Understanding the Hospital's Reluctance to Recommend Hospice for My Mom
A 76-year-old woman is currently nearing the end of her life, yet the medical facility is hesitant to suggest hospice care. I'd like clarification on this situation. Medical Background: She has a history that includes a hemorrhagic stroke earlier this year, epilepsy resulting from the stroke, chronic obstructive pulmonary disease (COPD) complicated by emphysema, ongoing right basilar lung opacity issues, and a small right pleural effusion. Additionally, she has a MRSA infection in her nostrils, acute cerebrovascular disease, hypothyroidism, hypertension, a notably low BMI of 14, and dementia. Medications: Her prescriptions currently include levetiracetam, atorvastatin, levothyroxine, albuterol, ipratropium, and trazodone. Furthermore, she is still smoking. Since July 31st, my mother has faced several hospital stays, totaling just five days spent at home and entering her fourth hospital admission now. During my latest conversation with the care coordinator, I mentioned that we have been contemplating hospice care, which she has expressed willingness to consider when she feels more alert. However, the attending physician has refused to provide a referral. At this point, she is unable to walk, has great difficulty breathing, and is entirely incontinent. Although she continues to smoke, I regard this as her choice, especially given her current state; it seems to bring her some momentary joy in her bleak circumstances. What baffles me is the hospital's refusal to facilitate the hospice referral, especially in light of her recurrent hospitalizations. I seek insight into why this decision is being made.
Answers (1)
8/18/2025, 5:21:10 PM
OpenHealth AI
It sounds like you're going through a deeply challenging and emotional time with your mother’s health. Understanding why the hospital is hesitant to recommend hospice care can be complex, especially given her multiple health issues, but let's break it down.
Main Points:
- Multiple Health Complications: Your mother's various medical conditions can make her situation complicated for hospice care eligibility.
- Physician's Assessment: Physicians often assess patient prognosis based on clinical criteria, which can affect their decisions regarding hospice referrals.
- Patient Autonomy: Your mother’s ability to express her wishes plays a significant role in end-of-life care decisions.
Explanation:
Hospice care is generally considered for patients with a life expectancy of six months or less, alongside an overall decline in health. The attending physician is likely assessing her current health status, considering factors such as her chronic conditions (COPD, dementia), recent hospitalizations, and overall prognosis. Given her complexity, the physician may feel uncertain whether she fully meets the criteria for hospice care based on their clinical judgment.
Another important aspect is your mother's expressed willingness to consider hospice when she feels more alert. This consideration indicates her ability to engage in the decision-making process, which monthly involves assessing her current state and comfort levels.
Next Steps:
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Discuss with the Care Team: Continue conversations with her care coordinator and express your concerns. Ask for clarification on the criteria they are using to determine hospice eligibility.
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Request a Care Meeting: Ask for a family meeting with the attending physician and care team to candidly discuss her prognosis and options. This can be an opportunity to advocate for her wish to consider hospice care.
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Explore Palliative Care: If hospice care isn’t yet an option, inquire about palliative care, which focuses on providing relief from symptoms and improving quality of life—this could align with her current needs.
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Consider a Second Opinion: If the situation remains unclear, and if you feel it’s necessary, consider seeking a second opinion from another physician who specializes in geriatrics or palliative care.
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Ensure Comfort and Support: Continue to focus on her comfort, addressing her emotional and physical needs as much as possible during this time.
This is a sensitive journey, and prioritizing your mother's comfort and wishes is crucial. Please feel free to reach out for any further support or questions.
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