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If a person is in hospice, with a DNR, I can't think of too many circumstances where calling 911 would even be a consideration. In general, the instruction is, under no circumstances call 911 (and with all the mobile phones these days, make darned sure any friends or family that may be visiting got that memo).
General procedure would be, upon witnessing apparent end of life (and doing at least first level check of vitals), summon hospice nurse to confirm end of life (where that is permitted by local law). That would probably mean at least a 20 - 30 minute wait especially outside core hours. Then the nurse confirms, call undertaker / Neptune Society / etc.
Second, hospice emphasizes caring for the patient at home. Who does the caring? Not the hospice staff! Hospice staff visits every other day, or perhaps daily. Instead, the caring is done by the patients' relatives, or by paid home health aides. Round-the-clock care is required for bedridden patients, and that care costs around $400/day. This is rarely covered by insurance, and is NOT covered by Medicare.
This must be state by state also.
My father had 24-hour hospice home care in 2001. No charge. All equipment, no charge.
It was something the hospital set up, and the insurance wasn't billed either.
My mother was in hospice in 2013 - she didn't need 24 hour care, but the equipment was no charge
My father had 24-hour hospice home care in 2001. No charge. All equipment, no charge.
It was something the hospital set up, and the insurance wasn't billed either.
My mother was in hospice in 2013 - she didn't need 24 hour care, but the equipment was no charge
I believe it may even differ significantly agency to agency. That was the experience of my student. The hospice that wasn't so great was affiliated with a particular hospital. Yet a hospice nurse I know works for an agency does not bill, how they get paid I don't know.
This is from the hospice I will use if needed. I support them with donations.
We offer expert, compassionate care to all, regardless of age, race, religion, sexual orientation, or ability to pay. Services can be provided in the patient's home or in our hospice residence.
Physical Care:
Under the direction of a physician, we use sophisticated methods of pain and symptom control that enable our patients to live as fully and comfortably as possible. Our interdisciplinary team of physicians, nurses, and physical therapists works together to provide optimal and truly individual care.
Our clinical team, highly trained in the hospice tradition, provides around the clock nursing to ensure the best medical care for the unique and individual needs our patients.
Physical therapists help patients to stay limber and give gentle massages, from foot rubs to full body treatments. They may also offer art and music therapy.
Occupational therapists increase our patients' physical independence and help them adjust to new challenges.
Our nutritionist assures appropriate and good nutrition, which contributes to the quality of a good life. Accordingly, we are able to accommodate most specific dietary requirements of our residents.
Spiritual Care:
A team of clergy of all denominations is available to any resident who desires spiritual guidance in the last phase of life.
Medical social workers assist residents and their families in resolving social, emotional, and financial problems and work as a liaison with other community resources.
Volunteers, specially trained to assist hospice patients, provide friendship, companionship, and nurturing care.
Bereavement Services:
We stay connected with families for bereavement care for one year following the death of their loved ones. We provide bereavement support groups for anyone, within or outside of the Hospice community, experiencing a loss. This support is free of charge.
Other Services:
We also provide short-term respite care for patients, so that families/caregivers may have some rest.
Pain and symptom management.
Home Health Aides for personal care.
Nutritional, physical, occupational and speech therapies are incorporated to facilitate care.
Instructional in-patient care is provided for family members and other caregivers.
If a person is in hospice, with a DNR, I can't think of too many circumstances where calling 911 would even be a consideration. In general, the instruction is, under no circumstances call 911 (and with all the mobile phones these days, make darned sure any friends or family that may be visiting got that memo).
General procedure would be, upon witnessing apparent end of life (and doing at least first level check of vitals), summon hospice nurse to confirm end of life (where that is permitted by local law). That would probably mean at least a 20 - 30 minute wait especially outside core hours. Then the nurse confirms, call undertaker / Neptune Society / etc.
If you're in hospice, you're terminal. I don't understand why a DNR isn't automatically part of it. But yes, when my mom died, I called the hospice nurse @4:30 a.m. She came quickly and called the funeral home and removed my mom's meds. With dad, the nurse (24 hour care) was with him struggling with hospice on the phone. She didn't know how to alleviate his struggle so he died in pain but he also fought for many years to live.
Last - 911 would seem contrary to the purpose of hospice. I vaguely remember not being able to use them and my parents were on their last legs. There was no purpose to calling them.
Last - 911 would seem contrary to the purpose of hospice. I vaguely remember not being able to use them and my parents were on their last legs. There was no purpose to calling them.
I believe that if you call 911 the responders are bound to resuscitate you. So if you don't want this, don't call 911. This may vary state to state (?)
I believe that if you call 911 the responders are bound to resuscitate you. So if you don't want this, don't call 911. This may vary state to state (?)
In Texas, there's an out-of-hospital do-not-rescusitate (OOH DNR) form that's entirely separate from advance directives used in hospital and care-giving facilities. However, it's my understanding that 911 responders are within legal rights to disregard it, and will likely do so. When my loved ones were under hospice care, the hospice providers advised us under-the-radar to not call 911.
When my parents were in hospice, we were instructed - by the administrator and in writing - not to call 9-1-1.
We were to call the hospice phone number when they passed away.
The thread title is "Healthcare Directives" not "Hospice" hence my mention of DNR and emergency personnel. Here is a link to an NYT article that mentions that EMT and other emergency personnel (even IN the hospital, after admitting) don't always use or even find the documents.
Moreover, emergency medical personnel operate under standing orders to attempt resuscitation, whatever an advance directive says. (Only a state do-not-resuscitate or Polst form can prevent that.) “You may already be on a breathing machine before you pull into the E.R.,” Dr. Tolle said.
Quote:
Too often, though, an advance directive hardly seems to matter. Stories abound of documents misplaced, stashed in safe deposit boxes, filed in lawyers’ offices. Dr. Aslakson remembers a frantic search to unearth a directive that was eventually found tucked into a Bible.
Frequently, “the directive never gets to the right place, or isn’t referred to when a decision needs to be made,” said David M. English, chairman of the American Bar Association’s Commission on Law and Aging.
And when hope trumps documentation, the patient’s instructions can be overridden. A hospice staffer told me of an older woman whose directive prohibited life-sustaining measures. Nevertheless, her sister assented to feeding tubes, which a physician had encouraged “just to see if it would help.” The woman lived for months with interventions she had expressly rejected.
The article goes on to say that many people rely on standard forms that have ambiguous wording - for instance, what does "terminal" mean, exactly? - or have documents that haven't been updated in so ong that they don't reflect an accurate view of the person's illness or beliefs. Just filling out a document doesn't guarantee your wishes will be honored - file the document in multiple places, with doctors, hospitals and multiple family members. Make sure you are clear about what you want and across a range of conditions.
There is a retired attorney in Boston who is quite the firebrand on this issue. He runs a blog, and has all sorts of activities going. I will see if I can dredge up links later (unless someone beats me to the punch).
You can Google his name for many other links and articles.
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