I have posted on here many times and answered questions every now and then. Dad passed away Oct 7th 2013 from Liver Cancer . He was in a hospice facility for 11 days until he died. The day before he was admitted he was in the hospital and was talking,eating and very clear headed but his ammonia levels were high and he had been very combative, not eating and wouldn't take his meds for 4 days at his nursing home. ( He was in for a Psych Evaluation.) The hospice worker talked to me about admitting him instead of returning to the nursing home. I agreed to this and arrangements were made. He was transferred later that day and was alert and in good spirits. The next morning he was unresponsive and stayed that way until he passed. They gave him morphine and ativan around the clock. He never got any water but they did cleanse his mouth and moisten it with swabs. It seemed like he could hear me the first few days because I would shake his shoulder and say "dad". His eyes seemed to be moving under his eyelids and his mouth would move slightly. I did ask about them lowering his dosages so he could wake up a little. The nurse said he was getting a very small dosage already. I just wonder if the drugs made him unresponsive and if less was used he could have ate and drank and lived longer. I know it was time for him to go but I'm kinda puzzled about his going from complete alertness and straight into unresponsiveness so quick. The nurses did a Great job. I myself don't know how they do it. They treated dad like he was their baby. So gentle and compassionate. I was just wondering if anyone else had the feeling that death felt a little rushed once their loved one was placed in Hospice.
I learned many years ago how to keep house, plus keep up the lawn and house repairs, this means I have double the burdens to deal with. I am 71 years old with chronic back problems, yet I push on, why because I have too.
Now we are dealing with a parent that needs care 24/7 and the doctor doesn't seem to care, or they don't know the answers. It is very frustrating to ask a question and get a shoulder shrug for an answer.
this was assisted living facility and so she passed alone. I still have issues with her care or lack thereof.
For me, I did not go the hospice route. I read everything I could put my hands on. I asked for every bit of literature I could get from every source, including hospice.
I concluded that giving up the control was not going to happen.
My Dad passed away. He was not in pain. He was not among strangers. He was on his usual mess to help control the many health issues he had, as well as pain meds. I am still convinced that it was right for him.
The question keeps coming back to control. Simply put, it is better to have control than to hand it over and wish you hadn't.
I can agree with that idea, but I'd qualify it further to say that we are handing over control to those who have far more experience with end of life than we do. That's a godsend for most families. I'm thankful my grandmother had hospice care. I made enough mistakes trying to do all the End-of-Life care myself, making bad decisions about forcing food, etc. Having them to give me guidelines was very welcome and made my grandmother's transition easier on her.
I'm very glad that you feel not going with hospice care, in your dad's case, was the right choice. That's all of any of us want - to feel we did what is in the best interest of our Loved One.
I too was told that I could take him out of hospice care anytime, yet..read on..all too often the attempt to remove the loved one from hospice results in investigations by APS for accusations brought by hospice!!
I do not doubt that many people are glad for the hospice care. But, sitting on the edge of having that decision put before many people...they make decisions without real information, and they lose control when they put their loved one in hospice, then spend the rest of their loved ones life fight to get control back because of the standard of care that was not revealed to them up front.
For someone who is in a state of agony from which there is no recovering, I would opt for medical suicide. Perhaps, hospice fills that role...heavy painkillers and removal of lifesaving meds. But, if that is truly the state of affairs...then withdrawal of needed meds and administer of just painkillers and meds to calm is truly cruel. This is a slow motion medical suicide. I would find a way to take loved one to Beliguim. (Perhaps, here in Colorado that option will be available after next week). But, again..that option is not available once you give control to Hospice.
If I had it all to do again..I would have discussed all of this back when my Dad was still mentally able to understand. Back when he signed the DNR, I would have included directive on hospice and/or medical suicide. It only makes sense to be able to add that to all the other medical decision the law allows a person to make up front while they still can. Then, this topic would not even exist.
Here's the thing: different family or people perceive/understand medical comfort care differently.
Example: my father had severe sepsis in Oct 2014. I was caring for him at home and he couldn't swallow and stopped producing urine. I knew he was going to die if I didn't get him into the hospital. I called 911 and the EMTs assessed that he was able to refuse treatment even though he was clearly in serious medical trouble and would die w/o treatment.
There's more to this story - but there's 1 example where the patient doesn't understand what is best for them, even though it should have been OBVIOUS... but it wasn't and there was nothing I could do that night as I called in other family members to come help me prevent my father's death.
My mother drives up, thankfully, and she helps me to convince my father to go into the hospital. We take him in and get him admitted in the evening. I know, at that point, that he is exactly where he needs to be, and I go home and get some rest and am comforted knowing my dad is exactly where he should be. My mother stays at the hospital and hounds the nurses and staff all night, demanding they remove the embedded catheter that was the cause of the sepsis. I KNOW that general overnight staff can't do that. They needed a specialist to assess my father's situation and remove the catheter w/o creating further damage. My mother perceived that they aren't doing their jobs and she is only exhausting herself and getting herself worked up unnecessarily by demanding something that's not in the best interest of my father's care.
In the end, the specialist was called in, and it took about 6 hours after being admitted to remove the embedded cath -- not a time period that put him in any extra danger, and it was necessary to do the best removal.
But that wasn't the end of my mother's accusations of medical mistreatment.
They gave my father on IV fluids and antibiotics and did everything to clear up the sepsis and hydrate him... but they couldn't give him solid foods or even thickened liquids because his ability to swallow was so compromised.
I know that my dad is through the worst, and that these medical pros will figure out a way to get my dad better. They performed lots of scans and had therapists and different things to assess how best to treat him. Meantime, my mother is DEMANDING they feed my father, and my father - instead of resting - is getting caught up in my mother's drama, and now he's crying for food, and asking me to bring him food. I know he'll be ok w/o food for a bit, and that his hunger isn't even close to the biggest medical problem, but my between my "crazy" mom and "crazy" dad... the 2 of them were driving me to tears, and I had to leave the hospital. I couldn't reason with my mother. She knew best, not the trained med pros. They were starving him, she was sure of it.
The good news is my father fully recovered, as I trusted he would, but it took time. And my mother's incorrect interpretation of what the trained staff was doing just made things horrible for me and much harder than need be for my dad.
Death is inevitable and everyone/anyone can have a different opinion about the physical/mental state of a Loved One/patient at any given time. No legislation will change that.
I see so many different experiences voiced in this thread: "hospice killed my Loved One with too many meds." - vs - "Hospice let my Loved One suffer horribly and didn't administer enough pain/sedative meds." - vs - "Thank god there was someone there to help, because this is just an extremely difficult time no matter what, and I didn't know what to do."
There's no legislation that can help, imo, but educating yourself and communicating with staff is good. If you feel that medical staff is unsupportive of your Loved One's needs or family desires, get a 2nd opinion from other impartial medical personnel.
And, if you're interested, you can look up the sad case of Dr. Hootan C. Roozrokh and Ruben Navarro. A doctor with an impeccable record had criminal charges pressed against him (later dropped) because a nurse said "something didn't seem right" about how much morphine Dr. Roozrokh administered to the terminally ill, braindead, and chronically morphine-tolerant Navarro. Navarro's mother, due to a non-scientific allegation leveled against the doc, is now left believing that her long brain dead son was not treated with dignity at the time of his passing. Ridiculous and sad that an under qualified medical person could strip a prodigy doc's career based on allegation.
End of Life is a time that brings out the best and worst in some people. It's usually very stressful, no matter what, and suffering is inevitable for some and so incredibly difficult to witness. I'd much rather my LO or myself is sedated thoroughly and I don't care if it hastens my impending demise.
I had to come back though to make sure that I clarify something important: I'm not implying that anyone's anguish over your Loved One makes you "crazy" in any way. I was only speaking to my experience with both my mother and my father not trusting the decisions of medical staff when those decisions were for the best of the patient. I know your concern and love is very much valid. Please interpret what I wrote in the loving spirit it was intended.
Nurses can't give any medicine not ordered by a doctor. The medication must be given exactly as it is written by the doctor, the milligram strength, the frequency (how often), the route (oral, injectable), etc.
I worked in hospitals 27 out of 37 years as a nurse. I have given Morphine to dying patients but ONLY with a doctor's order and giving it only how it was ordered.
Have those who have had bad experiences with hospice ever witnessed any other people dying? Do you know that dying people can be alert one day and dead the next, even without any medications? Do you know that they can be so agitated, near the end, that they can fall out of bed? Do you know what intractable pain is?
Death is complex and each person enters and goes through their stages in their own way.
But, since so many of you believe that Hospice has taken the life of your loved one, let's lobby to make Hospice illegal. The burden of caring for the complex needs of the dying patient would fall back upon the patients doctor and the family. Then the "killer nurses" would be gone. If you're lucky and can get enough signatures, you might get it on the ballot for the next election.
At the point when you are out of YOUR mind trying to care and comfort your loved one, who might also be out of his/her mind, remember that there was once an institution that tried to make your loved ones comfortable in their last days.
Thus the patient will pass in a day or two, so to the family it feels like Hospice had placed a "rush order" on this patient.... which isn't true. Hospice came in to help with pain management, nothing more.
I wish we could stop this myth/conspiracy that Hospice causes the death of a patient.
Been a while since I've been here. Thank you for your posts and condolences. I'll try to be more sensitive to others, but my experience (though probably different than most here) with my mom, was truthfully based on economics. From hospital to limited hospice, it really was about the money. This has been the point of my posts to other members;when it all boils down to it, it really is about the money.
No biggie in mistaken me for a woman.
As for calling hospice nurses,"murderers" that was not the case with my mom. She was already dead before hospice got involved. The only one involved was hospice doc. The ICU nurses did all monitoring of vitals, giving of any medicines,etc. The NH PCP, even bowed out, and sent his NP when they disconnected life support.
I understand and it would be nice if others here it was patients over profits, when dealing with medical folks. My experience was vastly different, and very true. All told with expenses the hospital alone made over $250,000. The room, alone, was a little over $2100 per day.
I'm glad your father is a rare survivor of sepsis.
I'm sorry about your mom. Maybe, they felt sleeping was best for her so she would not be awake and in pain.
What now? I said I'd try to be more sensitive, to others. If what I post is a help, where's the harm? Isn't that what this site is about?"