Who decides how much and how often pain medicine is given to a patient? Primary or hospice doctor?

Good Lord! This person is telling us s/he's going into Hospice and people are debating the effects of whether or not morphine will help him/her?

Quite frankly, Veronica's suggestion to call Hospice is best. What Hospice did ten years ago is not necessarily what Hospice does today.

And to the person who asked the question: I've seen many patient's survive longer than six months once in Hospice Care. You are going to meet a lot of really great people. Know that I will be thinking about you!

Some of these statements , I don't understand. My dad lived with us and was on Hospice. He got pnuemonia (sp) once a month and and went to the hospital at least once a month. So, yes you can go to the hospital, also my dad's Hospice dr made a house call when I decided I wanted the dr himself to see my dad. They did everything that I asked. My only regret is that he was on so much morphine at the end that he stayed knocked out and we couldn't talk to him or vice versa. I knock without it, he would have been in great pain but I still wanted him to wake up for a little while.

One would hope this poor man has already been under a Dr's care and is recieving all medications usually prescribled for COPD including portable oxygen.
As long as he is still able to drag himself to work he is unlikely to be approved for hosice at this time. He obviously has his reasons to continue working, at this young age probably financial. Athough as Ferris said morphine is addicting for some people but in the case of very severe COPD it provides a great deal of comfort. Addiction is not a concern because they are going to need this comfort medication for the remainder of their life along with all the prescribed medications available. If he leaves work SSDI is not automatic and however bad you are it may still take up to 2 years if you get it. Once he is approved it will be far less income probably than when he was working.

You don't have to take morphine to make your breathing better with COPD. Morphine is almost a "last resort" med because it is so addicting. Who said you are close to going into hospice? Just because you are having trouble breathing, there are inhaled meds that can help (Spiriva comes to mind). Talk with your doctor, and if you have lost confidence in him/her, find another. Keep trying to find a doctor who will help you breath better.

SuziQ, The decision to work is his. Chances are he will keep going, keep fighting the COPD as long as he can. At 59, if he was totally disabled, he could go on Medicare and SSDI. It is totally his choice and his decision. Being disabled does not mean being on Hospice. Support his decisions.

My understanding is that if you go on Hospice, you don't go to the hospital for acute treatment any longer. Can he go on Disability?

Each drug, whether given by mouth, IV, IM or subcutaneous has its own duration on it. Some wear off in four hours, some six hours or more. This information is known usually to the physician and nurse. As a patient you are entitiled to this information. The morphine which you mentioned has a sustained influx through a pump....patient controls the pump by pressing on the wide strip on the outside of the body. Check with your medical people for this . Keep in mind that a pt cannot overdose with a pump. If you pt is in hospice, then they should work with you on any needs or questions that you may have. Good Luck!

THANK YOU VERONICA YOUR ANSWER WAS VERY HELPFUL

My brother in law has COPD and has been in and out of the hospital. He still works so he can keep his insurance, but he is so bad he shouldn't be working. Can he go on Hospice and what if he went into the hospital and can't pay for it? Some days he feels like he isn't going to last long. Very hard on the family and he's only 59 yrs. old.

Everishlass you are correct from the understanding of a general nurse. As a hospice nurse it is quickly learned that morphine actually prevents the patient from feeling they can't breath and the extreme anxiety and fatigue that accompanies that. This is the reason morphine is so widely used in hospice care. It is effective. cheap and easy to administer. In many hospice the patients own dr will in fact continue to see and oversee the patient's care with advice and requests from the hospice team. Most physicians are glad to have the day to day responsibility assumed by hospice which enables them to maintain a relationship with their patient. The patient's physician will continue to see and prescribe for the patient but the hospice Dr can also do this. Some physicians will even make house calls. As long as they are able the patient may continue to make visits to their personal Dr. Of course this does vary from area to area but this has been my experience.
Patients can be reassured that they will only be given adequate medication to control their symptoms. Hospice nurses are very experienced in the types of drugs most likely to provide maximum comfort to the patient and will often advice the physician on a specific conbination which given the patient faster relief rather than a trial and error approach.
Matpower if you feel you are "almost ready" for hospice my advice would be to contact them now. let them assess your needs and if they feel you are not ready you won't be admitted. Again if you don't like the way they are managing your care you are free to discharge yourself and can be readmitted at a later date. It is not mandated that you have to die within six months but that you have a stage of disease that makes it likely; As long as your health continues to decline even foe many months or even years you can remain under hospice care. It is far cheaper than constant hospital admissions. You will not be allowed to try expensive new treatments but no one can stop you leaving hospice to try something new. the hospice experience is patient driven. The staff may recommend certain things but it is up to you to agree. Morhine is not mandatory BUT there will come a time when you are very thankful it is available. You can still go out and about and do anything you are able for as long as you wish but you will be advised not to drive yourself. I hope hospice is a good experience for you.

when my son was dying, they gave him morphine which helped him to breath
better, you could hear his anxiety going down and his breaths evening out

P.S. Once you go on hospice the hospice physician will take over your care from your primary care Dr.

Morphine does not make breathing easier, it can inhibit your breathing. Morphine will increase any kind of respiratory problems you may have: COPD, pneumonia, asthma, etc.

If you are on hospice, the hospice Dr. writes the prescriptions which go through the hospice nurse and this is done very efficiently and quickly.

Morphine does make your breathing better. YOU decide, as the patient, how much you need. Hospice writes the Rx and the visiting nurse will ask you how much you are taking and whether it helps and may suggest a little more or a little less.