Can my 95-year-old mother refuse hospice? She fell three weeks resulting in a hip replacement.
After the hip surgery she went to a skilled nursing home for therapy. She was biting staff. A week into this she was vomiting blood so she went back to Hospitol and they scoped her. No active bleeds but large ulcer upper stomach. They did not biopsy it due to fear causing more bleeding. Few days later we decided to have her go back to her room at Asst, Living., at least it was more comfortable for her there and I called in Hospice. They came and Mom at that time was coherent enough to refuse it. SO I set up Palliative Care. Last night I received a call from hospital she was back in the ER (Asst. Living facility did not call me, I had to call them). She fell again and they found her at end of her bed laying on her back in a lot of pain. The day before she fell but nurse said it was not a bad fall and she was ok. Anyway, X-ray last night shows fracture of femur below the new hip joint and later today she having 3 'clips' put in, to make femur bone more stable. They also claimed it will help reduce her pain.Awhile ago I spoke with a Care Team NP who said she needs hospice, that she will probably fall again (she has a walker but refuses to use it and often forgets to use it). I told her the Hospice nurse, after the hip surgery, said Mom has right to refuse Hospice. Today, the NP, said, not true... because I am her POA and Mom has dementia. Does anyone have any experience with this? Advice? We are in Ohio. Thank you.
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If the Doctors are suggesting Hospice there is a reason. Basically, the doctor has to feel the person has 6 months to live. At that point if still alive, the person is re-evaluated. Some people are on it longer. Does mean no more hospital visits or doctors. Its end of life care.
I do not see a problem with this type of "therapeutic fib" as it is done to benefit the patient and no harm would come of it.
Prior to her hip surgery and subsequent surgery who signed the consent for the procedure? Did mom sign it or you as POA? If you signed it because she is not cognizant then she is not cognizant to decline Hospice. If she signed it because the doctors believe that she is cognizant then why are you acting as her POA? (I am being a bit sarcastic here)
I would contact another Hospice if it was the hospice Nurse that said a person with dementia can decline service.
I'd only sign her up if she needs higher level routine pain meds like morphine daily.
We also got access to a free hospital bed, a free wheel chair, free depends or chuxs, and an RN once a week.
Does your Mom still want treatment at the hospital ?
I have now taken care of 3 family members during their final years and months. In all cases I have been inflicted with "disappearing family members" so I have had to go it alone - but this part of the story is for another time.
My dad had cancer and when the doctor told him that the drugs were no longer working he suggested and sent Hospice out. They talked with dad and he agreed to be signed up. He died 3 months later. Although this Hospice only came out once or twice a week, I finally felt like I had help.
My mother, who moved in with me, had COPD so her story involves a lot of "in and out" hospital visits, falls, and every nick resulted in a lot of blood loss. I asked about palliative care at her doctor appointment. The doctor looked at me like I was betraying her (she was 80 at the time and frail). He said, "you mean Hospice?". She didn't speak to me for 3 days, angry that I would suggest such a thing. Long story short, the hospital visits continued until a social worker at her last hospital stay came to talk about Hospice with her. Where her doctor failed her, this social worker patiently listened and explained how it would be going forward. Mom agreed. She came home from the hospital and died 24 hours later, never having the chance to experience a visit from Hospice.
My third experience with Hospice was very recent and involved another family member. I took this man to every doctor appointment, which were numerous, in order to stay organized AND to keep him from driving. This man and his wife had moved into an AL just 2 months before. One evening he appeared incoherent and drowsy so 911 was called. It was found that he had sepsis. He was at the hospital for a few days when I was called to get him placed in rehab. After a week in rehab he started to decline again. His AL told us that in order to come back to his apartment, he would either need to accept Hospice or he would have to show that he can get up from a chair, walk three steps, turnaround, walk back and sit down on his own. If neither of this requirements were met, he would have to go back to rehab. His AL has been wonderful but how are these options fair or humane? Eventually, he accepted Hospice. Vitas Healthcare was his Hospice provider and they were INCREDIBLY WONDERFUL, visiting everyday for the last 5 days of his life.
Your mom is in the hospital/ home cycle. This is incredibly painful and challenging and thank goodness your mom has you.
I would call the lawyer that set up the DPOA. You can't decide to start using your POA on your own - make sure it is in writing and notarized. He or she can visit your mom and help you make the decision to transition to POA legally. Once you are officially POA, your attorney can help you keep all transactions and decisions transparent in order to protect yourself legally. Being POA is a thankless job with legal pitfalls. I know, I'm going through it right now.
I hope this helps - I wish you peace.
Aso mom if she likes going to the hospital? If not, hospice is the only sane choice. It's not like you're taking her off life support......youre making a choice to keep her comfortable during her end of life journey!
My mother would insist she wanted her coffee microwaved until it was literally boiling. The staff would accommodate her request until one day she spilled that coffee and burned herself. Then they had to make decisions about residents rights vs. Common Sense and their wellbeing with dementia. What if they wanted to sit in the sun for 2 hours and the staff knew they'd get heat exhaustion or heat stroke by doing so? Its the same analogy as with hospice. Should you decide to forfeit hospice bc mom doesnt want it and choose to let her die a possibly agonizing death as a result?
Best of luck.
If a doctor again suggests to you that "mom NEEDS hospice" I would tell said doctor that your Mother refuses end of life care and wishes to continue to be treated.
Again, this is a personal choice for all those competent enough to understand and make the choice. Why in the WORLD this doctor is PUSHING hospice when it does little more these days than provide three baths a week, a medication bottle of morphine and a hospital bed, along with a call from clergy and social worker and one RN visit a week, I honestly cannot imagine. You might consider asking him for this old retired RN. I personally am all FOR hospice, and would wish to have it myself. But I am not your mother and she gets to make her own choices while she is able.
Providers seem to be more skiddish these days , I have found that if the patient seems “ lucid “ at the moment and wants to refuse , that’s what they go with .
This is a common problem we caregivers may have to face.
My mother just passed at age 100. She was in AL, we had to call in Hospice, it was a blessing, they were wonderful. She fell several times and we believe that she broke her hip, at her age, and with her heart issues, nothing could be done. She died almost 1 month after Hospice stepped.
Although my mother did not have dementia, on the morphine she was not able to make sound decisions, and we made them for her.
My brother was the lead for the DPOA and I was second in line if he was unable to continue. Although all decisions for her care were made jointly, fortunately we work well together.
Might be time to move forward with her DPOA, for her sake.
Sending support your way.