Dad and I met with the hospice admissions nurse tonight at his house. She asked him a lot of questions and he was able to participate in the interview. After we went over his symptoms, she said, "How would you like it if we could provide you some additional services over what you are getting here?" He said, "Fine." She said, "We could have someone come in and see you five days a week helping you with showering, shaving, making sure you get you skin moisturized with lotion. All kinds of things." I told her I would like his meds reviewed so we could discontinue anything he doesn't need. So we got out his list (about ten different ones every day) and figured out which ones to quit. He was very much for that.
We finally got around to the word "hospice" and he said, "You think I need hospice?" to her. She said, "Do you feelings about hospice?" and he said, "It's scary. It means I'm going to die right away." She was very honest with him, "We all do sometime." I said, "It might not be soon Daddy. It could be many months." The intake nurse was very soothing, "Hospice doesn't mean you're going to die right away. It might not be months; I've known people in hospice for three years. All it means is that we will provide you with services and help you avoid going to the hospital. If you have a fall, we can come here and take an X-ray. We can make sure you are comfortable. If you change your mind and decide you are getting better and want to go to rehab, you can discontinue hospice."
All this was news to me. It used to be a lot more black and white. I told her in our prior dealings they said to him he had to agree not to take Mother to the hospital for any reason, in order to get hospice care. She said, "That's not the case anymore. You might change your mind and decide you want to go to the hospital. And you can always get back into hospice care after you get out."
He was then taken to dinner. She and I continued our discussion. She would start us tomorrow with daily visitation. I told her I'd like someone to take him for walks outside and play cards. She said if he was agitated at night and hopping out of bed, they could have someone come out and sit with him within an hour. She said the falls and catastrophes always seem to happen at night. She said if he has a fall, they could have someone there within an hour to calm him down and take and x-ray. By taking over his cleaning they would take some of the work off the in-house caregivers. She said sometimes people improve because of all the additional attention. He qualifies because he has an illness he will not recover from. Hospice used to be a death sentence, but it's basically just a word.
In my view, it fills the gap between what he currently gets with assisted living and what he might have gotten in a nursing home with more qualified and numbered nurses. All paid for by Medicare. He also gets to keep his doctor, but also gets a hospice doctor. If Dad needs a doctor to come out for an emergency in the middle of the night, they have someone on call 24 hours per day, and their doctors answer the phone.
I had seen other residents who had dedicated caregivers who came over every day to entertain them. I always thought, "I bet that's pricey! Just having someone come to watch him sleep is $16 - $20 per hour! I wish we could have a little buddy for him, but we could never afford it. Dad needs friends outside of me coming over to visit. We all do!" Now Dad can have that.
As my sister said to me tonight, I just don't see a downside! This is my Christmas present to Dad. The admissions nurse felt the key was downplaying the word "hospice" and pretty soon he would love it.
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