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Old 05-30-2018, 10:50 PM
 
13,389 posts, read 6,370,095 times
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Quote:
Originally Posted by lae60 View Post
Before Hospice starts providing services they want to know who will pay and generally that the person has 6 months or left to live.

So if the person is on Medicare, then they do not need to dr referral if the hospice dr can verify life expectancy. The hospice provider can verify the coverage by the persons SSN.


If the person is not elderly and has regular insurance to pay for the hospice care, then they may need a dr referral under their insurance rules to have service.

And some hospices will provide free services, but they are few and far between.

So families can contact the hospice providers. Or the dr can.

When my aunt was terminal with pancreatic cancer I called difference hospice providers. Her area had many to choose from and since she was elderly Medicare covered whoever she choose.

The hospice providers do provide different services. Some provide service in your house, some in their hospice center, some have RNs more readily available, some transport folks for some treatments like wound care, some bring drs to your home for wound care, some use RNs, NPs, etc.

So, if you want to screen the potential providers, call hospice yourself and if you just want to take whatever provider, or you live in an area with only 1 provider, let the dr office call.

Screening was nice for us. We got to hear how they treated us on the phone, how long we were on hold, how responsive they were, their general attitude, etc. Also, some would do general house cleaning like dusting and vacuuming, mopping floors, cooking meals, shopping, others did not.

Oh, and ALL of the hospice folks can look up the Medicare info and use their Hospice DR to do the paperwork, so if they say that you need a referral for a Medicare patient, then you have a bad hospice that you will likely have to push to do their job....IMO
Good info. I think it is different when you are in the hospital and death is imminent if certain treatments are withdrawn.

My father was simply moved to a room outside ICU but still within the hospital. There is a paperwork transfer in that case between the hospital and hospice.

In my father's case, they told us if they stopped the ICU drug treatments that were regulating his blood pressure he would be gone within an hour(note they didn't tell us this until the day we moved him to hospice). As it turned out, it took more like 16 hours for him to die.

The same thing happened with my BIL, except they left him in the ICU......same room he had been in for 2 weeks and did a paperwork transfer. In that case, they had told us they didn't know how long he would last, but a kind nurse(as far as I am concerned) gave him a heavy push of morphine that resulting in him dying in about 30 minutes.
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Old 05-31-2018, 06:10 AM
 
51,568 posts, read 25,482,936 times
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You are all grieving. Your Mama lost her lifelong companion and you and your sister lost your Dad.

Grief counseling and support would likely help you all say goodby and face the future together.

Part of that will be negotiating how you will share caregiving as your Mama needs more and more help.

Encouraging her to drive at 84 seems unwise. At best, it is only a short term solution.

Uber would be great if it operates in your town. Or find a person who would be glad to earn some money taking your mom on errands.

If your Mom won't stay with your for a few nights, what about going on a short holiday. Maybe a car trip to visit relatives or friends. Stay in a BnB. Live it up.

Or maybe all three of you go on a cruise. I have an aunt who goes on cruises with her daughters every year. They cruised the Panama canal not long ago. They always share room with a balcony. They have a ball.

Whatever you all decide to do from here forward, count your lucky stars that you have a sister, controlling though she may be, who has taken on caring for your Mom.

Count your lucky stars that you had your Dad for as long as you did and you still have your Mom and your Sister. Not everyone is so fortunate.

Lot of bitterness can build up over the years. Let it go, girl. Life is too short.

Keeping a good thought for your and your family.
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Old 05-31-2018, 07:02 AM
 
16,235 posts, read 25,071,093 times
Reputation: 27047
Quote:
Originally Posted by Blondy View Post
Two years ago my parents sold their house and used part of the proceeds to add an in-law suite to my sisters house for themselves.

This was a plan they all had in mind for some time as my mother was always adamant about not going into a nursing home. My father always joked just stick him in the VA home in the nearest big city and he was not in any hurry to implement this move especially when my BIL was still alive as they had an uneasy truce based on lots of bad blood from early in my sister's marriage.

I never thought this was a great idea and told them as much. Fast forward, my BIL died suddenly in 2014 and by 2016 they had all decided on this.

My parents were functioning independently with help with doctors visits and more help whenever they were sick or had emergency room or hospital procedures/stays.

Once they moved to my sister's she took over more and more stuff and they started becoming more dependent as well has having more health issues and generally declining.

My sister is very controlling and she has seemed to become even more controlling after her husband died. Almost as if she can prevent bad things from happening if she controls everything. She's also a perfectionist, overthinks, overanalyzes and frequently overdoes many things. Sometimes these qualities are great, but more and more they have become intolerable to me when dealing with her.

My father went into the hospital in April with acute pancreatitis and subsequently after a month's hospitalization passed away basically from multi organ failure. He was 87 and my mom is now 84.

Right before he passed, my sister and I had a huge blowup because she was bullying my mother to make decisions about my father's care and calling in hospice. That's a whole other story, but in attempting to resolve this and move past it, her answer to my complaints that she was too controlling was that she had to be because I am too passive and basically she inferred that I'm not doing my share. This was also in response to me reminding her I never agreed to the current set up.

No one on the planet would ever use the word passive to describe me. What's more accurate is that she has sensed me pulling back from getting dragged into whatever she is orchestrating because I don't agree it even needs to be done and/or how she's doing it and discussing it with her seems like a waste of time/energy.

My rationale...…..ignore whatever hoopla she is creating and save my energy for real situations.

She started telling me that my mother was lonely and needed distraction and she couldn't be back in the apartment with her 24/7. Well hello...….I don't need anyone to tell me she is grieving, lonely and adjusting to her new normal. She mentioned something about taking her to lunch. When I reminded her that I just took her to lunch two days before and told her I had just spent two hours talking to her on the phone, her response was "that's exhausting for her". So now apparently she plans to tell me how to interact with my mother.

I'm really angry with my sister right now and I feel that most of this criticism is unwarranted and is being trotted out as defense of her behavior which led to our blow up......mainly because there isn't much defense of the things she said and did.

But I don't know......I am having trouble being objective. And, more importantly I want to fix the relationship with my sister if we can. We haven't even begun to get to the really hard parts of caregiving that could be coming up with my mother.

Just looking for some feedback.
Your sister is priceless. Your criticism seems childish, and obviously you had no problem stepping back and letting your sister do it all until she called you on that. you should step up....Who cares if you just took your mom to lunch.....Don't keep score. Take an active role in caring for your Mom....which in your case seems minimal.....just spend time, without resentment.
Love your mom more than you are upset with your sister!
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Old 05-31-2018, 07:52 AM
 
Location: Wonderland
67,656 posts, read 60,168,407 times
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Quote:
Originally Posted by Blondy View Post
Kind of ironic because you are one of the people who was very vocal when I posted this living arrangement two years ago...….basically saying it was a disaster in the making.

I would never have either of my parents living with me unless there was no other option, nor do I think they would be happy living with me for longer than the 3 days we would all remain on our best behavior before falling back into toxic family dynamics. Doesn't mean I wouldn't make sure they got care, just wouldn't be in my house.

The issue with hospice wasn't that we didn't know how it works. The issue was my mother was not at a point where she was ready to make the decision and let my father go. So yes, he did need hospice care and there was no point to some of the extraordinary stuff that was still being done. But, as I'm sure you know things are not always that black and white, not everyone in a family that has input gets to the same place at the same time. Doctors imo are not always straightforward and it can get even more complicated when you are dealing with almost every specialty in the hospital.

The bottom line was it was my mother's decision to make...….not my sister's. And, all she was doing was making it harder for my mother to make the decision. When my sister could not get her to immediately agree she started on about my father suffering which was just false.
I didn't say it was a good idea for the parents to move to the sister's property. But that ship has sailed. I am only dealing with the here and now.
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Old 05-31-2018, 07:55 AM
 
23,717 posts, read 14,826,704 times
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Thanks for all the helpful information about hospice. My mom had congestive heart failure. She had lived with us for 20 years, but preferred the climate of the High Sierra where my brother lived, so she went there. When she got sick, her Dr suggested she would be more comfortable as she died at a lower altitude, so she came to Houston.

She was once hospitalized. When that Dr wanted to do dialysis, she refused so they sent her home to die. A hospice nurse came once a week for 6 months. I had previously tried on one occasion to get hospice but was told they needed a Dr. referral. The company sent by the hospital was not so good. Now I know, I do not have to use what is referred. Thanks y'all.
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Old 05-31-2018, 09:11 AM
 
17,383 posts, read 11,885,796 times
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Quote:
Originally Posted by Blondy View Post
She has been through a lot. I don't think she is still in heavy mourning or depressed. I'm sure she has days, but she doesn't generally act or talk that way when we talk about it.

And for the record, I haven't been calling her a martyr even when she complains. I usually just let her vent, find out if she wants me to do something or suggest solutions if I have one or think she's open to one. She explicitly played the martyr card with me.

Sorry you have so much on your plate. Glad I gave you a place to vent.

Maybe start your own thread. Lot of experienced caregivers here with good advice.
Mars, meet Venus.

Men problem solve. Women discuss.

Yes, to you she's playing the martyr card, but she may just need an ear. Someone to listen to what she is feeling.

Don't suggest solutions. That's not why she's talking to you. She doesn't want a fix. She wants to talk, with no solution necessary.

That may be the root of why she is upset with you. By suggesting solutions, she probably feels you are questioning her judgement and criticizing her decisions.

You're upset with her because all she does is talk, but doesn't take your advice. Because, as a guy, you talk to figure out a plan.
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Old 05-31-2018, 01:19 PM
 
13,389 posts, read 6,370,095 times
Reputation: 10022
Quote:
Originally Posted by ringwise View Post
Mars, meet Venus.

Men problem solve. Women discuss.

Yes, to you she's playing the martyr card, but she may just need an ear. Someone to listen to what she is feeling.

Don't suggest solutions. That's not why she's talking to you. She doesn't want a fix. She wants to talk, with no solution necessary.

That may be the root of why she is upset with you. By suggesting solutions, she probably feels you are questioning her judgement and criticizing her decisions.

You're upset with her because all she does is talk, but doesn't take your advice. Because, as a guy, you talk to figure out a plan.
Well not really. I'm a woman.

And, my sister never met a problem or situation that is not screaming for a solution. Whether its her problem, my problem, your problem or a strangers problem...…….they all need her to solve them.

The problem is that when you operate that way, you're frequently crossing lines and boundaries with other people because you cant solve all things all your way...….and lots of things are just not your business to solve in the first place.

So yeah before anyone says it...…..that's a bit of exaggeration to make a point, but its not far off the mark from how my sister approaches life.
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Old 05-31-2018, 09:47 PM
 
13,389 posts, read 6,370,095 times
Reputation: 10022
Quote:
Originally Posted by GotHereQuickAsICould View Post
You are all grieving. Your Mama lost her lifelong companion and you and your sister lost your Dad.

Grief counseling and support would likely help you all say goodby and face the future together.

Part of that will be negotiating how you will share caregiving as your Mama needs more and more help.

Encouraging her to drive at 84 seems unwise. At best, it is only a short term solution.

Uber would be great if it operates in your town. Or find a person who would be glad to earn some money taking your mom on errands.

If your Mom won't stay with your for a few nights, what about going on a short holiday. Maybe a car trip to visit relatives or friends. Stay in a BnB. Live it up.

Or maybe all three of you go on a cruise. I have an aunt who goes on cruises with her daughters every year. They cruised the Panama canal not long ago. They always share room with a balcony. They have a ball.

Whatever you all decide to do from here forward, count your lucky stars that you have a sister, controlling though she may be, who has taken on caring for your Mom.

Count your lucky stars that you had your Dad for as long as you did and you still have your Mom and your Sister. Not everyone is so fortunate.

Lot of bitterness can build up over the years. Let it go, girl. Life is too short.

Keeping a good thought for your and your family.
Thanks.

I don't really feel I need grief counseling. My dad had a good run. We had our issues...…...some toxic/extreme ones, but I came to terms with that years ago through hours of therapy and thousands of dollars. He did the best he could given where he started from. And, I have known for a while that my father was simply wearing out.

I am not feeling bitter.

My mom does not travel well. On top of all her physical stuff, she has chemical sensitivities. She is afraid of flying. Long road trips are hard on her.

She might be able to be convinced to meet her sisters halfway if I can get my cousins to drive their mothers as well, as I know she wants to see them. But, they aren't in great health either.

We live near the coast and maybe a fall trip there would give her something to look forward to. She wont want to go during the summer.

But, she also has a puppy and that's a problem. So, who knows.

One of her grandchildren has a wedding in NY in the fall. Getting her there if she wants to go will be an ordeal. So that may be all she is up to for now.
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Old 06-01-2018, 09:30 PM
 
13,389 posts, read 6,370,095 times
Reputation: 10022
Quote:
Originally Posted by ceiligrrl View Post
sit down with a good therapist in aging issues.... you, your sister and the therapist.

you meet with that therapist first and make sure you make it clear you love your sister very much and for the life long bond and your mom, you need to fix this

then the therapist sits down with you both

third visit... include mom, a frank discussion on her directives in regard to her health, care and final weeks or months of life must be made sooner than later. draw up a living will as the last step.

Lot's of places are able to facilitate this, geriatric specialists, nursing homes.... even a 'compassionate care giver' department at your local hospital.

tell your sister you've made this appointment for you both because you do love her so much, cherish the bond you've always had.... include a huge bouquet of flowers or gift card to her favorite restaurant for you both, in the gift card state the time, date, place where you will meet, no excuses!!! with a smiley face.... some smiley balloons??? whatever, just be as charming, light hearted and sincere as possible. Make it happen with all your heart and it shall be so. bright bright blessings!!!!
Thanks for the input.

Its taken me a couple of days to respond to this because frankly the idea of sitting in a therapist's office with my sister makes me physically ill right now.

In my view, she has become the walking/talking spitting image of my verbally/emotionally abusive father.

And, since most shrinks would tell you now not to go into therapy with an abusive spouse, I don't see any real difference re going into therapy with an abusive sister.

The other side of that is when she herself raised her own issues with my father I suggested she might benefit from some therapy to deal with them. Her response was "Want to go with me?" At the time, I said, "I've already done that work." Maybe I should call her bluff and go.

Have to think about this longer. I am truly loathe to reopen that can of worms and not really enthused about doing my sisters work for her. I may reconsider if I think it will get her into therapy I am more and more convinced she needs.
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Old 06-01-2018, 11:20 PM
 
13,389 posts, read 6,370,095 times
Reputation: 10022
Quote:
Originally Posted by JanND View Post
Your sister is priceless. Your criticism seems childish, and obviously you had no problem stepping back and letting your sister do it all until she called you on that. you should step up....Who cares if you just took your mom to lunch.....Don't keep score. Take an active role in caring for your Mom....which in your case seems minimal.....just spend time, without resentment.
Love your mom more than you are upset with your sister!
My sister has her good sides.

But, you are basically 100% wrong on what has happened and is ongoing. Perhaps if you read the whole thread you would understand that.

I didn't step back at any point from taking care of my parents. I stepped back from being involved with my sister. The idea that my sister is doing it all is ludicrous. If it weren't for me helping my sister she would be six feet under by now.

I am not keeping score on how many times I've taken them or mom to lunch. My sister told me I should take mom to lunch. I responded I did that. Totally rational. My sister was being over controlling and/or gaslighting.....I dunno. Makes no sense for her to criticize me about something I was already doing.

There is no resentment to spending time with my mother. You made that up.

It has nothing to do with loving my mother more than being upset with my sister. I am doing what my mother needs me to do regardless of what my sister does.

What my sister needs from me and what my mother needs from me are two different things although there will inevitably be some overlap.

My mother knows that she can ask me for whatever she needs.

If my sister needs something more than I am giving, then she needs to speak up like an adult rather than a petulant child. For the record, I have never said no to her when she asked me to do something.
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