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For lack of a better analogy, my dad is like an elderly pet, requires assistance with some aspects of daily living, (meals, some mobility) takes a couple of maintenance meds (thyroid, heart), but still enjoys life. He doesn't need oxygen, or a hospital bed, help with toileting, special diet, etc.
I don't understand what service Hospice would provide, other than being on-call for pronouncing his death.
Please enlighten me.
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worriedinCali Feb 2020
You don’t have to use any of the services they provide. You can have the nurse come check his vitals weekly or bi weekly and leave it at that. The benefit would be not having to deal with an emergency response circus and the coroners office should he pass at home.
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Ricky something else to think about. Does your city or county have crime watch or neighborhood watch Facebook groups? Or Facebook pages run by people who post police, fire and ambulance scanner traffic? Consider this......social media has turned us in to nosy neighbors. People see an ambulance at the neighbors house and go to their local Facebook group or page to find out what is going on. I personally find it intrusive. If I or my family member has a medical emergency, it is nobody’s business what happened. So consider this......should your dad pass at home without being on hospice, you will have the police, fire dept and paramedics at your house. Do you want the neighborhood or nosy passerby’s who want to know what happened, posting a picture of all the action on Facebook? Because that happens where I live frequently. And I personally would not be happy if that happened to me or my family. Would you want to open Facebook and see that reminder?

If your dad goes on hospice, which would be palliative care at this point, no one will know if and when he passes. The mortuary isn’t going to roll up to the house with a hearse. When my MIL passed, they came in a minivan that was backed in to the garage. Totally discreet and dignified.
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anonymous951699 Feb 2020
You make a valid point about that kind of unsavory voyeuristic behavior. It is certainly the darker side of human nature to peep and post. I'm not on FB or any other social media sites, (other than this one).
While I am never stoked to have the cavalry come to my house, I live next door to a long term care facility and that side show occurs about once a week.
I appreciate all the great information and insights I've received so far, and think that in the foreseeable future, having Hospice come a couple times a week to just take vitals, is not a bad idea.
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Ricky, I think you said several times that you don't see the advantage of having hospice on board, but the big advantage is that there won't be any investigation of his death at home if he's a patient on hospice, even if hospice is only providing palliative (comfort, not treatment) care services.

It was great for mthr to have hospice to call first when she fell instead of rushing to the ER to see if she had a brain bleed. If we made the decision to keep her home on our own, and she had the brain bleed and died in her bed, then there would have been an examination, head trauma would have been noticed, an autopsy performed, and then an investigation into why she was not taken in (negligence on caregivers) or was there elder abuse (active abuse). Neither of those are what you want to face when you are grieving a loved one and want to get everything tied up.

Hospices can provide palliative care as well which has a cost - it is my understanding that Medicare covers hospice 100% but not palliative care. With hospice someone has to be at home with the patient at all times, but with palliative care, the rule differ.
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Pasa18 Feb 2020
Good points to think about. My mother is on hospice but has improved over the past two months and I was thinking of revoking hospice services or waiting until the next evaluation. I will call medicare to find out coverage for palliative care. I think in CA it is covered under Plan B, so there will be co-pays for services.
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Ricky, they don't provide medical services per see, they offer support and oversight of the decline. So you can be assured that he will not get any pain meds daily, but you will have them in the refrigerator for the time he may need them.

He could be eligible for hospice or not, Medicare covers this service 100%. So he would not have any fees.

Can I recommend interviewing several hospice providers and find one that fits your needs and has a business model that you like, they are not all created equal. If you hire one and you decide that they are not a good fit, you can fire them and bring a different one in.

They helped all of us when my 52 year old sister was dying of cancer and refused any treatment. They helped us understand what was going on, what would most likely happen next and they treated her painful bedsores so she didn't suffer from those. She couldn't move because her back was broken from the cancer eating her spine away. I have been told that they are a sign of impending death and that they are painful when untreated.

I hope you find the perfect solution to your situation.
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anonymous951699 Feb 2020
Thanks, I've been getting a lot of good advice. I suspect quite a number of people had the same question, and they're now helped as well!
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I had a coworker whose mother had advanced alzheimer's and was living at home with her husband. She had a catastrophic stroke or heart attack and "died" at home, but because nothing was in place EMS revived her on the way to the hospital and she lingered another couple of weeks. That spurred me to make sure I had all the documents in place, with mom's DNR prominently displayed on the fridge door.
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Isthisrealyreal Feb 2020
Using humans as guinea pigs, that situation was so wrong on so many levels. That poor family and woman.
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My father died in his bed in California while not on hospice, and everything happened exactly as Cali says. Police, fire dept., and ambulance all came; ambulance whisked my dad off to the closest ER; and my mom had to answer the questions from the police. My dad was pronounced at the hospital. Had my dad been on hospice, the whole experience would have been less traumatic for my mom.
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anonymous951699 Feb 2020
Aw crap. That sounds terrible. I've had enough freakin' stress, I don't need that.
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I am in California and you have to call 911 if he is not on hospice. They will send the police, fire dept and ambulance. You cannot call the family doctor and then the morgue. So I would suggest putting him on hospice that way if he gets his wish, all you have to do is call hospice and once the nurse comes out to pronounce the death, you can have the mortuary come out.
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anonymous951699 Feb 2020
Thanks for your response. Given that my dad is just super old, but doesn't require much in the way of medical attention, I'm unclear as to what Hospice would do. My last experience with paid Hospice services was so-so. My mom needed lots of support, and they did provide it, for a price and with multiple phone calls.
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I would get him set up with hospice. He can have his wish of being home and dying in bed. They don't force you into a facility.

If you die in my state, not under hospice or a physician's care, it is an unattended death and there is an investigation. That can be simple, but they are always looking to determine if foul play was involved, so it could be unpleasant to go through at the same time as losing your dad.

Hospice will keep him comfortable and pain free, they can help bathe him, change his bedding and it is a phone call when he passes.

You need to be considered in this situation as well, hopefully you can convince him that you need him to be on hospice.
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anonymous951699 Feb 2020
Thanks. My dad doesn't need require any special medical care. He's old and rickety, with short term memory issues, but not in pain. I'm not sure what service Hospice could provide.
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When my mom was seriously ill before she went in to hospice, I asked her doctor what to do if she died at home and was told to call 911. Once you explain the situation to the dispatch operator they will decide which first responders to send and the police if needed. Since your dad does have a DNR make sure you have that ready to show the emergency team or they are obligated to begin life saving treatment (at the ER as well).

I'm in PA so maybe CA is different; now is a good time for you to call your dad's doctor and ask them exactly what you should do.
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worriedinCali Feb 2020
In California, the police will be sent if he’s not on hospice. It’s not up the dispatchers to decide who to send.
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While not in California (Maryland), my mom's doctor said you don't have to call 911. Call the family doctor - making sure he has a copy of the DNR and MOLST form in chart - and then you can just call the funeral home. Ask the family doctor what to do in that case, as I'm sure all states are different.
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anonymous951699 Feb 2020
Thanks.
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I don't know about California but here it would be investigated by police as an unexplained death in the home, avoiding that is one of the benefits of being enrolled in Hospice. Is there a reason your father isn't with a Hospice provider? You don't have to accept their full services, just having the paperwork and a nurse on call if needed would be valuable for you.
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anonymous951699 Feb 2020
Thanks for your response. He doesn't need to be on Hospice. He's not in pain, just old and winding down.
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