63 year old alcoholic brother. Any suggestions?

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Bootsiesmom Asked July 2019

63 year old alcoholic brother. Any suggestions?

My 63 year old brother is being discharged from hospital to hospice. He is at the end stages of alcoholism. He his cirrhosis, not much (if any) kidney function, cannot swallow, keeps pulling out his feeding tube, and is confused and hallucinating.

His wife doesn't want him back in their home. It's been up and down with them but recently she said she is done. She called me today and said Medicare won't cover the cost of an inpatient hospice facility, but will cover in-home hospice care. I am familiar with hospice as my husband died of cancer in 2010. I told her I am willing to speak to the doctor or whomever will plan the hospice protocol because I may be able to ask questions and get more information about what specifically will be done to keep him comfortable. I cannot and will not care for him.

My 85 year old mother cannot care for him. His son, my nephew, may be able to but not sure what that may look like. He is married and has a small child. My brother has another adult son who is unable to care for him because he has special needs. His adult daughter and he are estranged and have been for sometime.

I spent a fair bit of time in Al Anon and certainly believe in detachment with love. I didn't cause it, cannot control or cure his alcoholism. No magic wand here. I need to take care of myself, which I suppose my sister in law (wife) is doing.

Any suggestions are appreciated. Just not sure what to do, if anything. His alcoholism is life-long, but the negative aspects have exacerbated in the past five years or so. He and current wife have been married about ten years. It's been a roller coaster for some time.

Alcohol Abuse End of Life Hospice

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score 1 · Answer 1

I began a response and read he has died. RIP and condolences to you and family.

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score 1 · Answer 2

Praise The Lord that he was kept comfortable and passed peacefully.

My condolences to you and your family. Hugs!

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score 2 · Answer 3

Thank you all for your kindness and compassion. He passed away peacefully today on comfort care at the hospital.

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score 0 · Answer 4

Problem with Home hospice is family still does most of the work. Keeping him in a facility will cost maybe 10k a month. As Community spouse, she may be OK if she applies foe Medicaid. Or she hires outside help. Not to sound cruel, but if they remove the feeding tube and his kidneys are shutting down he may not live long.

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score 1 · Answer 5

I have no answers, just compassion. Lots of hugs, luck, and prayers for peace for him and the whole family.

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score 2 · Answer 6

He can be placed on hospice while they are waiting for a bed, if there is a wait.

His wife should be handling all of this, yeah, I get she's done but come on. Get the life prolonging measures stopped, she has all the authority unless he assigned a POA and let him die with the dignity he has left. I am sorry if that sounds harsh, not my intention. But you don't want to intervene and then his legal next of kin makes accusations or sends the debt collectors to your door because you made decisions that are not yours to make.

Such a tough place to be. Hugs!

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score 0 · Answer 7

AlvaDeer, thank you from the bottom of my heart. So helpful.

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score 5 · Answer 8

He needs placement. The facility will likely get him hospice quickly enough. I do not know why anyone would have a tube feeding on this man to prolong his agony. I would place him and move him to palliative care only (that is to say no treatment to cure, only to keep comfortable.) Definitely no dialysis. That will prolong things with enormous misery involved for all. So placement. Unfortunately you are going to have now to refuse to take him home. You are going to have to say "He is beyond any care that any of us can provide for him". I am a nurse. They are NOT going to want to hear that and you will be inundated with social workers promising you the world. "We will make this work; we will get you help" and blah. They will not make it work and the cost will be enormous and the care needed impossible. So you must say NO HE WILL NOT COME HOME to any of our homes. The choice is hospice or placement. Once he is placed you can ask for Hospice again. They do serve all extended care facilities. I know that I sound without compassion but that is not the case. These are the people (along with others) I cared for all my career when I worked. But I have MORE compassion for you, as you will now be manipulated to the inth degree by this dreadful system. You need now to get together as a family, to stand strong, and to FIRST, realize you CANNOT care for him in the home, SECOND insist that he be moved to palliative end of life care with no prolonging by tube feedings (think aspiration pneumonia, diarrhea, pulled out tubes, restraints, diarrhea, bed sores). This is the end of life for him. Sadly. Very sadly. We all die. Alcoholics die too early and the hard way. I am so VERY sorry for all you are going through, all he is going through, and all you will go through. I hope he will be able to pass with the most peace. Hospice, sadly, is no longer what it once was. It has morphed into money making, home visits that are inadequate. But it is all we have left. Just don't prolong this for any of you, and especially for your poor brother.

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AlvaDeer, he was previously in a "skilled" (not really) nursing facility. Do we ask that he go there and then proceed to ask for hospice when he gets there?

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63 year old alcoholic brother. Any suggestions?

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