My uncle was in hospice and started having more pain. His hospice said the family must ‘revoke’ hospice so he could go to the ER and be admitted. I thought that it was hospice’s job to control his pain and keep him out of hospital.
There are really two issues here.
1. Can you take him to the ER? One of Medicare’s goals for hospice patients is to help them remain at home and die there comfortably with dignity. Therefore, hospice is obligated to do whatever it takes to achieve that, including providing continuous care if necessary.
If the hospice can’t control a symptom, patients can be taken to the ER either to be stabilized and return home, or to be admitted; both are covered by Medicare.
Hospice cannot force a patient to ‘revoke’ and go to the ER. To ‘revoke’ means you choose to stop hospice or want a different one. The hospice can only ‘discharge’ if the patient refuses care, moves away, or is a danger to the hospice staff. Controlling pain must be part of their Plan of Care and if the pain cannot be controlled at home then the hospice is responsible for arranging an admission under hospice.
2. How to control his pain? For mild pain, extended-release acetaminophen [Tylenol Arthritis] combined with non-drug options [such as rubbing a mentholated cream, like Bengay or Biofreeze, into the painful area] is often adequate. If that’s not enough, narcotics such as hydrocodone, oxycodone, morphine or methadone are used, either by mouth or by injection.
Because we are unique individuals, if a drug didn’t help one person, doesn’t mean it won’t work for someone else.
So if he is hurting, call the hospice nurse. Ask what they can do now and if a crisis occurs, so you can be better prepared – which should help you and your grandfather be more comfortable.