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.
Why did you allow this to happen with your knowledge of medication?
As you know nurses are only allowed to administer what is prescribed it should have been possible for you to question the Dr doing the ordering
I realize that you are hurting and angry at the way your mother died and feel the blame should be laid somewhere.
Hospice can not admit a patient without a terminal diagnosis.
You certainly can request a private autopsy. Not usual in hospice but I personally have arranged one for a family which of course they had to pay for.
I absolutely agree that unessassary high levels of sedation are unacceptable but as you know what may be reasonable for someone younger may be too much for the very elderly
When your initial grief has subsided I hope you will be able to think about this more clearly and if you still feel it to be a wrongful death make sure those responsible are properly identified.
I repeat what I have said many times before "Hospice nurses are not licensed to kill" Again please accept my sincere condolences
That said, I had a patient with brain injury who was "euthanized" in this way against what we all wanted as rehab people, and I know it is very hard not to come across as too pushy and demanding with your fellow professionals, and yet you end up regretting not being more forceful when you turn out to have been right about something.
My husband is also an MD and saved my life several times when I was close to death by questioning the treatment I was or not getting in a hospital A good example was being asked to sign a DNR on my way into surgery for a burst appendix. I politely declined and was then asked "Well how much do you want us to do." I was then told I would probably wake up intubated and have to keep the tube in for a couple of days. Some people are so insensitive it bogles the mind. Forgive yourself you did the best you could. Blessings.
My condolences on your mother's passing. As a hospice (crisis care) nurse in the patient's home, I know that there are criteria that have to be met (set by the government) in order to sign up with hospice. Your mom was in a nursing home, so I'm assuming there was some deficit where she needed more care than she or you could provide. You say the nursing home suggested hospice to "provide some help (what type of help?) and spiritual support in the next year". Were you looking for the diapers, Chux, and other items that are a free service? Your family is Catholic, so I'm not sure why spiritual support from hospice would be needed. A parish priest or deacon are usually able to visit the sick at a moments notice.
What "real medical interventions" weren't working....what was her condition?
Was your mom eating and drinking well before hospice?
I'm sorry, I have to correct you when you say "hospice does have literally permission to kill with meds." Most hospices have "standard orders" that cover most conditions (nausea, temperature, pain, agitation, etc.) The meds are given after assessing the patient's signs and symptoms.
All hospices explain the entire enrollment procedure and operating procedures. Were you in attendance? You always have the right for input or denying any meds you don't want for her. Were you supervising her meds during those 2 weeks?
Your mother was very advanced in age and was well within the age range to pass away.
It seems your sister was either realistic that your mom would be passing soon or actually wanted her gone. Even if that was the case, there would have been no way a nurse could "kill" your mother. There seems to be gaps in the story.
I hope you can come to grips at a later date that your mother didn't suffer and probably would have passed within a couple of years with no interventions. Given your bias, please don't recommend hospice to any of your patients. At least we, the nurses, won't be deemed "murderers", when we relieve any pain or anxiety we observe.
The option of cancelling hospice is (or should be) completely explained when you sign up. To sign up with hospice, the patient is agreeing that they do not want any interventions in the dying process. IF the patient and family doesn't agree with that, then hospice won't sign you on. You are "allowed" to go to the hospital for comfort measures (for example, the patient fell and broke their leg. That is painful. They can go to the hospital to set/cast it, etc.). That is not considered "prolonging" life.
Hospice is for patients that are considered terminal and will die within 6 months.
I was a private duty nurse for a patient in his home (NOT hospice). He was 92, extremely weak and emaciated, chronic diarrhea and had a few other non life threatening illnesses. He wanted to die. He did not want any intervention. He signed onto hospice. When he fainted on the commode, I had to call paramedics to help me get him up. THEY took him to the hospital due to his blood pressure bottoming out. (Obviously, at that time, he couldn't speak for himself.) He was discharged from hospice because they took him to the hospital for "life-saving treatment ". When he came home, he was readmitted to hospice.
You can cancel hospice anytime and for any reason. I can only speak from my nursing experience working with one hospice company in Southern California but I can't imagine that all the others operate much differently.
In the end stage of dying, the circulation slows/shuts down, affecting the extremities first,(lower legs and hands), often turning them a crimson or purple color. They are cold to touch due to lack of blood flow. The process is called mottling. Occasionally, with light mottling, simply repositioning or massaging the extremities will bring back the normal skin color or lessen the appearance of darkness. With severe mottling, it does not resolve and death will be following soon after.
Was the hospital able to reverse the black color and restore circulation to your mom's legs and hand?
I think that most hospice organizations use some volunteers. The nurses and doctors and social workers and chaplain are paid, but there are other roles that are staffed by volunteers. For my mother the volunteers just spent time with her, talking about her interests, doing her nails, etc. For my husband I passed on the volunteer because I had a PCA and thought the volunteers should be used with caregivers who had no help. I can't imagine why any hospice program would be all volunteer, when there is insurance money (Medicare) to pay for most of the program. Are you sure the hospice in Idaho was all-volunteer? If so, why?
Both of my hospice experiences were in the Twin Cities and they were excellent. Which is not to say all TC hospice programs are excellent, but I know that some are! I have a young friend who provides musical experiences to hospice clients. She plays instruments and/or sings. She is not a volunteer. This is what she does for a living.
I am really very glad that you will review the forensic toxicology labs. That should either set you mind at ease, or give you the basis for further action. If this Minneapolis hospice program acted as you suspect they did, that needs to come to light and changes made.
BTW, were you in Minneapolis with your mother, or dealing with this from Idaho?
My mom is in stage 6 and is eating, sleeping and talking (albeit, confused) very well. Slight urine incontinence (not bad for 94) and uses "pull ups" but can tinkle in the bathroom too. She's been in stage 6 for the past year or so.
Maybe your mom just had a dip in her health and regained strength with the extra medical attention (?)
Check out Alz.org for the list of Alzheimer's stages. Good luck.
Your Mom would have passed on the same timetable with or without Hospice. Without Hospice it would have been an extremely painful death. With Hospice she was to pass being comfortable and in peace. So think about this, you made the right choice having your Mother be in Hospice.
I'm sorry for your loss.
You did the best you could for your mom. Depending on her age, the hospital doctors probably thought it best not to submit her to any more treatments. That is what hospitals do.
My father died suddenly, he just walked into the den and dropped dead. None of the six children knew it until I called them. He was suffering but at home. On the other hand, my mother died in hospice from cancer. That was an ugly way to die. I will say she was a fighter, hard headed but stayed at home until 5 days before her death. That was hard on the family because someone had to be with her 24/7.
After her death, I sat down and wrote out what I wanted, sealed it in an envelope then gave a copy to my wife and one to my only daughter.
I want it to be simple, cremation, spread my ashes near my favorite forest. If they want to celebrate my life I wrote down my thoughts and said what I wanted to say to the people who may come. I have seen too many deaths in my life, but I realize my time is coming. Just let me die with dignity.
Until that day comes I'll take it one day at a time, I don't worry about yesterday or tomorrow. I want my life to be a celebration, not a burden on my family.
My Dad passed a couple of months ago, it was sudden. This time it turned out that when he tried to eat or drink the food/liquid was going into his lungs and he developed an infection then pneumonia. Being he was 95, there wasn't a whole lot the doctors could do.
My Dad had an "Advance Medical Directive" regarding medical care drawn up by his Elder Law Attorney. I used that as my guideline, what steps to take and if he wanted Hospice. Dad passed very peacefully.
I think what happens is a patient has been over mediated for so long that when they are taken off of the vast majority of their prescription meds as per Hospice, they actually start feeling better.