What happens when a living will is invoked on a resident in a nursing home?

Jinx4740, I hear you. My mother was in intensive care (hospital but it could have been a nursing home) with "Failure to Thrive." She came in and out of lucidity, but the hospital began denying her water because she "failed the swallow test and could choke." We immediately asked the supervising doctor about Hospice. He said she qualified and would begin the paperwork. My mother came into lucidity, with her parched-white-cracking lips (because hospital staff did not even offer the comfort of lip-swabbing). She said, "Get me out of here. Take me home." See if your loved one can utter where they want to be. Contact Hospice and ask them how to accomplish that without medical bill. You will sign a contract with Hospice. Then get them there. Then be there or have a rep be there, and communicate heavily about what is happening. We do not want our loved one to suffer, and Hospice takes care of that. In fact, I witnessed Hospice coming into the hospital, and Hospital staff stepping aside and deferring to Hospice. My dear Mom's troubles in the Hospital ended when Hospice stepped in. My Mom was a Hospice volunteer, so knew exactly what her signature meant. To this day, we can't fathom why she was so lucid, but she was. When the first Hospice Social Worker walked into the room, Mom began holding our hands and calling for family conferences. Til then, she was delirious. Be strong, Hospice will respond to any and all questions and concerns. This is their expertise, and no Hospice staff member would ever blow off the smallest of concerns.

Just FYI in our case, Mom came home for a total of seven days. During that time we saw her rise mightily, grabbing her upper arm and saying, "Oh no." Then rising to eat all soft food we prepared. We learned later that she could not process that food. But the comfort the two spoonfuls of ice cream or home made potato soup gave to her was one of my best memories in life. She also one one day became incredibly hostilely delirious and it was awful. But as she went to sleep the last three nights, she winked at us. We think she knew. I am still in shock and grieving after three years. But I ask myself, "Who would do what you did for her, for you?" The answer is "Nobody." You just go with the moment and your good heart. Nobody could ask for more. You are a dear human being to even post your concerns, as I know you felt guilty for taking the time to do so. I recognize what an incredible human being you are. And you are not alone.

There is a great book to read about this, "A Good Death" or something similar. Apparently people are only hungry for a short time, and then the urge passes. If you keep pushing calories in, they get hungry again, so it prolongs uncomfortable feelings, If they don't want to eat, that is choosing not to live and a passive act, which is different from the action of killing oneself, to be sure.

Hospice is certainly a great service, since they understand all the subtleties of food and water and will keep the person from hurting and suffering. Musicians are even hired by hospice to play for the patient- what a loving way to go!

In general, hospice means that they will no longer try to "cure" you, but they will keep you comfortable and as pain-free as possible. If you have cancer, they won't do surgery or chemo to cure it, but if a little chemo or radiation to shrink something means you will breath better, they will do that.

If you break a leg, they will set it, but you probably will get little or no PT, and you won't get hip replacement. They will maintain you on blood pressure medications, and manage your diabetes and your COPD so that you can continue to live. The most important thing they are supposed to do is to manage your pain and anxiety so that you can pass peacefully when the time comes.

Unlike doctors and regular medical people, their goal is not to cure, but to comfort and ease the dying. Good ones are a blessing.

I don't know what happens when someone can no longer eat. I think they will offer liquids, but will not "push" her to take them. I think they will try to keep her mouth comfortable with ice chips.

Someone here will correct all my errors, I am sure.

May I ask you all a question about the use of hospice....what does that mean exactly? If his mother can no longer eat food or wishes not to and he asks for hospice, then they just stop feeding her and giving her water? Do they put her on morphine or something to allow her to sleep until she passes?

Don't move her now, this is her home. Provide the MD and NH with the living will so they can make a copy. Hospice has to be recommended by her MD. Hospice also needs to have visiting privileges at her nursing home, so talk to the supervisor at the NH and he/she will work with you.

Living in a nursing home for the past four years certainly can't give your mom much reason for wanting to continue living. We all have to face up to the fact that the time will come when our loved ones will leave us. Be grateful for the time that she has left and shower her with love. The day will come when you will be thankful that you did.

Usually a person already in a nursing home will be visited by hospice there. I am sorry for your impending loss, but know this is the way she wanted to go.

Hi John, Hospice can be arranged but you have to initiate it. Ask the nursing home to have the M.D. write a script or a hospice evaluation. Find out which hospices work in the area of the nursing home. Choose the one you think is best and have them do the evaluation. They will make sure your mom is comfortable. You might also consider supplements such as ensure and boost shakes. Some facilities don't provide them so you would have to bring them for your Mom's use. They are thick fluids and easier to swallow. Thinking of you . . .