Would a nursing home be better than hospice care?

Mocha asked...

My question is related to hospice care. My mother is in a personal care program through SOURCE. After a recent hosspital stay for a "TIA", Mom was recommended for a home health aide as she recovered in the personal care home. After two weeks passed, no one showed. I inquired about it and was told that hospice may be the only way to keep her in the personal care home due to her condition, and that hospice could provide the support she needs. Her health background other than the"TIA" due to a blockage: She has Altheimers, moderate to severe, along with Parkinson's disease. Currently, she needs assistance with all daily living tasks. She has had two TIAs within a month and is very weak. Hospice sounds good but I did not like the idea of her not getting medical attention but just being made "comfortable". I suspect that being in this program would stop the physical therapy and speech therapy services she has been getting in the personal care home. I am thinking that a nursing home may be a better option after all.

Expert Answer

Jennifer Serafin, N.P. is a registered nurse and geriatric nurse practitioner at the Jewish Homes for the Aged in San Francisco.

You sound as though you are really torn about the best way to care for your mother. Your question really comes down to Care Home vs. Nursing Home in your mother's case. So, let's try and figure this out. Your mother would be eligible for additional help in the Care Home through hospice, as that would be paid for under Medicare. In the personal care home, it sounds as though she needs more help than she is getting. Placing her on Hospice would allow her to stay where she is, and she would get the extra care she needs. If you move her to a nursing home, she would also get more care, but she would be in a new environment. So:

1) Where do you think that she would be most comfortable? If she has lived in the Care Home for a while, it may be traumatic to move her to a nursing home, especially with her health problems. Sometimes the stress of such a move may cause more problems.

2) Did she ever discuss her health wishes with you? What is your goal for her? Remember, that the goal of Hospice is comfort, but that doesn't mean that people do not get medical care. In fact, they often get more attention in Hospice than anywhere else. It's often assumed that hospice means "we let people die." (Forgive my bluntness.) In truth, this isn't always the case. Hospice means that invasive procedures, tests and hospitalizations will not be done if they don't make the patient comfortable. So, if your mother was on Hospice, she may not be sent to the hospital the next time she has a TIA, as there is nothing that the hospital can really do to help her at this point. She would be kept at the Care Home, and they would see how she does there. She would be given medications and medical treatment at Home instead of the hospital. Keep in mind that the hospital is often a hard place for older people, especially if there isn't much chance to make someone better. I'd just like to add that 've seen people really do well under Hospice, as they often thrive under the additional care. Good luck with your decision.