Now that I have more time to elaborate on my previous post, let me do so.
Yes, the referring MD needs to say that he would not be surprised if your dad passed in 6 months or less. No, he is not God. No one expects him to be, not the insurance, not Medicare. And the doctor is not saying he will be gone in 6 months or less, just that he would not be surprised. See the difference? I had a patient on hospice for 2.5 years with Medicare never blinking an eye about it. She was not receiving life prolonging treatment, she had a terminal diagnosis, she still qualified. Period. (I left that job, so I don't know how much longer she lived, but she was still tending her own garden when I left.)
What hospice can/must provide:
All medications related to the admitting diagnosis. That does not mean they will pay for all meds. Just the ones that pertain to why he is on hospice.
Medical equipment deemed necessary due to the admitting diagnosis. Again, not all medical equipment. But if he needs thing X only because of his diagnosis that got him on hospice, then they are paid to provide that. Every agency has different definitions here, so ask before assuming.
Pastoral care(chaplain). If you have your own pastor that is taking care of those needs, he or she will check in with them to see if the agency needs to provide any additional care or not. You can opt out if you desire.
Social worker. One must be made available. When I worked hospice, they had to see the patient or family once every two weeks, this may have changed.
Home Health Aide. Bathing and personal needs. Change the sheets, bath, dressing, etc. They are not maids, they are aides. They do not clean house. You can, however, rightfully expect them to not leave the bathroom a wreck when they get done, put the towels and sheets in the washer, and clean the patient's immediate area. You can, as mentioned above, possibly work out with them and the agency if you need some short term respite care. Time to go to the grocery store, etc. The agency may instead have volunteers to help with that. ASK.
Nursing care. This could be an LPN/LVN or an RN. If you have aides and LPNs, you will have intermittent "supervisory" visits from an RN. It is in the regulations. The nurse should, at the very least, teach you and the family symptom management and anything else that pertains to his diagnosis. They should also be monitoring for symptoms related to the diagnosis and interacting with the MD on how to best manage them. You must be very, very honest with them about what goes on when they are not there. They can't help if they don't know.
The hospice can also provide up to two weeks respite care where you can go on vacation, and your dad gets placed into a nursing home for the duration.
They can also see your dad if he is in a nursing home to provide an extra layer of care. Even a locked unit nursing home.
Some hospices even have in-patient facilities where people move into to receive hospice care.
What they hospice can't provide: 24/7 care in your home.
I also understand this from a personal perspective. My mom had hospice before she died. Although she had lung cancer, she had some sort of dementia going on. We are not sure if she had brain metastasis or something else going on. She got very difficult to deal with. I worked for a very small agency where I was one of two nurses, so I opted to use a different agency. It was a very wise decision, because I could either be the daughter or the nurse, not both. I needed someone objective dealing with her medical side.
