Wednesday before Thanksgiving.  Serious cold weather arriving perhaps driving temps into single digits. 

Because I have been spending an inordinate amount of time working on my next column, I have a lot of ground to cover to catch up.  I’ll begin where I left off with Clare’s suggestion that I consider signing up for hospice services.

The word “hospice” suggested end of life to me and that is why my initial reaction to Clare’s mentioning it as a possibility for Carol was to want no part of it.  When first I realized how serious Carol’s illness was and at that time someone mentioned hospice for her my mind jumped to final arrangements.  I even got in touch with a neighbor whose husband had recently died suddenly from a heart attack to talk with her about whom I should be talking to.

About final arrangements.

For Carol.

Because of the suggestion of hospice.

My original understanding, perhaps from media sources, was that hospice  was a prelude to summoning the undertaker, a transition period when a dying person was made comfortable.  At the time, hospice was first suggested to me for Carol I heard that to be eligible the individual had to be diagnosed as having some six months to live.

Thus the thought that I should be thinking about arrangement.

My neighbor said she would put me in touch with the funeral director she had worked with.  I said fine.

I didn’t follow up, nor did she get back in touch.  Perhaps she was waiting for me to take the initiative to proceed with preliminary discussions.

It was wise of her to wait on me because I was not ready so to do not only because of my  obvious emotional resistance to the idea, but because despite Carol’s cognitive issues she was quite obviously in good shape physically, a fact routinely confirmed by the medical professionals who on occasion saw her.

That is all background to Clare’s bringing up the idea.  She made it clear, however, that I was not to concern myself about that six month mortality requirement.  I now know that Medicare requires an assessment of eligibility in order to pay for the services hospice provides.  Exactly what the basis for eligibility is remains a mystery to me, but it certainly does not involve a six month prognosis.  Once eligibility is established it is reviewed periodically.

In any event, having understood that my old understanding was wrong, and  because Clare emphasized the services that would be available to us at no cost I agreed to at least explore the idea and Clare said she would set up an evaluation session to determine if Carol was, in fact, eligible.

Hanna, a nurse from Heartland Hospice came the day after I called.  She did the usual check of vitals, talked with Carol, I imagine to get an idea of cognitive functioning, saw that Carol’s right arm was held stiffly to her side and resists having it moved, which makes dressing and undressing a bit of an issue, none of that coming as a surprise to me, of course.

Hanna had me,trace as best I could remember the onset and progress of the disease.  She inquired about what help I was now getting.   She then announced that Carol was eligible for hospice, verified that I wanted to enroll her in it, which I did, as I now understood that hospice is a kind of Medicare funded insurance program.

Got this difficult topic started.  Will continue next time with the nuts and bolts.

Sunday night, the end of the four- day Thanksgiving weekend.  Watched less television tonight because Poldark’s season ended last week.

The most important service hospice offers is that Hanna will visit once a week.    I am  happy to have regular visits from a medical professional.  I checked with Chronic Care, Clare’s practice that has been supervising Carol’s medical condition, to ask about coordination with hospice.   It seems hospice is now in charge but that Chronic Care will check in every three months to verify that Carol remains eligible.

Although I do not now know, nor care particularly to find out what criteria made Carol eligible, I cannot imagine why she would lose that eligibility.

Some miracle improvement perhaps?

One should not try to find rational answers to the rules established by insurance companies, private or governmental.  Just go with them.

Besides Hanna’s regular visits, hospice will also send someone to the house whenever a situation warrants an immediate intervention, and that too is a comfort.

Hanna is a case manager, so all issues and services flow through her.  Medicare, through hospice, pays for Carol’s meds, and Hanna will need to stay on top of keeping me supplied since they are dispensed in a fifteen day supply as opposed to the 90 day supply my employer based insurance provides.  She will also put in orders for  care items, such as hygienic items, or liquid thickener, that I have been buying but will now come to me cost free

Also available from hospice are relief aides.  Since all hospice services are paid for by Medicare, I could save considerable money by replacing my current relief aides with ones from hospice, but  I declined to do so because I am well satisfied with the ones who have been providing that service for me for quite some time, a year or more, and I did not want to go through the process of working with new individuals.

I did contemplate replacing one aide to save that expense, but Hanna informed me  that hospice aides only provide bed baths, which my current aides provide.  They would not give me the block of free time I need.

Whether or not there was any truth that shaped my original foreboding about hospice for Carol,  I am relieved and pleased to see that hospice has turned out to be so supportive without any of the negativity I had associated with it.

I had been handling this situation pretty much on my own.  I now feel that although the disease will continue to do what it does, a support team now has my back and will be there to help me deal with whatever difficulties will inevitably arise.




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