Hospice Care expectations and cost in MD

[Anonymous]

My dear FIL has been given 10 months to live(stage 4 bone cancer, has aspiration issues, no mobility from waist down, arrhythmia, incontinent -has a catheter)I've toured a few places in Charles county&PG county. I was quoted 16k/monthly (yes, 16k!!)as he doesn’t qualified for hospice at home anymore. For 16k I expect the facility to be somewhat fairly clean, skilled nurse 24/7, help with meds, sponge bath, change brief/diaper, 3 meals. None of the places I toured are optimal and understaffed. Am I being unrealistic to expectations? What kind of care does a hospice resident gets for that price? I’m looking for a facility that can provide proper dignity care, kind treatment and keep my FIL comfortable and pain-free. Any tips, suggestions and thoughts are greatly appreciate it-

[Anonymous]

I don’t have personal experience, but the facility in Arlington has a good reputation, I think. Capital Caring Hospice.

[Anonymous]

Your post makes no sense. He should qualify for home hospice but hospice provides general support and not 24/7 care. There are some facilities, like Montgomery Hospice that have their own in-patient facility but it sounds like you need a full care nursing home and those can run $12k+ a month. 16K sounds a bit high. What happens is he goes into a regular nursing home. There isn't a huge amount of care - maybe bathing 2 times a week (but hospice can send someone in to bathe more frequently) at most of these facilities. You have to bring in a private CNA for more care. Hospice just supervises things, gives support for the family and patient and provides a few services like a nurse to do check ups, medication reviews, and comfort care.

[Anonymous]

I just went through this with my mother who died last week. You can hire 24x7 home health aids at around $28 per hour. My mom was already in an independent living facility which charged $5k per month. If you keep him in his home you can avoid that charge. Hospice provides support including a hospital bed and oxygen. These expenses are covered by Medicare. I used an agency which managed the aides coverage when they call in sick or take time off. I chose this route because I was told that if your parent is in an institution, you end up having to hire a private aid anyway to get the level of care you want. It’s a painful process, but at least I knew my mom was well cared for til the end.

[Anonymous]

As others have said, the caregiving and hospice are separate services (hospice is more of a consultant, so to speak).

[Anonymous]

Anonymous wrote:Your post makes no sense. He should qualify for home hospice but hospice provides general support and not 24/7 care. There are some facilities, like Montgomery Hospice that have their own in-patient facility but it sounds like you need a full care nursing home and those can run $12k+ a month. 16K sounds a bit high. What happens is he goes into a regular nursing home. There isn't a huge amount of care - maybe bathing 2 times a week (but hospice can send someone in to bathe more frequently) at most of these facilities. You have to bring in a private CNA for more care. Hospice just supervises things, gives support for the family and patient and provides a few services like a nurse to do check ups, medication reviews, and comfort care.

If his life expectancy is really ten months, wouldn't he not qualify? I think it has to be six months or less.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Your post makes no sense. He should qualify for home hospice but hospice provides general support and not 24/7 care. There are some facilities, like Montgomery Hospice that have their own in-patient facility but it sounds like you need a full care nursing home and those can run $12k+ a month. 16K sounds a bit high. What happens is he goes into a regular nursing home. There isn't a huge amount of care - maybe bathing 2 times a week (but hospice can send someone in to bathe more frequently) at most of these facilities. You have to bring in a private CNA for more care. Hospice just supervises things, gives support for the family and patient and provides a few services like a nurse to do check ups, medication reviews, and comfort care.

If his life expectancy is really ten months, wouldn't he not qualify? I think it has to be six months or less.

Apply and let hospice decide. There has to be a steady decline, which there may be to qualify. It is hard to predict. My MIL got hospice and I was surprised. Worst case, you do an assessment and they say it's not time. Montgomery Hospice decided it for us and when MIL got better thanks to their support, they pulled out (and then she passed quickly after that as the quality of care in the nursing home was bad and even worse without their help). Medicare pays for hospice. It's free to the patient, so there is no harm in applying and seeing what they help with. For us, it was advocating at the nursing home, medication management, getting in additional supplies she needed, providing us with end of life guidance (and take the pastor even if you aren't religious as they are a wealth of knowledge and they were very respectful to our beliefs and no religion was involved), 1-2 time a week extra bathing (forget how often), etc.

But, on top of that you'd still need skilled nursing and that should probably be around $12K, $16K sounds very high but its been a few years since I dealt with it.

[Anonymous]

Anonymous wrote:Your post makes no sense. He should qualify for home hospice but hospice provides general support and not 24/7 care. There are some facilities, like Montgomery Hospice that have their own in-patient facility but it sounds like you need a full care nursing home and those can run $12k+ a month. 16K sounds a bit high. What happens is he goes into a regular nursing home. There isn't a huge amount of care - maybe bathing 2 times a week (but hospice can send someone in to bathe more frequently) at most of these facilities. You have to bring in a private CNA for more care. Hospice just supervises things, gives support for the family and patient and provides a few services like a nurse to do check ups, medication reviews, and comfort care.

PP-he did qualified for home hospice at the very beginning of his illness. Now, he’s not longer able to get that as condition worsen and needs to be in private facility that offers skilled-nursing 24/7-that’s what i was told. He’s been declared terminally ill and can’t be kept in a regular facility where he currently is. Bringing in additional help can help, thanks!

[Anonymous]

Have you tried Hospice of the Chesapeake? I was impressed by them.

[Anonymous]

Anonymous wrote:I don’t have personal experience, but the facility in Arlington has a good reputation, I think. Capital Caring Hospice.

Do they have a brick and mortar facility for full time hospice patients now? When my father was in hospice with them it was at our house and the facility was for short term stays if I left town. In home hospice is skeletal. They had someone to come up to 3x a week for a bath, a nurse came once a week, the social worker came every other week and the doctor came at most once a month. That was it, regarding care. Otherwise they did well on getting equipment- a bed, a poop chair, a soft cushion for his wheel chair - things like that.

They will also come to nursing homes or other places, but they do not provide 24/7 care.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I don’t have personal experience, but the facility in Arlington has a good reputation, I think. Capital Caring Hospice.

Do they have a brick and mortar facility for full time hospice patients now? When my father was in hospice with them it was at our house and the facility was for short term stays if I left town. In home hospice is skeletal. They had someone to come up to 3x a week for a bath, a nurse came once a week, the social worker came every other week and the doctor came at most once a month. That was it, regarding care. Otherwise they did well on getting equipment- a bed, a poop chair, a soft cushion for his wheel chair - things like that.

They will also come to nursing homes or other places, but they do not provide 24/7 care.

Capital Caring does have an inpatient hospice. It's on the Sibley Hospital grounds. It is an acute inpatient hospice. I'm not exactly sure how you get access to it, but I think it can be used for respite stays (5 days) and to stabilize a patient when symptoms cannot be managed at home (e.g., IV pain meds). It's designed for stays <2 weeks. It's 100% covered by Medicare.

[Anonymous]

Anonymous wrote:

Anonymous wrote:Your post makes no sense. He should qualify for home hospice but hospice provides general support and not 24/7 care. There are some facilities, like Montgomery Hospice that have their own in-patient facility but it sounds like you need a full care nursing home and those can run $12k+ a month. 16K sounds a bit high. What happens is he goes into a regular nursing home. There isn't a huge amount of care - maybe bathing 2 times a week (but hospice can send someone in to bathe more frequently) at most of these facilities. You have to bring in a private CNA for more care. Hospice just supervises things, gives support for the family and patient and provides a few services like a nurse to do check ups, medication reviews, and comfort care.

If his life expectancy is really ten months, wouldn't he not qualify? I think it has to be six months or less.

I’m surprised he did not qualify, with the diagnosis and symptoms you describe. How can they really predict he has 10 months to live, versus 6? He seems like an appropriate candidate for hospice.

Regardless, home hospice does not provide caregiver support; they are focused on pain management and comfort care for patients who have made the decision to suspend curative treatment. The patient/family needs to pay privately for a home health aide or private duty caregiver, because it’s not covered by Medicare, even for end-of-life patients. Inpatient hospice is a short-term situation for patients whose death is imminent, or they require clinical care (but not curative) that cannot be managed at home.

If your FIL goes to a nursing home or assisted living/group home, he can receive home hospice services there (since it would be considered his home). So you can keep him home and pay for however much care he needs, or find a placement.

This does not really answer your question, I’m realizing. 16k a month sounds expensive. Does he need an assisted living, or nursing home?

[Anonymous]

PP here and I read your post; sounds like he needs a nursing home. Where did you tour?

[Anonymous]

Anonymous wrote:

Anonymous wrote:Your post makes no sense. He should qualify for home hospice but hospice provides general support and not 24/7 care. There are some facilities, like Montgomery Hospice that have their own in-patient facility but it sounds like you need a full care nursing home and those can run $12k+ a month. 16K sounds a bit high. What happens is he goes into a regular nursing home. There isn't a huge amount of care - maybe bathing 2 times a week (but hospice can send someone in to bathe more frequently) at most of these facilities. You have to bring in a private CNA for more care. Hospice just supervises things, gives support for the family and patient and provides a few services like a nurse to do check ups, medication reviews, and comfort care.

PP-he did qualified for home hospice at the very beginning of his illness. Now, he’s not longer able to get that as condition worsen and needs to be in private facility that offers skilled-nursing 24/7-that’s what i was told. He’s been declared terminally ill and can’t be kept in a regular facility where he currently is. Bringing in additional help can help, thanks!

That makes no sense! If he qualified, and then his conditioned worsened, he is still a candidate for hospice! What kind of facility is he in, currently?

[Anonymous]

PP here. Something is getting lost in translation here. What kind of a facility is he currently in?