My MIL has lost her words, seems to not recognize us. She has had rapid deterioration due to Alz. during the last 2 years. Scores about 7 on the mini-mental (max 30). Unable to explain if something is bothering her...just says "it's not right"; takes scissors to her hair (we got all the scissors out of the room finally). I don't know if hospice is appropriate? Doctor mentioned it in passing a month ago. ... also, how are we going to communicate with her when she can't manage her hearing aids any more?
They have her on drugs which stabilize her mood and keep her from being so paranoid and anxious. The doc had her on a mishmash of dru,gs some of which he'd thought he'd stopped and she was so confused. Hospice has her meds straight and checks them from the pharmacy. It is such a relief to have someone else checking these things!
I signed my husband up when he began to physically go downhill, sleeping more and more, having trouble swallowing, getting too weak to walk. He was at home at the time. I can't tell you how wonderful it was to have medical attention come to him. There were several conditions they solved immediately. The nurse even came up with something to minimize his constant drooling. He definitely was more comfortable and dignified with hospice care. He died after five weeks, holding my hand.
My mother is in a nursing home. A few months after being there she broke her hip and became delirious. The hospital didn't expect her to survive the week. She went back to the NH with hospice care. She got lots of extra attention, a very comfortable wheelchair, a special bed, volunteers spent time with her, doing things like giving her gentle hand rubs, and doing her nails or fixing her hair. Hospice took over her medications, and it was very easy to work directly with the nurse. Hospice is awesome for cutting through red tape. After three months my mother "graduated" out of hospice. She improved enough so there was no reason to believe her death was imminent. (In her mid 90s it isn't far into the future, but not within 6 months, as far as anyone can tell.)
Since your MIL has nothing "fixable" I don't see any downside at all to involving hospice. (If she had to decide to forego chemo, it might be a tougher decision.) If she is on the final leg of her journey, hospice can make it smoother for all of you. And if that prognosis is wrong, she can leave hospice and come back to it when it is more appropriate.
As to communicating with her, hospice could help you with that, too. Remember that even if she doesn't know exactly who you are, she will know that a kind person is visiting and treating her nicely.
The basic indicators include progression of disease (infections, weight loss, difficulty swallowing, weakness, change in level of consciousness) as well as a decline in the Palliative Performance Scale, dependence with activities of daily living and disease specific guidelines.
Disease specific guidelines for Dementia include a FAST (Functional Assessment Staging Scale) of 7A with contributing factors such as sepsis, wounds and malnutrition. A FAST of 7A presents with inability to ambulate, dress or bathe independently, incontinence and limited speech (6 words or less).
It is best to have your mom evaluated for eligibility, as these are only guidelines. If your mother-in-law doesn't qualify for hospice, a palliative care program may be a good option. Palliative care can be supportive of you and your mom through this difficult disease and personnel have a good idea when it is the right time for hospice.
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