine cocktail. That would have killed her, I have no doubt, then that would have been a cloud over me for the rest of my life. I was not going to administer drugs that she didn't need just to hasten her death because that is how they operate.

So her death was less than optimal. I did my best to work within an unforgiving system that just isn't flexible. Is death ever how or what we choose? Nope. I just hate the feeling that $8 worth of antibiotics would have knocked down the UTI, and instead my mom died because of THEIR protocols. How was that humane?

I held her as she died, just the two of us at home alone. It sucked, but I'm glad that her torment was over, but it was the beginning of mine. It's now 10 years later and I still feel very tortured.

We had a very opposite experience than poster Survived did with hospice. I think this shows that different hospice providers just like different medical providers, handle situations with differing protocols. My dad easily received antibiotics while on hospice, it was made clear there was no expectation of any six month or other timeline, and he would certainly be free to see his dentist if he so chose. This does sound like it may be a dental issue, it may be the next step to see a dentist. I wish you well, I know what a trying time this can be

A dentist is needed. This is a dental issue. There may be the root of a tooth in there. It could be anything stuck in the socket of the lost tooth. This could go to a bone infection and death. It is not to be ignored as it has already been addressed (and addressed through palliative care) by antibiotics.
Dental xrays are done. Those aren't done by doctors.
GET TO THE DENTIST before this ends in sepsis and a rapid death.

When Dad was in hospice with cancer and dementia, he had a rough tooth that was bothering him. I'm not sure if part of it broke off or what. Dad didn't know either, but it was all he'd talk about. His dentist, after we told him the situation and how difficult it was to move Dad, volunteered to come to Dad's house (dentist was quite fond of dad, a longtime patient). Dentist filed the tooth until it was comfortable. That was a nice thing for him to do! Dad died at home a couple of months later.

You can always ask (but might not get) a house call.

Yes this is a Dental thing not a doctor thing. And yes, Hospice means no doctors. Only the one who is associated with Hospice because a doctor has to prescribe the medications and give orders. When u enter Hospice you have agreed to no medical intervention. No heroic measures are taken. You sign a DNR. Hospice is there to keep u comfortable. Morphine is given for pain and to ease breathing. Sometimes a client has to have enough morphine that they needed to be knocked out to ease the pain. Its end of life.

Survived, I have never heard that a person receiving Hospice who ends up opting to go to the hospital, the hospital bill is not paid. I have heard that Hospice will drop them. But, what u say does sound logical. I am so sorry about Mom. If your Mom was in pain from an infection, antibiotics should have been ordered. The purpose of Hospice is to keep a client as pain free as possible. To make their final days as peaceful as possible. If you had posted to this forum at that time, we would have told you to find another Hospice.