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djbailey

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Jan 9, 2015
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100
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Lost a loved one
Diagnosis
03/2014
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US
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IA
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Blue Grass
Went to clinic last month and the Doc started pushing hospice. We have discussed this between us and don't see the benefits of going at this point in our trip down ALS's rocky road. At this point we get out 3 to 4 times a week, vital lung capacity is around 36%, but she is never short of breath and only uses bipap at night. We are in the process of trying to get an AAC. I retired to take care of her and I do. We go at our own pace, still use the toilet and shower, PW chair has a head array. So what are the benefits of going to hospice at this point that we don't see? I think we would have to give up our RT, current PT and be under a more structured routine. We Medicare and a supplement that picks up what Medicare does not so insurance coverage is not a huge issue. Are we missing something?
 
Hospices provide services other than being a place to die. In Ontario they can even provide extra hours of in home care, in house physician services, and other services to help you stay in your house for as long as possible. There are lots of reasons to get hospice involved earlier than later.
Vincent
 
Darcey's FVC is at 15%. She now uses the Trilogy both nights and days. And at our last Clinic visit in March, our neuro commented, "At this point in progression, I'd normally recommend and encourage you begin hospice." But he went on to say that because she continues to be active (she goes into work with me each weekday at our Mom & Pop business)... and because she's not showing any signs of depression... and because we're still living each day to its fullest potential... he agreed to hold back that recommendation and leave it to us to suggest when hospice became appropriate.

For us, not being confined to a single location each and every day does much to keep us mentally stimulated and able to climb atop this nasty disease. So for the moment, we'll continue to enjoy that freedom. We understand and recognize that she is more at risk with such low a lung capacity... but for her (and us) the greater risk is giving into this disease. So we left it as "we'll call you, Doc, when we're ready to change things up". And he was quite fine with that.

It will be good to watch this thread develop and to learn more as to what others have experienced with their hospice care and services. Our best to you and yours, djbailey!

Jim & Darcey
 
DJ, I'm with you. You're not missing anything. Kudos on the way you're handling the rocky road.

Vincent, things in Canada are no doubt different, but here most hospice care is delivered at home, the payor structure is different (hospice benefits are paid by traditional Medicare taking precedence over other plans) and the incremental value of bringing new people into the home less certain (full disclosure: we did not do hospice). And when you say, "to help you stay at home as long as possible," many of us don't envision going anywhere else, so that "benefit" may be a bit of a red herring for us. To be perfectly honest, I don't see how a "medical professional" in our home would have made Larry any more comfortable, whereas someone besides his family at his side definitely would have made him less comfortable. From others' posts here, I perceive I am not alone. As with all things ALS, YMMV.
 
Hospice can be a big help if you are having trouble handling everything, or there is pain. If she is not struggling with the care that you provide and you don't feel a need for more help, then you don't have to sign up. Your wife sounds like she is at the point that my husband is at also. I would not consider Hospice right now either. he was on it a few years ago but because he is slow progressing they dropped him. I probably would call them toward the end to help manage the end and keep him comfortable an pain free, but at this time I know they can only offer very little help.
 
Hospice can be a big help if you are having trouble handling everything, or there is pain. If she is not struggling with the care that you provide and you don't feel a need for more help, then you don't have to sign up. Your wife sounds like she is at the point that my husband is at also. I would not consider Hospice right now either. he was on it a few years ago but because he is slow progressing they dropped him. I probably would call them toward the end to help manage the end and keep him comfortable an pain free, but at this time I know they can only offer very little help.

ditto....that pretty much sums hospice up.
 
Thanks all,

Sounds like most of you confirm our thoughts on this. My wife is in no pain other than a sour muscle or two. I take her the massage envy every other week for that and all is well as it can be in her world. We will most likely call them toward the end, but for now we will put hospice on the back burner.

DJ
 
Hello all,
I haven't been on here for ages but I wanted to weigh in on the topic of Hospice. I have quite a different view of Hospice. At my last lung doctor visit back in December - he told me I was at 50% lung capacity (I'm sure it has gotten much worse) and ordered Bi-pap to use at night. At the time I was not sleeping well. I would wake up several times a night (I didn't know why at the time but I have read it is because your body is craving oxygen and wakes you up) and then I couldn't get back to sleep. In the morning I had headaches.

I got the bi-pap and started using it at night. It does help.

After discussions with the ALS Society about my lung situation they suggested getting involved with Hospice sooner rather than later. So, on Feb 12th we had an appointment with Hospice and signed up. I LOVE HOSPICE. I feel VERY secure that they are there when I need them. I can call them any time day or night 24/7. We had a nurse visit early on a Sunday morning because I was having a problem. We figured all we needed right now (I guess it's the basic service) is a nurse to visit once a week. I am on a quite a bit of meds now and she manages them beautifully! If I am low on meds - she orders them and they are delivered to the door. I have gotten equipment thru then, delivered to my door and set up. So far shower chair, hospital bed, oscillating mattress, hoyer lift, bedside comode, bedside table. All I have to do is mention a problem and it is taken care of. The nurse who comes out is VERY knowledgeable about ALS and she is very personable.

Along with the "at home" services is a spiritual adviser, if one chooses to have one, who will come to your home and also a social worker. At first I thought , "What in the world would I need a social worker for?" She is helpful and resourceful. I have had several "family problems" that she has helped us with. She also said she would call my daughters to see if they have questions she could answer if I wanted her to.

I do not want to go into a hospital or Hospice facility when I pass, I want to be at home - they assured me that is what will happen. They can manage it to make sure I am comfortable as well as my family. I'm a big believer in Hospice and the wonderful work they do.

Lynne
 
Lynne lovely to see you here again!

Your hospice experience sounds exactly like the one I had here in Australia. It is called palliative care services here, and it was done through their community service.

By the time we reached the end stage, both Chris and I knew our nurses well and they were wonderful with him. I had the 24/7 phone line for support which was my saving grace as he went into active dying over Easter so there were no services coming in.

It really saddens me more than I can express when I hear that others here are having such poor experiences with a team that is designed to help with the terminally ill. I know it is a local issue as even other CALS I talk to in other parts of Australia have not had the great experience I had with our team here, so I count myself very lucky.

They also had counselling available to all our children.
 
Lynne

Thanks that was very well put, and I am thrilled to hear the positive experiences with hospice. I do believe we will use hospice I just don't know when the best time to bring them. Discussions like this help a lot.

David
 
Lynne
Thanks for your input. It sounds exactly as I would want things for myself. My father in law passed, last July, with Hospice help, at a nursing home. It was a dreadful drawn out ordeal. He had Parkinson's disease, going on 25 years, and he managed pretty well at his own home for most of that time. Towards the end though, because he was incontinent, frequently choking, falling during transfers, and difficult to communicate with- I sold his house, and moved him to a nursing home. He was 87. Things went downhill fast at the nursing home- he fell out of bed, his roommate assaulted him, an aid rushed him during a meal and he aspirated food and developed pneumonia- went to the hospital, got a feeding tube, laid in a hospital bed for 10 days- developed bed sores. By the time he got out of the hospital, and back to the nursing home- he was a shadow of the man he was just a month prior. I felt helpless and angry at the nursing home. I called in hospice, and in a matter of 2 months, he passed.
I didn't know that hospice would have come to his house. It would have been so much better. I feel guilty whenever I think about him, and how I didn't do what was best. My husband left all the decisions up to me. My sister in law was far away, and not helpful. She made things worse by criticizing everything I did, but not physically helping.
Just after my father in law passed, my own father was diagnosed with ALS. He is 78, and has been told by doctors- that he has a "mild case", and if they had to have ALS, they would want what he had- not another form. So it is bad news good news. But since his diagnosis, August 2014, he has lost vital strength and is having trouble breathing. His ALS seemed to start in his trunk- he was all bent over for a good year before the diagnosis. His arms are weakened, and his hands, but it is his weak diaphragm that is most troublesome. He uses BiPap at night, and sometimes during the day. I myself, have a birth defect- pectus excavatum, that causes reduced lung function- so I know what it is like to feel breathless.
Even though my dad looks good- his reduced lung function will be his downfall. I feel do bad for him and my mom. My dad was like a super hero- well into his seventies, and still doing major home repair/renovation work, and sailing his 25' boat. He and my mom drove their huge motor home up and down the east coast frequently. Now he can barely walk, is easily winded, and can no longer do the simplest of home repairs.
I have a feeling he will go down fast with ALS, that he will run out of breath one night. My brothers and sister seem to be in denial- saying that Dad is OK, he has ALS, but he is OK. I was the one who got him the tolling walker, while my siblings insisted I was jumping the gun. He could not move without it just weeks later. Next I insisted on the power chair- my siblings getting angry that I was digging his grave. The chair gives him more freedom- not less. Now I'm going to bring up hospice. We shall see how that goes.
 
Dear Augustmoon, please try to throw off that guilt. Know it's hard because I'm still playing the "what if I had..." Game since my husband died of ALS in November . This I know for sure. We did the best we could with the information we had at the time. ALS (and other diseases like Parkinson's) are so unpredictable, especially for the elderly. If only we had those crystal balls- but since we don't we have to feel good that we did what we could with love and caring. Your father is lucky to have you being proactive. Good luck and hopefully, your siblings will someday thank you.
 
My mom was diagnosed in January. She has been on a bi-pap 24/7 since late March. She is on a feeding tube since mid March. Since she has been on the bi-pap she no longer takes food in. She can't get enough air to eat and breathe at the same time. Last week, I suggested that she consider hospice. Of course, at home. I am not with her 24/7 but am there several hours every day. (In addition to working 2 jobs, trying to be with my hubby, family, friends). My husband thinks she is being selfish about entering hospice. In a way, he is right. She really only likes me to do everything for her. I also feel that she will know when it is time to concede to hospice. Last week, she said she has to be sicker than she is. Well, 1 week has passed. She can no longer make it to the bathroom. I have a commode very close to her couch where she is 24/7. She had a breathing emergency on Thursday and another last night. Ugghh.... She doesn't like the nurse who comes to the house twice a week, so I can't enlist her help. My mom only trusts me...I finally got my aunt on board to go there 3 times a week, but then something comes up with my mom and I have to be there anyway. I think I will bring it up again today....She finally agreed to a Lifeline button, that comes next week.
 
Traci,
Sounds like she has some misconceptions about hospice. Signing on doesn't mean she's at death's door. If you guys are struggling with keeping her breathing at par, there's nothing wrong w/ getting help one way or another. You may have to share w/ her that you are getting burned out and this is not working. As with those who posted positive hospice experiences, the key variable is clearly whether you get something out of it that is more than what you would have otherwise.

If your mom doesn't like her PT nurse, can you switch?

Let me know if you need any help adjusting the BiPAP to meet her changing needs.
 
Thank you. Through her past employment, she had clients in hospice, so she is very aware of the benefits of hospice. It's the added support that I think stresses her out. Training in new people, even though they are professionals, everyone has different ideas. She dislikes it when people assume what she is trying to convey. Meeting new people in general is not an issue, however. We have to get through this and I have to try to push her toward it. Of course, new people coming in would also involve me being there to translate her feelings, needs, wants - goodness.

We have a respiratory therapist that is johnny-on-the-spot whenever we need him. He is totally awesome!

About the nurse, she doesn't want to hurt the nurse's feelings, but it's about her, not the nurse.
 
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