Just got the news today that my dad (83) has lymphoma that is advancing rapidly. Doctor says that typical treatment would be too much for Dad and recommends hospice care. He gave a “low number of months” as an estimate. My dad wants to go home. He has been in a facility since mid-October (hospital then rehab then better hospital again for diagnosis).
My mom needs a caregiver herself. Is there a way to get in-home care for them both during this time?? What will Medicare pay for?
Your dads MD or MD at the facility write orders for a hospice evaluation.
Hospice is a seperate company, bills separately to Medicare. It’s “self directed” in that - in theory- your dad can select the vendor. In reality it’s limited to the handful of hospice that work the facility he’s in now or those that work in the neighborhood where your folks live. There may not be much choice, especially if your dad is on serious pain meds as some hospice just won’t do those clients due to risk.
The issue imo will be for inhome is that hospice worker or volunteer is limited to coming in 2-4 times a week, perhaps 2 -4 hrs per visit. Thier time will be abt health checks, bathing, helping them eat a meal, maybe helping to make that meal, perhaps putting fresh bedding on the pneumatic bed that hospice ordered for the patient. But other than those brief visits, your mom & you & your family are on your own for all other care time. Unless y’all hire inhome caregivers.
Maybe if he were to apply for Medicaid, Medicaid could provide for additional in home care. BUT they too will have limits on hours. Inhome cannot exceed # of hours that push it into over 28-32 or so hrs per week as if it’s more than that, they are showing to be “at need” for full time care. Like placement in a LTC facility. It’s not cost efficient for in home plus inhome cannot meet the level of care needed. Comprende?
On your mom, she would have to show her on “at need” situation to become herself eligible for hospice. The rub would be that if both are in home hospice, hospice will need someone not on hospice to be there for oversight. So you or another family member will need to live there.
Realistically the best way to have 24/7 oversight - which probably is what he needs - is for him to be in a facility.
As an aside on this, my mom was on hospice for 18 l...o...n...g months at a NH she had been living at (she fell pulling her wheelchair behind her on way to arts n’ crafts, what can I say). Mom stayed at the NH and was 100% bedfast & between hospice and NH staff got really lovely care. Hospice was mediCARE benefit but her room&board at NH was LTC Medicaid. My MIL - a most difficult person - went into hospital from her NH as very ill. She was on LTC Medicaid at the NH. Hospital discharged her to an specialized facility that was also free standing hospice adjacent to a hospital. She was very ill, extremely septic, cascading organ failure and died abt 3 weeks after exiting the hospital. Her hospitalization and hospice were Medicare part A. MILs path was kinda unusual as most of the time they go back to their old NH and back to LTC Medicaid & off Medicare. Mil had mediCARE coverage because she was super septic sick on discharge; had she lived beyond a month in hospice, imho, she would have been discharged back to NH LTC placement.
i really hoped we could have brought dad home for his last days but I live in Virginia. My brother is local but has a family and career of his own to manage.
I could take FMLA but I would have to leave my kids behind in VA with their dad. That is not an acceptable option.
Right now they are on Medicare with the part B and D insurance. It looks like we have to start liquidating their assets and getting them into a home that might be able to take care of them both.
I think your idea to liquidate assets and get them even in a AL would be good. He can have Hospice while in an AL. When Hospice is not there, you still have the facilities aides.
Medicare will pay for Hospice care (not the cost of the facility though) but they don't pay for in home caregivers.
I'm glad I was able to help my dad die at home. He was never in a nursing home or hospital, as he went from seeming the peak of health and self-sufficiency to terminally ill practically overnight. Nevertheless, the eight weeks I spent taking care of my parents and then just my mother darned near wiped me out.
I assume you want the best for him, and the best for him might be a hospice facility where he really will get 24/7 care.