Dr. Jigar Virenbhai Joshi, MD

Palliative care consult is available for people suffering with any disease that is considered terminal. Dementia is also a terminal disease. Depending upon the progression and stage of dementia, your mother may qualify for hospice or palliative care. As a concept, both are the same. However, provision of services is more than likely going to be significantly different. With hospice, usually being more comprehensive with multiple team members visiting multiple times a week vs. palliative care could be 1 provider visitation every few weeks to months. I would recommend reaching out to her primary care physician to get further guidance and get a referral to palliative care if available. If palliative care is not available, request a hospice referral as they may be able to guide you with available resources.
Hope this is helpful.

Being on life support is not the same as hospice. Hospice is a service for people who are suffering from terminal health conditions with a life expectancy of fewer than 6 months if the disease process runs its usual course. It is unfortunate that your mother's friend has to go through so much at the age of 50.

In case family believes that this is not the quality of life that patient would want to live. Per medical teams assessment if there is no real scope of significant improvement. Then it may be a reasonable options to consider to forgo life sustaining treatment so as to not to further prolong her suffering. At that time hospice could be a great service to consider.

Palliative care is focused around using the principles of medical science to provide comfort care to patients/families with the help of an interdisciplinary team. Depending upon the prognosis, he may be offered palliative care or hospice services. Usually, as a disease progresses, the help required increases. Hospice services may be a reasonable option to consider when doctors believe life expectancy is less than 6 months if the disease runs its usual course. Hospice services don't stop at the death of the patient, and a hospice bereavement team can continue to support the family who is grieving their losses. Bereavement team can follow up for up to 13 months after the death of the patient based on the need.

If I understand your question correctly, you are considering palliative sedation for your mother. Palliative sedation is usually the ultimate measure in case all other modalities for symptom management were not able to effectively control the symptoms. Please discuss your concerns with the provider. There are many lines of pain medications and procedures (very selective patients) available out there.
Hope this helps.

Per CMS (Centers for Medicare & Medicaid Services)
"An individual is considered to be terminally ill if the medical prognosis is that the individual’s life expectancy is 6 months or less if the illness
runs its normal course."
"Predicting of life expectancy is not always exact. The fact that a beneficiary lives longer than expected in itself is not cause to terminate benefits."

Other insurances usually follow CMS guidelines for determining eligibility for hospice.

There is no finite limitation to duration of hospice services. In the beginning 2 physicians and after enrolling to hospice 1 physician needs to certify for the eligibility of hospice services on regular bases. There are guidelines and clinical criteria to determine eligibility. They are reviewed in relation to patients health condition/decline with help of interdisciplinary team. If patient continues to meet the criteria they would continue to receive hospice services. If patient's health does better than originally anticipated they are discharged (or graduated) out of hospice.

hope this is helpful. in case of further questions please feel free to ask.

You may want to ask and look for available reviews about the organizations you are planning to work with. Additionally you may also want to know what complexity of a patient's that a particular organization is working with. As at times the currently available satisfaction scores may not be able to appropriately judge the quality of care. if some organization chooses to work with high complexity patient care measures are more than likely to receive poor scores compared to organizations taking on simpler complexity of patients.

Again, word of mouth can be useful more than certain online surveys. So please ask around within your family or friends or your physician that you trust.

Staff to patient ratio is definitely an important factor. At the same time it may also be important to know how many disciplines would be involved on a regular bases.

Per CMS (Centers for Medicare & Medicaid Services)
"An individual is considered to be terminally ill if the medical prognosis is that the individual’s life expectancy is 6 months or less if the illness
runs its normal course."
"Predicting of life expectancy is not always exact. The fact that a beneficiary lives longer than expected in itself is not cause to terminate benefits."

other insurances usually follow CMS guidelines for determining eligibility for hospice.

There is no finite limitation to duration of hospice services. In the beginning 2 physicians and after enrolling to hospice 1 physician needs to certify for the eligibility of hospice services on regular bases. There are guidelines and clinical criteria to determine eligibility. They are reviewed in relation to patients health condition/decline with help of interdisciplinary team. If patient continues to meet the criteria they would continue to receive hospice services. If patient's health does better than originally anticipated they are discharged (or graduated) out of hospice.

it may be a good idea to request for palliative care consult and have family meeting.

Anesthesia is usually associated with procedures or surgeries.

It depends upon how the general anesthesia was achieved. For further details, you may want to consult anesthesiologist.

Palliative care is designed around managing your symptoms. Hospice care is a small subset of palliative care that is provided when life expectancy is about 6 months or less if the disease runs its usual course. You may need to know:

1. The stage your disease process
2. How this disease process is affecting your day to day physical functioning
3. How this disease process is affecting your cognitive functioning
4. How often you are utilizing ED and hospital visits in relation to the disease process that you are suffering in last few months or a year.
5. How effective is current management plan.
6. What resources are available where you live

What is the goal of your health care planning? With an understanding that the disease process may not be curable. For further details, please reach out to your primary care to receive more resources.
Hope this is helpful.

Usually the effects would start wearing off within a couple of hours. Depending upon the age group and individual metabolism, could have significant variations.

Any disease process that is not curable can be considered terminal. Palliative care is specialty designed to achieve patient comfort. You may want to reach out to her primary physician to see if she can receive a consult for palliative care or if she qualifies for hospice.

These are very common concerns that we hear from our patients and families. If you worried about her safety while her being alone in the house, it may be a reasonable option to have someone stay with her. For further details, you may want to reach out to her primary care to obtain what additional resources are available where she lives.

The goal of palliative care is to manage symptoms. In other words, palliative care's goal is to make patients feel comfortable. Hospice on the other hand is a subset of palliative care where life expectancy is less than 6 months if the disease runs its usual course.

I believe you meant Palliative Sedation.

Palliative sedation is usually the ultimate measure in case all other available modality for symptom management could not effectively control the symptoms.
please discuss your concerns with your provider. there are many lines of pain medications and procedures (in very selective patients) available.

If you think she is really sick, that she is spending a significant part of her time in hospitals and she wants to be comfortable in the company of loved ones at home, then you may want to consider hospice care. Hospice usually would be able to provide significantly more services than home health.

Hospice care is primarily designed and intended to be provided in home set up.

What will help depends upon what we are trying to achieve. This is very limited information to understand complete medical condition. Assuming your grandfather has terminal condition. If you and family believe that your grandfather would want to focus on being comfortable, then palliative services and maybe hospice services would be a reasonable consideration. Palliative care doctors at the palliative care unit may be a good resource for further information.

Yes, infections can be treated with antibiotics in hospice. Like any treatments, the goal needs to be to achieve comfort or reduce the suffering. There can be timed trial of antibiotics for reasonable improvement in the symptoms. If we see the improvement in the symptoms, then the goal is achieved. If not, then would have to use additional measures to achieve comfort and may have to forego antibiotic treatment as proven ineffective.

Hospice is very extensive and comprehensive service. it has 4 levels of care provided with an interdisciplinary team. these services can be provided at home or nursing home for most part. if needed and available hospice in patient unit can be utilized to achieve comfort for the patient/caregivers.
i would reach out to your grandfather's primary physician to obtain referral to hospice provider for information session.