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  • Writer's pictureLickety Glitz

Hospice 101 (and a half)

Updated: Dec 9, 2020

Poor Mom. Nobody picks her for anything anymore.

Well, we didn't make the cut. Our hospice Admissions Evaluation Meeting has come and gone, and it was determined that Mom is not yet ready for hospice. And I don't know how I feel about that just yet.

On the one hand, when Dr. Monica made the referral I felt... relief. "Really? We're that close to end-of-life? By this time next year I may be a free agent?"

Then I felt panic.

"Shite! When I'm no longer focused on Mom, then I gotta focus on me." (Mom's dementia has been an excellent excuse for not getting my own life together - an unintended benefit.) "What am I gonna do? Where am I gonna live? How am I gonna survive?"

And after all that THEN... I felt sadness. Yeah, not my finest hour as a daughter.

On the day of the Admissions Evaluation Meeting that sadness deepened to true grief; Mom is going to die - soon. My pragmatic, matter-of-fact efficiency failed me as the realization of what this meeting was for - to determine the nearness of Mom's departure from this world, from me - swept me up in a swirl of sorrow.

So later that evening, when Nurse Apple declared Mom not-ready-for-primetime hospice, I was shocked when my emotions flipped a 180. Suddenly my competitive side rushed to the forefront, ready to protect Mom from this rejection. In my head I was screaming, "Hey lady, my mom can be just as ready for death as anyone else's mom! She not good enough for your hospice? Well, fine then! I'll just take Mom and go home!"

Now there's several things wrong with this reaction. Firstly, we were at home, so grabbing Mom and storming out would have looked pretty foolish. Second, hospice is not a school-yard game of dodge-ball, not getting picked is not a bad thing!

And lastly, when my emotions are wildly ricocheting around an event, as mine clearly were/still are, it's best to keep my mouth shut and process later vs. voicing my immediate thoughts and looking like an unhinged nincompoop.

(Although I am rather proud of my past performances of unhinged nincompoopery. They've been quite stunning, and have brought the house down, i.e. killed the party, at many a low-brow establishment.)

So, instead of pointless theatrics from me, Nurse Apple offered a helpful list of things to look for that would indicate Mom is closer to end-of-life, and would qualify for hospice.

  • Decrease in mobility (Mom did spend all of her time while Nurse Apple was with us ping-ponging around the house at good clip.)

  • Decrease in balance

  • Decrease in appetite/eating

  • Increase in sleeping

  • Sudden weight loss

  • Difficulty swallowing

  • Any medical emergency (a fall, fainting, flu, etc.)

Nurse Apple explained that Mom was right on the cusp of acceptance, but not quite there yet. When any of the above occur we are to call hospice immediately - she felt Mom would definitely pass Medicare admissions muster then.

So, there you have it. I still can't decide whether I'm delighted by the rejection, or disappointed. Many of the hospice services would be nice to take advantage of now, but the upside is I've delayed the heartache of losing Mom sooner rather than later.

I guess we'll just keep picking her for Team Stumped Town Dementia, and be thankful that (for now) we've kicked that final losing-season can right on down the road.

P.S. Read Hospice 101 for the beginning of our hospice saga. To be continued...

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Janelle Martin
Janelle Martin
Sep 07, 2019

Seems to be different in Australia, we have Palliative Care which is supposed to be for anyone with a life limiting diagnosis and available in residential care facilities. In reality the lack of resources means it is generally limited to those deemed "actively dying" or end of life. There is a specialised hospice facility in our city with limited beds run by the hospital and I think some people do get some help at home. Yes we've had the medication issues too and currently a bit reverse of the usual complaint it seems she is NOT getting PRN for agitation because they don't give it when she's calm and as soon as anger flares she refuses. We've tried lots o…


Lickety Glitz
Lickety Glitz
Sep 06, 2019

I was not aware of that book, Janelle. Thanks for the recommendation.

We got frustrated with Mom's memory care for a lot of the same lack of communication. When she started refusal pills no one thought to let me know, even through I was there everyday! And made it clear I would drive the 10 minutes to the MC to get her pills in her if need be. It was a lot of that ball-dropping that finally had us pull her out. Def not the right decision for everyone, but it was for us.

Is your mom on hospice now?


Janelle Martin
Janelle Martin
Sep 06, 2019

Handy list of indicators. Have you seen the Barbara Karnes booklets? Still plenty of people seem to die unexpectedly or accidentally so I guess we never really know. For what it's worth my Mum has been bedridden since breaking her ankle, and was losing mobility when it happened. However successful surgery meant it should be weightbearing but she can't stand since. Her balance was already precarious. That was April 2018. She's still eating well despite the residential care facility losing the top and bottom partial dentures and not even noticing. I know she is angry and aggressive but they could have at least documented the regular refusal to allow staff to do oral hygiene and let me know…

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