This is part 4 in a 5 part series…

Let’s go back up to a critical point. I had pleaded for this hospice evaluation, but was afraid. We had no reasonable option other than inpatient care. Our family is small and scattered, we had been told it may be weeks before the stroke shut her brain down, we knew how scary her agitation and secretions were.

What if the hospice felt they couldn’t justify to Medicare that her needs required that level of care?

This question planted doubt in my mind in the hours before that dawn: would having a hospice evaluation that confirms the goals but not the disposition plan push up the hospital’s urgency for discharge? Should I cancel this evaluation for that reason? I had the knowledge to highlight the real symptoms I knew she had that would increase the likelihood of her acceptance. I do not argue against the criteria, but I shiver thinking of the many families every day who come close but need to scramble to find outpatient solutions. My mom looked and sounded different within an hour of her arrival at hospice: she was finally comfortable.

I am a palliative care social worker who has made a hundred referrals to hospice, and yet I almost got stuck.

The final part 5, next week…