Mom is in Assisted Living and was formally diagnosed with Alzheimer’s in January. She says she wants to die, to be with Dad.
She has an advanced directive DNR- with comfort care. She falls daily, often won’t eat. Has severe aortic stenosis and a partially occluded blood vessel in her brain. Is it time to put her in hospice and withdraw food and water?
A DNR simply means your mother doesn't wish to have CPR administered if her heart stops beating. Do Not Resuscitate doesn't mean she's ready for hospice or that food and water will be withheld from her! She'll need a formal hospice evaluation first which her doctor can order if she fits the hospice criteria. My mother is 94 and has been suffering from vascular dementia since before she was diagnosed in 2016,,,,and I STILL can't get her a hospice evaluation in spite of the fact she lives in a Memory Care Assisted Living and has fallen 68x, is in a wheelchair with severe neuropathy and can't even stand up, is incontinent, has AFib and CHF.....has had a stroke, and says she wants to die constantly. She can choose to stop eating if she wants to, nobody can force feed her, but until she meets the hospice criteria, she won't be accepted into hospice and the horror show must go on, unfortunately.
Very soon now, I'm going to ask again if the doctor will write an order for a hospice evaluation, but I doubt it. They want to see not only a decline in health and dementia but also a loss of 20% of their body weight. It boils down to mom being too fat to qualify, in spite of all her issues and chronic pain! Wanting to die isn't enough. The whole situation is dreadful, really, and very frustrating for me because I've tried 1000 things to help her quality of life and nothing works. Nothing.
In the end, food and water isn't "withdrawn" by hospice, as the others have said. The patient herself is the one who refuses food and water when she's at the end of her life, and that's when hospice administers medication to keep her comfortable and to ease her passing. It took my father about 10 days to pass under those exact conditions with hospice. It's one of the hardest things we daughters will ever have to witness in our lives.
the new hospice nurse.. showed my how to crush the pills and swab them in the mouth... I was the one to put the motions in play to put mom down...my team was off that weekend.. not fun... didn't know what or why I was doing this, the nurse said every hour... and she forgot to show me the other pill to crush and swab. nope not fun...
So why is she falling everyday? get her a medical bed, put it down to the ground as closely as you can... put a mattress down to help her.. ask for palliative or hopsice care evaluation. get her a walker or put a porta potty close to her... sometimes easier said than done... make your stays happy,, bring her treats music and joy... ask doctor for POLST n DNR.... dnr is on polst... usually... make sure you have a copy pasted over her bed or next to it or in a drawer just in case.
If mom made a DNR when she was completely in her right mind, and now wants to implement it, support her in this.
And no, nobody will 'withhold' food and water. As her body shuts down, she simply won't want either. The hospice part is for comfort and pain relief only. Well, and emotional support if you/they need it.
We want our LO's to live as long as possible--but with dignity. I've known people who have kept LO's on feeding tubes, IV's---and sustained 'life' for many many months past what would have been their natural time of death.
Depression and loneliness over missing your dad? I can certainly understand that. No amount of antidepressants will ease a pain like that along with her physical health issues.
No one will withdraw food and water. Stopping eating is a normal part of the dying process. It comes very naturally when a person nears the end. With both my parents we were advised by both doctors and hospice nurses to keep up minimal hydration as becoming dehydrated is a painful way to die. I’d hope you’d get a thorough evaluation of your mother’s status, including possible depression or anxiety before changing anything about her care
If you have access to an in-house psychiatrist or other affectivein her AL, I’d certainly give that a shot.
Depression is depression, and there’s no way to know whether some intervention, whether by medication or a resident chat group or some other therapy, might not free her to a more comfortable life while she’s here.
If she does deserve a shot at an improved life while she’s here it might be a shame to pass up the chance.
It’s a tough decision, so be sure to remember that a decision made with love and respect is always the right one.
I would not withdraw anything. It is up to Mom if she wishes to take food or water. You would be utterly amazed at how little of each it takes to keep one alive. But I would discuss hospice with her and ask if she would like Hospice care; I am assuming you understand that this is end of life care. Allow her to express her thoughts. I would not take/make the assumption that there is "depression" but I would ask her if she would accept evaluation; medications can help some people. I heard many patients near end of life express the wish to "go now" to "be at peace". They almost always told me, as their nurse, they could not discuss their wishes with their families, which I think is so incredibly sad. Some people just have honestly had enough. There is nothing ahead but a slow slide in which there is loss upon loss upon loss, including finally the loss of what makes us an individual, our memory. I am so sorry. Let Mom be your guide and honor her wishes. Discuss palliative care with her doctor. I am hoping you are already her medical POA.
She has been on an anti-depressant since summer 2018. Says her heart is broken and she wants to die because she is in pain. She’s been thoroughly checked with scans, bloodwork. Physically she’s very weak, is falling constantly, and sometimes refuses food. I tried to explain the hospice process to her but she does not understand. I believe the Alzheimer’s disease has progressed to the point where she cannot understand the process .
She has a legal document: DNR with comfort care and can legally choose to stop water and food. It is NOT murder. It is a legal document with her choice, signed years ago.
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DOCTOR WILL DO THIS FOR YOU WITH INSURANCE COMPANY.
Make sure your visits with her are happy, treats, music, and love and joy.
give her the milshakes put a lil ensure in it if you want.
what is her favorite food? bring it on !!! dance keep on dancing.... maybe she won't feel she needs to walk as much so she doesn't fall down...
GET A GAIT BELT !!! They help you to help them walk .. !!
JUST LOOK UP GAIT BELT... BELTS WITH GRAB HANDLES... They work great.
Very soon now, I'm going to ask again if the doctor will write an order for a hospice evaluation, but I doubt it. They want to see not only a decline in health and dementia but also a loss of 20% of their body weight. It boils down to mom being too fat to qualify, in spite of all her issues and chronic pain! Wanting to die isn't enough. The whole situation is dreadful, really, and very frustrating for me because I've tried 1000 things to help her quality of life and nothing works. Nothing.
In the end, food and water isn't "withdrawn" by hospice, as the others have said. The patient herself is the one who refuses food and water when she's at the end of her life, and that's when hospice administers medication to keep her comfortable and to ease her passing. It took my father about 10 days to pass under those exact conditions with hospice. It's one of the hardest things we daughters will ever have to witness in our lives.
Good luck to you.
So why is she falling everyday? get her a medical bed, put it down to the ground as closely as you can... put a mattress down to help her..
ask for palliative or hopsice care evaluation.
get her a walker or put a porta potty close to her... sometimes easier said than done...
make your stays happy,, bring her treats music and joy...
ask doctor for POLST n DNR.... dnr is on polst... usually... make sure you have a copy pasted over her bed or next to it or in a drawer just in case.
it's not fun... good luck
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And no, nobody will 'withhold' food and water. As her body shuts down, she simply won't want either. The hospice part is for comfort and pain relief only. Well, and emotional support if you/they need it.
We want our LO's to live as long as possible--but with dignity. I've known people who have kept LO's on feeding tubes, IV's---and sustained 'life' for many many months past what would have been their natural time of death.
Depression and loneliness over missing your dad? I can certainly understand that. No amount of antidepressants will ease a pain like that along with her physical health issues.
Depression is depression, and there’s no way to know whether some intervention, whether by medication or a resident chat group or some other therapy, might not free her to a more comfortable life while she’s here.
If she does deserve a shot at an improved life while she’s here it might be a shame to pass up the chance.
It’s a tough decision, so be sure to remember that a decision made with love and respect is always the right one.
Let Mom be your guide and honor her wishes. Discuss palliative care with her doctor. I am hoping you are already her medical POA.
Contact a hospice company to have her evaluated.