Is it possible to get hospice to pay for more visits? Are they opposed to doing more than 2 visits because it cuts in to their daily rate? Any tips on getting him qualified for pt to just preserve what little mobility he has left?
Hospice will cover hospice. PT for recovering from surgery is a totally different thing, so to get more PT it would need to be cash pay or from another angle other than hospice. (I'm not sure if one can have medicare home health with PT at the same time as hospice?
First let me say that it is next to impossible to get this done through hospice. You have done well to get a private therapist for your dad. You may find it best to continue private pay. That’s one choice. You are the only person I have heard say you got hospice to pay for ANY therapy. I did as well but very little.
Another choice, find a Hospice that also has a Home Health company. Leave dad on home health where he can get therapy, a nurse and CNA baths. The same nurse, cna would come whether home health or hospice has been my experience. He would see his regular doctor via Telemed as needed or a NP or PA would come to him. Then when the therapy is finished he can switch back to hospice if you see a reason to.
Or you could take him off hospice and put him in a rehab since he just had a hip replacement. He can stay in the NH after or go back to his ALF and back on hospice. It’s just paperwork and a ride from one facility to another.
You have to manage the system whenever you get a chance and you have a chance right now IF your dads condition allows and you have the stamina to deal with it.
Make sure your hospice provider of choice will be accepted in the NH for afterwards or back to the ALF. MY DH aunt went in rehab as private pay as she had no recent hip replacement as a reason to be there. Not all hospices, Rehabs, ALFs or NHs are the same. They are business people, if they know how to get Medicare to pay, they will. You have to check it out and then determine if dad is up to this, wants to do it, will do it after you arrange, you can have a DNR at the NH like at the ALF or your home or wherever he lives.
About hospice providing therapy. If you look on Medicare.gov regarding hospice you can find where it states therapy is provided through hospice.
Medicare foots the bill for hospice services but it seems Medicare doesn’t mandate that the hospice companies provide all the services one needs or wants or even that Medicaid states will be provided. There evidently is no penalty to the hospice company for not providing this service. It’s a useful benefit but only if you can find a hospice company that will provide the service. That’s the tricky and confusing part.
As a private company they can provide the services they choose. It’s up to you as a consumer to decide if you want to do business with them. My DH aunt went from home health to hospice because I wanted her to have more baths. My hospice comes 7 days a week for her. She qualified but I wanted it for her for different reasons than getting ready to die. We are all dying. Some just have conditions that often, maybe generally, lead to death within 6 months and that Medicare accepts as making the person eligible for hospice services. People can go on hospice the day of death or what turns out to be years from death. If Medicare can get you to stop going to the hospital seeking services that aren’t going to cure you, it’s cheaper and perhaps more humane to keep the ill person out of the hospital until they pass. But not everyone wants to lie around for months waiting to die and can benefit from a little therapy. Hospice doesn’t always mean painful cancer. A patient meets some criteria that allows a hospice company to offer their services. They have sales people whose job it is to sign up the ones who would qualify. There is some fraud. Some patients who go on hospice are not deconditioned. They have lived fit lives UNTIL they were put on hospice due to a recent turn of events. They will sometimes live past what the chart indicates. Having a purpose and a challenge is a good thing. good luck and take care of yourself. You are the consumer. Whatever you decide will be okay. Make it work for you.
Thank you. You are 100% correct in pointing out that it is odd to mix a hip replacement with hospice! He was living alone & active when his 40+ year old hip replacement wore out & basically froze up. He personally made the decision to have the surgery, after a great deal of consideration & several discussions with the medical staff. He has larger than usual bones, and there was a problem with his original hip surgery 40 plus years ago, so they took the precaution of waiting for a ‘special part’ to be delivered. His muscle mass further deteriorated in the hospital for a week before they could do the surgery. He was discharged to a SNF Rehab, but he has Medicare Advantage instead of regular Medicare, so he was subject to rigorous ‘case management’ by the facility and the Medicare Advantage plan. After only 12 days in the facility, with limited PT, the insurance case manager told me he ‘had plateaued,’ even though he was making progress in an uphill battle. They were relying on an algorithm, and not his age, health or the extended hospital stay that was necessary. Their complete discharge plan was telling me that I needed to find him a nursing home, and that he will probably live less than six months. His doctor prescribed continued SNF Rehab PT for at least 2 more weeks, but the facility and the insurance told me that the doctor’s opinion was not a consideration. 😳. We were fortunate to find a hospice agency that is excellent, combined with an assisted living facility. He can at least stand and walk to the restroom with assistance, and he would like to retain that ability for as long as possible. The physical therapy that we pay privately is specifically to retain current functioning. My Mom had cancer and was on hospice for five months before she passed. She had hospice authorized PT to help her maintain some physical abilities for as long as possible, because it was maintaining her current functioning (not building or recovery work) They viewed it as something that allowed her to retain dignity, which was important to her. I read the Medicare regs and while PT is discussed for maintenance purposes, as is pointed out here, it is not a hospice requirement. Thanks to you and to all others who took time to share insight and information here in this forum. Warm wishes.
Hospice may cover PT to prevent or ease pain but they will not cover PT to recover from hip replacement. I am sure that the hip replacement was done while he was off Hospice. Hospice can discharge a patient then re admit after a procedure like this. He can continue PT using his Medicare, Medicaid and as long as he progresses with PT it will be covered by that insurance. Once PT has been completed he can possibly be readmitted to Hospice if he still qualifies.
My dad started hospice one month ago. In our case, they said that if he wants physical or occupational therapy for whatever reason, it is not covered by hospice or medicare. We can still get it, but would have to pay out of pocket.
I personally can see how PT could make a person more comfortable in their own home while waiting to die, for example, maybe it could help with joint pain or with the ability to do some small tasks like get in/out of bed or onto/out of a chair or even feeding self, brushing one's own hair or teeth, holding a book, or using the TV remote.
But again, my understanding is that neither hospice nor medicare will pay for PT/OT. You can still get it and pay yourself if that is an option.
I'm guessing that it was actually your dads Medicare that paid for the PT and not hospice, as hospice like already said is for end of life care and not to pay for therapies that might improve ones health. I'm also guessing that you didn't understand completely the roll of hospice when you brought them on board for your dad. Perhaps if you're wanting more PT and even rehab for your dad you will have to discontinue the hospice services for now and let him go back to a rehab facility. And I'm a bit confused of the fact that your dad was placed under hospice care and thus deemed to be dying within the next 6 months as to why he or you agreed to have his hip replaced knowing that he is dying. Something doesn't make sense here. But what's done is done, so I guess if you decide to keep him on hospice, you and other family members can go in and work the side where the new hip is and do some in bed exercises with him to keep his hip moving.
Hospice does not determine how much PT someone can receive, Medicare does. Are you sure PT did not determine that PT would not help? Your Dad is on Hospice this means its been determined he has 6 months to live, could be longer. He is terminal, meaning whatever he is suffering from, Cancer, COPD, Kidney failure, ect, he is going to die from. Dad or his representative have determined he will not do any life sustaining procedures or meds. He is ready for nature to take its course. He will be kept comfortable with anxiety and pain meds. This is how Hospice works.
Hospice doesn't offer physical therapy, normally. You'd have to speak to them about the matter. We're just a forum of caregivers to loved ones from around the world.
Another choice, find a Hospice that also has a Home Health company. Leave dad on home health where he can get therapy, a nurse and CNA baths. The same nurse, cna would come whether home health or hospice has been my experience.
He would see his regular doctor via Telemed as needed or a NP or PA would come to him. Then when the therapy is finished he can switch back to hospice if you see a reason to.
Or you could take him off hospice and put him in a rehab since he just had a hip replacement. He can stay in the NH after or go back to his ALF and back on hospice. It’s just paperwork and a ride from one facility to another.
You have to manage the system whenever you get a chance and you have a chance right now IF your dads condition allows and you have the stamina to deal with it.
Make sure your hospice provider of choice will be accepted in the NH for afterwards or back to the ALF.
MY DH aunt went in rehab as private pay as she had no recent hip replacement as a reason to be there. Not all hospices, Rehabs, ALFs or NHs are the same. They are business people, if they know how to get Medicare to pay, they will.
You have to check it out and then determine if dad is up to this, wants to do it, will do it after you arrange, you can have a DNR at the NH like at the ALF or your home or wherever he lives.
About hospice providing therapy.
If you look on Medicare.gov regarding hospice you can find where it states therapy is provided through hospice.
Medicare foots the bill for hospice services but it seems Medicare doesn’t mandate that the hospice companies provide all the services one needs or wants or even that Medicaid states will be provided.
There evidently is no penalty to the hospice company for not providing this service.
It’s a useful benefit but only if you can find a hospice company that will provide the service. That’s the tricky and confusing part.
As a private company they can provide the services they choose. It’s up to you as a consumer to decide if you want to do business with them. My DH aunt went from home health to hospice because I wanted her to have more baths. My hospice comes 7 days a week for her. She qualified but I wanted it for her for different reasons than getting ready to die.
We are all dying. Some just have conditions that often, maybe generally, lead to death within 6 months and that Medicare accepts as making the person eligible for hospice services. People can go on hospice the day of death or what turns out to be years from death.
If Medicare can get you to stop going to the hospital seeking services that aren’t going to cure you, it’s cheaper and perhaps more humane to keep the ill person out of the hospital until they pass. But not everyone wants to lie around for months waiting to die and can benefit from a little therapy. Hospice doesn’t always mean painful cancer. A patient meets some criteria that allows a hospice company to offer their services. They have sales people whose job it is to sign up the ones who would qualify. There is some fraud. Some patients who go on hospice are not deconditioned. They have lived fit lives UNTIL they were put on hospice due to a recent turn of events. They will sometimes live past what the chart indicates. Having a purpose and a challenge is a good thing. good luck and take care of yourself. You are the consumer. Whatever you decide will be okay. Make it work for you.
He was living alone & active when his 40+ year old hip replacement wore out & basically froze up. He personally made the decision to have the surgery, after a great deal of consideration & several discussions with the medical staff.
He has larger than usual bones, and there was a problem with his original hip surgery 40 plus years ago, so they took the precaution of waiting for a ‘special part’ to be delivered. His muscle mass further deteriorated in the hospital for a week before they could do the surgery.
He was discharged to a SNF Rehab, but he has Medicare Advantage instead of regular Medicare, so he was subject to rigorous ‘case management’ by the facility and the Medicare Advantage plan.
After only 12 days in the facility, with limited PT, the insurance case manager told me he ‘had plateaued,’ even though he was making progress in an uphill battle. They were relying on an algorithm, and not his age, health or the extended hospital stay that was necessary. Their complete discharge plan was telling me that I needed to find him a nursing home, and that he will probably live less than six months. His doctor prescribed continued SNF Rehab PT for at least 2 more weeks, but the facility and the insurance told me that the doctor’s opinion was not a consideration. 😳.
We were fortunate to find a hospice agency that is excellent, combined with an assisted living facility. He can at least stand and walk to the restroom with assistance, and he would like to retain that ability for as long as possible. The physical therapy that we pay privately is specifically to retain current functioning.
My Mom had cancer and was on hospice for five months before she passed. She had hospice authorized PT to help her maintain some physical abilities for as long as possible, because it was maintaining her current functioning (not building or recovery work) They viewed it as something that allowed her to retain dignity, which was important to her. I read the Medicare regs and while PT is discussed for maintenance purposes, as is pointed out here, it is not a hospice requirement.
Thanks to you and to all others who took time to share insight and information here in this forum. Warm wishes.
I am sure that the hip replacement was done while he was off Hospice.
Hospice can discharge a patient then re admit after a procedure like this. He can continue PT using his Medicare, Medicaid and as long as he progresses with PT it will be covered by that insurance. Once PT has been completed he can possibly be readmitted to Hospice if he still qualifies.
I personally can see how PT could make a person more comfortable in their own home while waiting to die, for example, maybe it could help with joint pain or with the ability to do some small tasks like get in/out of bed or onto/out of a chair or even feeding self, brushing one's own hair or teeth, holding a book, or using the TV remote.
But again, my understanding is that neither hospice nor medicare will pay for PT/OT. You can still get it and pay yourself if that is an option.
I'm also guessing that you didn't understand completely the roll of hospice when you brought them on board for your dad.
Perhaps if you're wanting more PT and even rehab for your dad you will have to discontinue the hospice services for now and let him go back to a rehab facility.
And I'm a bit confused of the fact that your dad was placed under hospice care and thus deemed to be dying within the next 6 months as to why he or you agreed to have his hip replaced knowing that he is dying. Something doesn't make sense here.
But what's done is done, so I guess if you decide to keep him on hospice, you and other family members can go in and work the side where the new hip is and do some in bed exercises with him to keep his hip moving.
Did he got to rehab after the surgery?
Your profile says you are ill because you are doing too much. Please reconsider the care plan if it's making you ill.
Good luck.