Dad has been admitted to Hospice. I was told medicare will pay for it. Will they take his SS check also?

my brother is in a hospice being paid by vtas/insurance and Medicaid will he lose his SS payment?

rosie - you may want to prepare yourself emotionally that he will not be coming home. For us, our experience is that IF they are elderly & admitted to a free-standing hospice unit (rather than discharged back to NH or directly to home) it is because their medical situation is that they are close to end of life. Speak frankly with the floor RN on what his status is and what their experience is with others in the same situation as your dad. For my aunt, nobody was willing to ask hard ?'s from hospice (that is her kids & grandkids), but for my MIL...well we were all pretty blunt about wanting to know and not sugar-coat the situation and the RN said maybe 2 weeks that is why she came here rather than back to NH & she was right and it was about 10 days. Hospice called every day with an update in AM & PM.

There are 2 standards used for hospice placement: FAST & the Mortality Rick Index Score - aka a MITCHELL score (this is named after Dr. Mitchell who is a big researcher on end of life). Both are used, although Mitchell seems to be used more if it's a clinical setting.


Functional Assessment Staging Test (FAST) Stages:

1. No difficulties;

2. Subjective forgetfulness;
3. Decreased job functioning and organizational capacity;
4. Difficulty with complex tasks and instrumental ADLs;

5. Requires supervision with ADLs;
6. Impaired ADLs, with incontinence;

7. A. Ability to speak limited to six words & 7. B. Ability to speak limited to single word
& 7. C. Loss of ambulation
& D. Inability to sit & 7. E. Inability to smile &
7.
F. Inability to hold head up


Mortality Risk Index Score (Mitchell)

Points & risk:
1.9 Complete dependence with ADLs;

1.9 Male gender;

1.7 Cancer;
1.6 Congestive heart failure;
1.5 Bowel incontinence;
1.6 O2 therapy needed w/in 14 days;

1.5 Shortness of breath;
1.5 less than 25% of food eaten at most meals;

1.5 Unstable medical condition;
1.5 Bedfast;
1.4 Age over 83 years;

1.4 Not awake most of the day. You add these up & it's his Mitchell score.



Risk estimate of death within 6 months
(Mitchell score):
Score Risk %

0 8.9

1-2 10.8

3-5 23.2

6-8 40.4

9-11 57.0

= 12 70.0
The score along with the MD assessment is needed for hospice under Medicare rules. For my mom, 2 MD's - 1 the medical director of the NH & the other the medical director of the hospice had to be in agreement on the score & care plan.

The score can change, my mom was a 15.5 initially and now a 9.4. The score was done right before she got renewed for hospice. (First two 90 day periods, then every 60 days).

Hospice really is a wonderful benefit of Medicare. Stay strong and try to be objective. It is not easy to do. Good luck.

No, as long as they are at home they will continue to receive their SSI. My father was in hospice at home, and today my mom has gone into hospice care and will stay here at my home.

He went to a hospice facilty. It is only supposed to be temporary while we put together a plan for him to come home with me and have hospice come into our home to help. They said it will take about 2 wks to get everything together for him to be able to come home. He looked really bad today. I don't know if he will last that long

Where did he go? Is it a hospital facility? another nursing home? Is there a contract with the old nursing home and the hospice facility? There must be some admission papers , you need to read them.

My mom went onto hospice in June. She is in a NH and has been in a NH for about 2 years now. She fell and shattered her hip, so between her age & dementia (she is Lewy Body Dementia), surgery was ruled out (surgery not the issue but her successfully doing the after surgery therapy would be impossible). So she is bedfast and now qualifies for hospice but still living at her NH.

Hospice is 100% covered by Medicare but hospice in & of itself does NOT pay for all the caregiving needed for the hospice patient. My mom is still in her NH and her room & board costs are all paid by MedicAID but now MediCARE is assuming most (but not all) of the medical costs since her medical costs can get coded into hospice benefit of Medicare. NH still gets all of my mom's monthly income less her personal needs allowance ($ 60.00 a month for Texas). If your dad stays @ the NH, he will still be expected to do his co-pay of his SS and any other monthly income (retirement) to the NH. The cost of his medical care will shift to mainly Medicare paying for stuff more but Medicaid still involved in paying what Medicare doesn't. NH like hospice because of the additional medical staff it brings in.

What Medicare hospice is paying for my mom is:
a special bed, special mattress (an air mattress with a circulating flow so the mattress breathes and changes surface area so limits bed sores); a "geri-chair" (this is a special angled chair that she can sit into even with her broken hip and takes 2 to get her into - done when the hospice aid comes to see her with a CNA from the NH); disposable bibs for feeding; diapers; high protein fruit based meal supplements; morphine based pain meds. Hospice will pay for their hospice staff to see your dad...just how often depends on his evaluation for care. For my mom it is an RN twice a week; a hospice aid X5 a week; social worker & chaplain right now twice a month. All this billed to Medicare and runs about 4K a month. She has thrived under the personal attention from hospice and really has never been cleaner. The NH staff still takes care of her when hospice is not around. Like they do her med's, bathing and assistance in feeding the time when hospice is not there. All this is something to think about if you take dad home.

It really seems that hospice for the long run will need 24/7 someone to be there. If he is bed-fast someone will have to be able to move him about to keep bedsores from happening. My mom is tiny & petite so the special mattress really does take care of this but if she was big it would not be enough. If you dad is large, it may not be feasible to deal with this and changing him on your own solo. My mom can still grab and hold the bedguard when they change her diaper. FOr getting dressed she can hold up her arms and push off the bed a bit and she is pretty compliant in her care....if your dad is not this type it is going to be hard work for all. If he needs serious pain meds and pain monitoring, this is pretty labor intensive. Not all family is up to this. Pain meds, if they are level 3 or 4 meds, require a more skilled medical personnel to carry & distribute them, not all hospice providers have the staff with the credentials to do this, some of the smaller hospice just cannot afford staffing levels to have this, so ask. You just don;t want the situation to be where dad is in pain and serious obvious pain and the RN won't be there for a while to do or reset the morphine drip. Think hard about how much you can be fully time committed to all this and what the demands from dad will be. The NH will have staff 24/7 who can do these kind of things.

In my mom's city, a defunct children & women's hospital is now a full time hospice facility but admission to it seems to be limited to those who are either fully close to death or very serious pain meds cancer patients. My aunt went to it after a massive stroke and really was there a few days on hospice then died. My MIL went to a full hospice facility from a hospital discharge as she too was determined to be very end of life situation (this in another city), MIL there a couple of weeks then died. Now for my mom, she is now hospice 4 months and really not going anywhere. She could continue on hospice in her NH for months & months. One tough old bird! She is not a candidate for a hospice only free-standing facility as she doesn't have the critical care medical needs that my aunt or MIL had. Her needs are pretty minimal but there is no way she could be at home unless there was someone adult and knowledgeable 24/7 and checking on her every hour or so. Not feasible for us. Remember it could be many many months or years on hospice. 6 months is just a guideline for qualifying.

Since hospice is Medicare, you can pick the provider. You do NOT have to take the group you are currently speaking with. The NH has to give you names of several vendors. Social worker should have this easily available. If they say there is just 1, that is bullcrap and there is probably ground for a Stark Law investigation if that is what you are told. (By the way, a Stark Law complaint is the true "Wrath of Khan" for a NH or other health care provider.) Get several names of hospice, go on-line to see what their philosophy is. Vitas & Compassus are big national hospice and they are good but not in all communities. I'd suggest that you speak with 3 or 4 hospice providers to get their assessment of dad and what they will be able to do for the level of care he needs. You can switch hospice providers too - I am on the 2nd group for my mom. Many issues with first group but I am a big person on compliance and they did not fulfill theirs. Did it with 2 day notice to the old group too. That is totally allowed by Medicare rules too.

Good luck - not of this is easy or simple.

My dad had medicare no Medicaid. He had a Medicare HMO that provided a lot of additional stuff like dental and vision and prescription.
His hospice was covered we had a choice of a hospice in a hospital unit ...or at home...dad wanted to go home. Medicare paid hospice. SS never came into the picture because he lived at home. I had other unexpected expenses.

A few things you should know about at home hospice.
The dr at the hospital refused to release my dad because my elderly mom seemed unable to care for him and I honestly stated that while I was there a lot I did not live with them and I am employed. I think the dr just wanted the revenue for the hospital hospice unit. They explained to me that hospice covers 24 x7 care until the patient is stable, after that they visit daily, but they are not necessarily present for feeding, comfort, changing and meds. I think if someone is on morphine they continue 24 hour care.

The Dr called for witnesses, he challenged how I would arrange for and pay for this. Luckily I had answers for everything and I made a public statement that I had planned to supplement hospice with Visiting Angels 12 hours day and a private caregiver 12 hours overnight....when you multiply the rates by 24 and expect it can be anywhere from a few weeks to 6 months, this can add up a lot. I new how much it would cost as I had already had the overnight caregiver previously employed. This also made my position more credible. This was a very uncomfortable scene.
They had no idea how persistent I can be and that I had promised my father he could go home to die as he wished. I had actually thought it through.

I later learned from visiting angels, since their folks are not medical personnel, they cannot dispense meds.

What really happened is hospice ended up being 24 hour care, by the time the stabilized him, his end was imminent so they did not cut back.
The stress was very high for my mom, so the private caregivers comforted her. They cooked and the house was spotless, they even did laundry....these ladies really are angels.
Since mom was present, mom could "dispense" the meds the caregivers helped dad take the meds.
The hospice nurses were very nice as well. My mom and I made sure the good ones felt comfortable and they ended up requesting us as an assignment. One of the nurses would give my mom back massage for her asthma when it acted up. When people like their work environment they go above and beyond.

I was there every evening and on weekends. I met with the nurse every evening and reviewed the situation.

Dad was in house hospice for about 4 weeks, the entire time I had the 24 hour hospice and private caregivers, I was thinking of throttling back the private caregivers, but the end seemed imminent t that point, so there was no sense in changing things.

If you are able bodied and present, you may not need a supplement the care. Your hospice may offer 24 hours assistance, I only mention this because it was a wrench that got thrown in front of me and as the social worker later pointed out I was very lucky to have the means to deal with the problem.

I also learned that this hospice requires a family member be present all the time, while they are there. Luckily mom was.

I have heard differing experiences, this is mine.

Best of luck
L

That would be a very good question for the hospice people. Ask them what you should do. They will know the technicalities of your father staying at the hospice facility better than we do. Let us know what they say.