[DadsGirl]

Bring me up to date on hospice. My impression was that you had to be within days or weeks of certain death to be in hospice care. All that I've read on this thread seems to indicate that hospice can be good or bad. The fact that a non terminal patient like Terri Schiavo was in hospice has always puzzled me. Can you help me out with the differences and what to look for?

[cyn]

Hi, DadsGirl -- good to see you here! You and your family have been in my (our) thoughts and prayers.

http://www.fight4terri.com/

has links to other helpful, informative websites, including:

http://www.hospicepatients.org/ -- hospice "consumer advocate"

Margaret Cottle, MD (I mentioned her above) statement:
http://www.physiciansforlife.ca/pallcarecomments.html

[cyn]

"The fact that a non terminal patient like Terri Schiavo was in hospice has always puzzled me."

It has always perplexed me, too. In a true terminal illness, the patient is expected to die within (say) 6 months. In Terri's case (and we saw the documents), she was falsely listed as having a terminal illness. It is due to a willful blurring and misrepresentation of terminal illness with long term incapacitation or disability, to whatever extent.

good hospice/bad -- does it meet your needs? are they willing to work with you/the family through any difficulties or misunderstandings that might reasonably come up? the needs of the dying individual and loved ones must all be considered.

Dr. Cottle on Focus on the Family radio made the point that the person will die as he has lived, full of the love and support of loved ones.

gtg now. Take care, and may you be blessed with what you need the most right now.

[8mmMauser]

Your impression is what I understood, too. Looks like Cyn has you started on some good site info. Floriduh voter knows a lot about hospices good and bad and you would find more on our earlier Terri Dailies. Some hospice services obviously are very decent and others like so many in Florida are more like moneymaking schemes.

The fact that a non terminal patient like Terri Schiavo was in hospice has always puzzled me

That one puzzled all except maybe Michael. He has the sinister talent of bending just about any law to fit his own ends.

8mm

[BykrBayb]

Bring me up to date on hospice. My impression was that you had to be within days or weeks of certain death to be in hospice care.

Here's an article that addresses that question. It's from The Hospice of the Florida Suncoast. They are the ones that starved and dehydrated Terri Schiavo Schindler to death. They are also hosting a seminar promoting euthanasia this Thursday night in Seminole, FL (a suburb of St. Pete.) Please see my previous post on this thread about that.

New Prognostic Tool Helps Predict 6-Month Mortality in Advanced Dementia Patients

Boston researchers have created and validated a practical risk score for predicting 6-month mortality in nursing home patients with advanced dementia, according to their report in the Journal of the American Medical Association.

“Our risk score offers an improvement over existing prognostic guidelines used in this population because it is based on empiric data, has greater predictive power, and uses standardized, readily available MDS [Minimum Data Set] assessments,” write the investigators, led by Susan L. Mitchell, MD, of the Hebrew Rehabilitation Center for Aged Research and Training Institute and the Harvard Medical School, Boston.

The team conducted a retrospective cohort study of patients with advanced dementia admitted to all Medicare- and Medicaid-certified nursing facilities in New York (derivation cohort, n = 6799) and Michigan (validation cohort, n = 4631) during 1994-1998 and 1998-2000, respectively.

A mortality risk score based on 12 MDS factors associated with 6-month mortality risk identified in the derivation cohort was evaluated in the validation cohort. Six categories of risk of mortality within 6 months were calculated. The authors provide within their report a score sheet for estimating 6-month prognosis and stratifying patients into levels of risk.

When the researchers compared their risk score performance with that of the existing guideline for enrolling patients with a primary diagnosis of dementia into hospice — the cutoff point of 7c (nonambulatory) on the Functional Assessment Staging scale — their risk score was found to demonstrate better discrimination to predict 6-month mortality in these patients.

“Advanced dementia is an incurable, progressive condition for which palliation is often the primary goal of care, regardless of life expectancy,” state the authors. “High quality palliative care should be available to the large proportion of persons with advanced dementia who will be cared for in nursing homes.”

Source: “Estimating Prognosis for Nursing Home Residents with Advanced Dementia,” Journal of the American Medical Association; June 9, 2004; 291(22):2734-2740. Mitchell S, Kiely D, Hamel M, et al; Hebrew Rehabilitation Center for Aged Research and Training Institute; Department of Medicine and Division of Medicine and Primary Care, Beth Israel Deaconess Medical Center; and Division on Aging, Harvard Medical School, Boston.

.

RISK FACTORS

Identified risk factors to be scored for 6-month mortality include:

Activities of daily living score = 28
Male sex
Cancer
Congestive heart failure
Oxygen therapy needed in previous 14 days
Shortness of breath
Less than 25% of food eaten at most meals
Unstable medical condition
Bowel incontinence
Bedfast
Age greater than 83 years
Not awake most of the day

Mitchell, Kiely, Hamel, et al Journal of the American Medical Association

 

Note from BB: These are the factors they use to determine if a patient suffering dementia will live less than 6 months, so they can be admitted to hospice where treatment for their condition is forbidden, and death becomes imminent.

[floriduh voter]

There is rampant Medicaid Fraud in the State of Florida. It was fraudulent for Terri to be sent to Hospice of the Suncoast Pinellas. A doctor had to re-certify every six months that Terri had only six months to live i.e. she was terminally ill. It was all fraudulent.

Terri was at Palm Gardens Nursing Home until Judge Greer signed an order to move her to a facility for terminal patients. Judge Greer's Order was fraudulent too.

It was a crime and unfortunately, Terri's not an isolated case.