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You are in hospice, but are expected to have 6 to 8 weeks to live. You are still ambulatory. You fall, you dislocate your shoulder, or your knee, or have a compound fracture. You are in agony, and know that will will only get worse. You don't want to go to the ER and be discharged from hospice. Do you have any other choices? What would happen if you got to an orthopedist and were refused treatment for the compound fracture because the office doesn't have the faculties for surgery?

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you need to talk to your nurse as to other choices. when you sign up for hospice you agree that the patient will receive comfort care. your social worker or your head nurse from hospice will be able to help you with answers.
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hospice has drugs to give even morphine for cancer patients so if they want to give all that morphine to someone cause they might be going well more power to them ....my mom was the on hospice last yr i worked to get her off of it by giving vitamins to her ..& she got to a point to not want to stay in bed..so she got off hospice ..but under a year later she wants to stay in again ... but she has been doing that for a while she has dementia & always wants to sleep so i got to take her to a doc tomorow might have a nother u.t.i sucks ..by the vitamins is not going to work for breaks of bones ...they do work though google that they have like me or my mom dementia ,so i asked what is good for a person with dementia it will tell you it helps & i gave mine a lot like over 2 pills ..the reason i found is she is not eating to let her live so the vitamins will give her strength tomorow to take her to her doc //..ok everyone is different & problems to so use google & your brain us it it is there for a reason ..so glad we have google ....good luck..over all i did edit a little if it dont make sense sorry  
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Oh MontanaLady so tragic. This should not happen. So sorry :(
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meallen: A bone break or fracture is deemed a medical emergency and that would warrant a trip to the hospital.
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having both my parents on hospice I was told that your hospice would end and you would be responsible for the hospital bill in full if you went to the hospital. call hospice and tell them your situation. when my father got hurt they came in with a home visiting doctor to help out my parents. if you do something on your own you are responsible for the full tab and hospice can no longer care for the patient.
call first and they will tell you what their procedure is ..than decide what you want to do .good luck..
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Hospice will simply let you die and painfully I might add. Go to the E.R.
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Call your hospice first. You will probably have to revoke hospice in writing before going to the er. Medicare can't bill two parties simultaneously. What was explained to me was if, for example, you revoked hospice on day 40 of a 90 day period. You would have to wait 50 more days before going back onto hospice again.
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Thank you all for your answers. If was simply curious, a sort of just in case....
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Here’s my experience. When I asked the assisted living facility to have my dad transported to the ER, they called a non-emergency ambulance and I arrived at the assisted living facility before they did. Hospice advised that if the ambulance takes dad to the hospital AND he ends up being admitted to the hospital, Medicare automatically stops all payment to hospice because they will not pay two (2) different medical agencies for care simultaneously. Then once dad gets back to assisted living we would have to reapply for hospice again. Hospice states they are there to provide a comfortable, relaxing, peaceful environment for your loved one to pass on from this life. Even if the occurrence is not related to the admitting diagnosis for hospice. Fortunately, in our case, dad’s occurrence corrected itself within a few hours but needless to say, I was not happy. I guess it’s a call you have to make based on your loved ones condition. The staff at an assisted living facility is not skilled nursing and while on hospice you are at the mercy of the RN assigned to your parent. For the most part, the hospice RN has been able to handle all of dad’s issues with consult to the hospice MD. However, if your loved one falls and loses consciousness, needs stitches, or breaks a bone you have no choice but to transport them to the ER and hopefully the don’t need to be admitted. But if this happened to my dad, I would have him transported and if he was to be admitted, I would just have to go through the hospice admitting process again. So you really need to develop a good relationship with the RN assigned to your loved one and come up with a suitable plan of action. Hope this helps.
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When I was a hospice social worker, the patient would have been transported to ER, discharged from hospice, treated and readmitted to hospice. You can change to another hospice--ask for help in doing so. There are procedures for changing.
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My husband did not have much pain, but one morning he awoke with agony in his gut. I knew the hospice nurse was coming in that morning so I just waited. She poked around his belly and said that she thought he needed a catheter, went out to her car and brought one in, and set it up. Immediate relief! I was so glad we didn't have to get him out of his bed and take him somewhere! This was just a few days before he died.

If the nurse hadn't been scheduled I would have called the 24-hour hospice line. There are some things that can't be handled at home and do need more than pain relief. But if your loved one is on hospice, that is who you should call first.
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From the comments I'm seeing it appears the best course of action is to contact hospice first. It seems at least with the American healthcare system you can have problems (either or both medical and financial) if it's not on record that you "zigged" before you "zagged".
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My girlfriend had this with her mother.

She was allowed to have her mother treated but had to call Hospice who then took her to the ER.

For my friend, all she had to do was call Hospice whenever her mother fell and they would make the determination. Her mother remained on Hospice more than a year before she finally just had to put her into a NH again. The Hospice she used was not only for terminal patients.
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You call Hospice and they will arrange for hospital care. You are discharged from Hospice but easily re-instated after treatment.
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well hospice should supply any pain medicine even morphine ..& well if this person is really truely going to die i would have hospice to deal with it ..if not 100% sure that you die or not then go to the hospital & get fixed what is broke if this person lives a longer time then what has been damaged will set up & stay permanent ..my mom fell & broke her wrist well a week later they was going to reset it thru surgery & was going to be painful ...so she went in ..to get it done then they give her a pain blocker ..i told them before she was to get it i told them she has dementia & she cannot get like oxycodone & they give her the medicine & she went crazy so they had to cancel the surgery & put her in a behavior health care & never got her wrist fixed so she has to live with it for good ..so put that in the thoughts of this person ..
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When you are on Hospice they become your 911.
In the scenario you give I would call for a lift assist and call Hospice. Once the paramedics determine that the possibility of a broken bone is very likely they will transport you. You should notify Hospice. Think of it just as you would if you were on vacation and you fell, broke a leg and were out of your insurance network. You would notify them of the emergency and most likely they would approve the hospitalization. Think of Hospice as your Primary.
If you fall you can call 911 and ask for a lift assist.
If you are transported to the hospital Hospice is not responsible for the bill. (main reason for this is Hospice is billing your insurance or Medicare for services now the hospital will as well, your insurance or Medicare is not going to pay 2 billers) You can drop Hospice an let your regular insurance take over. If surgery is required that will be through your regular insurance. Hospice does not do re-hab so that would be through your regular insurance. Once you have recovered from the fall you can return to Hospice.
The main goal of Hospice is to provide comfort, relieve pain and to make EOL as comfortable as possible physically, emotionally and spiritually. That does not include surgery or re-hab.
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My mom was on hospice, fell and broke both her upper arms. Hospice wanted to give her morphine and put her to bed.
It took 2 hours to get paperwork signed to get her off hospice so that an ambulance would bring her to the ER.
It was a nightmare.
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This happened to my MIL. We were already unhappy with our hospice team and when MIL fell and was in so much pain, they were no help. We were inexperienced in this sort of thing so we signed her out of hospice, and went to the ER. They helped her immediately and put her on the hospice floor there, so she was signed back in. The hospice care there was far better than what we were getting at home.
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Sue; you make a good point about hospital treatment for an issue that is NOT related to the life-limiting illness. I think I would still call the hospice 24 hour line if a bone got broken at home and needed to be looked at. Medicare might balk at paying for an ambulance and ER visit while on hospice, so I would consult with hospice about the route to take in getting treatment.
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In the hospice that I work for, as long as the treatment in the hospital is for "comfort care" (a broken bone would qualify), you would NOT be discharged from hospice because you are not treating the underlying REASON for hospice care (cancer, etc.).

If you go to the hospital FOR treatment that has a link to your terminal diagnosis, then you will be discharged from hospice for the time you are in the hospital. You can be reinstated the minute you are out of the hospital.
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You call the Hospice 24/7 line, as Mac indicated. You get discharged from hospice temporarily for treatment of an acute injury. 

When that treatment is done, you go back on hospice. Not unusual, and not a big deal.
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I would go to the ER and get evaluated. Then you can make decisions. If you are discharged from hospice, you can requalify easily.
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I would hope so. Perhaps an admission directly to the floor rather than through the ER could be arranged.
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I'm not an American so I'm no expert, but from what I've read on the forum it really isn't such a big deal to be discharged from hospice temporarily, lots of people have gone to hospital to treat an infection or acute illness and then reinstated hospice when they are over the crisis. And I wonder if in a scenario like you have laid out whether treating the fracture wouldn't be considered a quality of life issue and they could have it treated without it causing hospice bow out at all?
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