6 m/c, 2 IVF w/CGH,1 IUI, TI
DX: Anovulatory cycles,Implantation Dysfunction, APA
High TNF, Low NK Cells
Treatment:Humira, IVIG, Baby Aspirin, Lovenox/Arixtra, High dose Folic Acid, LIT Treatment Mexico
1 Miracle born Aug 2013 Premature
1 Miracle born March 2015 39 Weeks
Miracles brought to me by Beer Immunology
I covered on an oncology unit and we worked with a palliative care team when my grandmother was entering hospice. Is there anything specifically you'd like to know?
I'm just going off what you said in the other thread.... Has your grandfather agreed to a DNR? Does he understand that he is not going to get better?
Are you looking for in hospital care?
In the hospital I worked in, we had patients who were palliative care, but not admitted to hospice. There were not too many differences, but things were more invasive than they would have been in n hospice. Hospice patients only had vitals checks once a day vs 3 times a day, bloodwork vs no bloodwork, less medicine ordered for comfort care. Hospice orders gave us immediate access to medicate for pain, nausea, breathing difficulties.
I know you mentioned some urinary difficulties- from my experience, palliative care wouldn't treat most issues, but rather manage either with medication or a catheter-whatever was most appropriate.
I had patients who were going for radiation treatments, but only because it was helping reduce pain from a tumor, not because there was any hope of a cure.
Started TTC# 1 5/10
DX: Unexplained IF
Lots of IUI's and 3 IVFs later we have a daughter!

TTC #2 IVF #4 and an FET brought us DD #2 on St. Patrick's Day!
He has a dnr and realizes he's not going to get better. The issue is that the case manager told us it's illegal once he starts hospice to leave him alone at all and that he has to exclusively stay home. It's not like he can really walk or goes a lot of places but if I give birth he wants to be able to come to the hospital and what if we want to take him out to dinner or if he lives that long to someone's house for passover. Also it's insane to ask us to be sitting at his side 24/7 even when he is sleeping. Also hospice would only come 3x a week for an hour what good is that? Is palliative care where they just basically hand out drugs? He won't be staying in the hospital they are kicking him out today even though he is still dehydrated, because they are worried they will do damage to his heart if they give more fluids.
6 m/c, 2 IVF w/CGH,1 IUI, TI
DX: Anovulatory cycles,Implantation Dysfunction, APA
High TNF, Low NK Cells
Treatment:Humira, IVIG, Baby Aspirin, Lovenox/Arixtra, High dose Folic Acid, LIT Treatment Mexico
1 Miracle born Aug 2013 Premature
1 Miracle born March 2015 39 Weeks
Miracles brought to me by Beer Immunology
Hospice patients are not under house arrest-that's bull. I've also never heard of any requirement that he be attended to 24/7....?? The case worker sounds severely misinformed
Have you been able to contact your local hospice center and speak with someone there? Coming by 3 times a week doesn't sound that unusual. If you need someone everyday, that would be a separate visiting nurse or home health aid, depending on needs.
I'm honestly not sure what would be done at home under palliative care. I assume that his doctor would give prescriptions and send him home....
IME hospice is really wonderful to work with. We had a hospice director in the hospital and a separate director outside the hospital. If whoever you are speaking with in the hospital isn't helpful, try and contact their outside office.
Started TTC# 1 5/10
DX: Unexplained IF
Lots of IUI's and 3 IVFs later we have a daughter!

TTC #2 IVF #4 and an FET brought us DD #2 on St. Patrick's Day!
I wonder if the CM is referring to requirements of home health when discussing house arrest. A patient can lose home health if he/she leaves the home. The thought is if a patient is well enough to go to the store, he/she is well enough to attend PT out of the home (as opposed to having PT in the home). But, I've never a patient having that requirement because he/she is using hospice (look at Make A Wish- some of those children are in hospice and still get to travel). Hospice encourages patients to spend time with loved ones, attend religious services, go to support groups...I'd contact a hospice agency directly and ask about that comment.
As far as the 24/7 monitoring, was the CM trying to scare you about elder abuse/neglect (I only say this because of the illegal comment)? If your grandfather is so ill he cannot be left alone and it's not an option for your family, the CM should be discussing entrance into a skilled nursing facility or exploring a financial plan for 24 hour nursing care of home health aide services. Hospice often will require 24/7 access to support (in the form of an emergency contact and life alert system), but not full time care. My grandmother had a night nurse, but was allowed to be alone until she could not manage her meds and was concerned about falls in the home. At that point, she moved into a SNF and received hospice services there.
Initially, a doctor recommended palliative care for my grandmother. As palliative care is comfort care, not curative, they do have the ability to prescribe medications at doses that would never be recommended for long term management (they aren't worried about addiction or significant side effects). Palliative care is part of hospice, but you can get it without being in hospice. We worked with a palliative care team in the hospital, but it got confusing once she got home until we enrolled my grandmother in full hospice and her hospice nurse and social worker were able to coordinate everything for us.
ETA: I should add that you can call your county's aging services department and get a lot of good info on services available to seniors in the area. They should have resources for personal care (bathing, shaving...) as well as homemaker and transportation services. If you get a good enough worker on the phone, he/she may be able to give you some very thorough answers to these questions as well since he/she would know the local agencies and the policies they use.
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