By proceeding, I agree that I understand the following disclosures:
I. How We Work in Washington. Based on your preferences, we provide you with information about one or more of our contracted senior living providers ("Participating Communities") and provide your Senior Living Care Information to Participating Communities. The Participating Communities may contact you directly regarding their services. APFM does not endorse or recommend any provider. It is your sole responsibility to select the appropriate care for yourself or your loved one. We work with both you and the Participating Communities in your search. We do not permit our Advisors to have an ownership interest in Participating Communities.
II. How We Are Paid. We do not charge you any fee – we are paid by the Participating Communities. Some Participating Communities pay us a percentage of the first month's standard rate for the rent and care services you select. We invoice these fees after the senior moves in.
III. When We Tour. APFM tours certain Participating Communities in Washington (typically more in metropolitan areas than in rural areas.) During the 12 month period prior to December 31, 2017, we toured 86.2% of Participating Communities with capacity for 20 or more residents.
IV. No Obligation or Commitment. You have no obligation to use or to continue to use our services. Because you pay no fee to us, you will never need to ask for a refund.
V. Complaints. Please contact our Family Feedback Line at (866) 584-7340 or
[email protected] to report any complaint. Consumers have many avenues to address a dispute with any referral service company, including the right to file a complaint with the Attorney General's office at: Consumer Protection Division, 800 5th Avenue, Ste. 2000, Seattle, 98104 or 800-551-4636.
VI. No Waiver of Your Rights. APFM does not (and may not) require or even ask consumers seeking senior housing or care services in Washington State to sign waivers of liability for losses of personal property or injury or to sign waivers of any rights established under law.I agree that: A.I authorize A Place For Mom ("APFM") to collect certain personal and contact detail information, as well as relevant health care information about me or from me about the senior family member or relative I am assisting ("Senior Living Care Information"). B.APFM may provide information to me electronically. My electronic signature on agreements and documents has the same effect as if I signed them in ink. C.APFM may send all communications to me electronically via e-mail or by access to an APFM web site. D.If I want a paper copy, I can print a copy of the Disclosures or download the Disclosures for my records. E.This E-Sign Acknowledgement and Authorization applies to these Disclosures and all future Disclosures related to APFM's services, unless I revoke my authorization. You may revoke this authorization in writing at any time (except where we have already disclosed information before receiving your revocation.) This authorization will expire after one year. F.You consent to APFM's reaching out to you using a phone system than can auto-dial numbers (we miss rotary phones, too!), but this consent is not required to use our service.
*If I am consenting on behalf of someone else, I have the proper authorization to do so. By clicking Get My Results, you agree to our
Privacy Policy. You also consent to receive calls and texts, which may be autodialed, from us and our customer communities. Your consent is not a condition to using our service. Please visit our
Terms of Use. for information about our privacy practices.
Upon further research on my part, I learned that it is a Medicare mandate that all Hospice agencies offer continuous care to their patients when needed. And if they are short handed, they must subcontract out to a Home Health Agency to be able to fulfill their duties.
It is now the 27th of this month and my husband is still hanging on. Hasn't eaten in 23 days and has stopped taking sips of his drink 4 days ago. He layed in excruciating pain from the 5th of Aug. through the 24th, which was horrific to witness, and his Hospice nurses only came out once a day for a half hour to change his pain pump, leaving me to tend to him for the rest of the 23 1/2 hours. Sadly I learned about continuous care too late into the process for my husband and when I emailed the "quality services" person at my husbands Hospice Agency this past Sunday, sharing my concerns, she responded, saying she would look into it and get back with me. Well, she has yet to get back to me, but she did have a nurse here the 24th first thing in the morning and again for the over night hours. However, they brought no more pain relief for my husband,(so I denied their services for future days, as I thought that was the reason they were coming was to relieve his pain) and I was later told by the supervisor that the only way for my husband to receive more heavy drugs was for me to have him taken to their facility, where he could be monitored by the Dr's and nurses there, That however is not an option for us, as my husband always said that he wanted to die at home, so I am honoring his wishes. Thankfully the excruciating pain stopped on the 25th, and now he just has a lot of congestion in his throat, even with the patch and drops hospice has given me to use for him. I'm grateful the pain has stopped as I just want my husband to die in peace.
And just FYI, the types of symptoms that might require continuous care at home (according to the Hospice Patients Alliance) include, severe pain, unrelenting nausea and vomiting, severe bowel impaction/intestinal blockage, acute "terminal restlessness", psychosis, or agitation, bleeding, acute respiratory distress, and many other symptoms, so don't be afraid to insist your loved one gets the services he deserves, if he needs them. And sometimes you have to go further up the chain of command to get things done the way they are supposed to be. And like it says in the article from the Hospice Patient Alliance, "remember, it's the squeaky wheel that gets the grease."
There is a tendency to try to address the small things (02 at this point is a "small thing" in that it is unlikely to help a whole lot but definitely cannot hurt) in order not to have to think about the BIG elephant in the room which is that you all are now losing a beloved elder. Let the decisions in the hands as much as you are able. I would say that the time to scream and yell alla Shirley McLaine in that movie where she was losing her daughter, is when you see pain or struggle. Best advice I can give anyone at the bedside and anyone rendering care is "Please don't let him struggle or be in pain. Please let him be at peace insofar as you are able". They aren't ALWAYS able. Dying involves air hunger, inability to handle secretions, uncomfortable noises and groaning and picking at covers.
When the end is near it will be visible in shallow respirations, in cheyne-stokes breathing which is breathing, full stop for some seconds, breathing again. In changes to the extremities. The feet and lower legs get cool, change color to bluish.
I am so sorry for the pain and grief.
I would kill to have hospice nurses round the clock with my elder. Most of the times this is covered by medicare when ordered in the end days, but hospice can be consulted about that.
My other uncle received continuous care from LPNs for two days before he was stable enough for me to take over the last three days. There was a day nurse and night nurse and each worked a 12 hr shift. This was last December. I had the same day nurse both days, but different night nurses.
They had to adjust his morphine and lorazepam doses numerous times because he was distressed and in pain (what they call "crisis state'). He was fighting to stay alive though, he had told me he wasn't ready to die.
I guess we were lucky then. I felt so much better once the day nurse explained what exactly her job was. I wish more nurses were like her. She pointed out the signs of pain that I had no clue about. She explained what I should expect and everything. Makes me want to look her up on Facebook and thank her.
Some Hospice will have a nurse stay if the patient is in distress, in pain. They also have volunteers that will sit Vigil for someone that might otherwise be alone, or if there is just one other family member or caregiver. BUT due to COVID some Hospice may find it more difficult to get a trained volunteer that will sit with someone. And due to COVID many Hospice are short staffed and the Nurses particularly are spread a bit thin with increasing caseloads.
Administering Morphine or other pain medication is just like administering any other medication. Once a person is taught to properly dose the medication Morphine is typically liquid given under the tongue or along the cheek just inside the mouth. And unless there is a gross miscalculation of the medication it is difficult to overdose someone to the point of killing them (with the amount left by Hospice)
I do not understand the reason she would refuse oxygen. Is it possible she is a smoker or your uncle is a smoker. You can not smoke when oxygen is in use.
And if his oxygen levels are normal then oxygen is not going to really do much.
The goal is to keep him comfortable.
If his daughter can not handle this she could ask to have him brought to the Hospice In Patient Unit. They can monitor him, manage pain and administer medications. This is part of Hospice and it is offered to manage pain, manage symptoms and provide some relief for family. (Hospice can provide Respite as part of what Medicare pays for)
According to the daughter, when she asked about it, the hospice nurse said the oxygen would make no difference in anything. That's why she refused - because it would make no difference. She called with an update right after I posted the question.
I temporarily forgot about COVID, so that part makes sense. My other uncle was vocalizing a lot when they wanted to do continuous care, so that may be the reason why they were so insistent with us. He was having obvious distress and pain requiring both morphine and lorazepam. This uncle now is just mumbling (or making mouth sounds - bbbBBbb) so I don't know what that is. Although I believe I've heard him make those sounds in the past, before all this started.