Sept 26 Hospice and Antibiotics

I just wanted to make sure everyone is aware of the direction that we are taking with Dad after our family discussion last Friday night. 

We have decided NOT to move Dad to Hospice at this point in time, but may at a later point.  Tom and I met with Hoffman Hospice on Monday for about three hours.  They asked about Dad's history, diagnosis, wishes, etc.  We asked about care and what that meant under Hospice.  In reaching our decision we felt that we all wanted very similar things for Dad and that was to allow Dad to have the best quality of life for the whatever time he has.  That meant to us no more lab draws or doctor visits and if possible, to take the picc line out and discontinue the antibiotics.  Hoffman Hospice stated they cannot support IV antibiotics as they do not have nurses that can administer them given Dad's schedule and that typically it is not supported.

I called Dr Trang and asked his thoughts on Dad moving to Hospice and he mentioned that he had discussed it with Dr Heidari and was in agreement, if that was the family wishes.  I then asked him about Dad stopping the antibiotics and he said he strongly advises us to not remove Dad from the antibiotics.  That the infection is most likely still present and that it could return within two weeks.  I asked him about pain management and he stated that no one could manage the pain and still allow Dad to have any quality of life, that they would most likely have to put him into an induced coma.  I then mentioned that this seems to counterdict his previous statement of supporting Hospice as Hospice will not provide Dad with antibiotics.  He stated that he would call any medical director at the Hospice of our choice and tell them that this would be required for pain management only.  I asked him if we could move to an oral antibiotic or reduce the frequency and he said we would be rolling the dice again and he was not in favor of changing the course of treatment from his current regiment, that we should stick with what has proven to work.  I thanked him for his time, support and understanding through this process with Dad.  He stated we could call him anytime we need him.

Also we talked to the Hoffman Hospice RN and asked for her assessment of Dad and she felt Dad might have about three weeks.  Later that evening I called Dr Memum and asked him his thoughts about moving Dad to Hospice and he said it was appropriate.  I then stated that Dad had children that were out of state and could he tell me if he felt that Dad had days, weeks or months.  He stated in his opinion that Dad probably has about two months, but that could change especially if his kidney fails.

So on Tuesday we informed Dad's nurse and Dr Memum (Rosewood Doctor) that we do not want any more blood draws or lab work, but that we will continue on the antibiotics.  Dr Memum mentioned that we might as well not move to Hospice as we would have to move to private pay for everything and if we decide later on we can always bring in Hospice.  Hoffman Hospice told us that they could have Dad on Hospice services with about 4 hours notice, given it is M-F 8 to 5 kind of timeframe and that they could do it outside those hours, it will just take a little longer.

So our official stance is that Dad is continuing his current course of treatments but that he does not wish to have the lab and blood draws anymore.  We do not know how Medicare will respond, but we will cross that bridge when we come to it.

Please let me know if anyone has any concerns or disagrees with this course of action.