I have posted on here many times and answered questions every now and then. Dad passed away Oct 7th 2013 from Liver Cancer . He was in a hospice facility for 11 days until he died. The day before he was admitted he was in the hospital and was talking,eating and very clear headed but his ammonia levels were high and he had been very combative, not eating and wouldn't take his meds for 4 days at his nursing home. ( He was in for a Psych Evaluation.) The hospice worker talked to me about admitting him instead of returning to the nursing home. I agreed to this and arrangements were made. He was transferred later that day and was alert and in good spirits. The next morning he was unresponsive and stayed that way until he passed. They gave him morphine and ativan around the clock. He never got any water but they did cleanse his mouth and moisten it with swabs. It seemed like he could hear me the first few days because I would shake his shoulder and say "dad". His eyes seemed to be moving under his eyelids and his mouth would move slightly. I did ask about them lowering his dosages so he could wake up a little. The nurse said he was getting a very small dosage already. I just wonder if the drugs made him unresponsive and if less was used he could have ate and drank and lived longer. I know it was time for him to go but I'm kinda puzzled about his going from complete alertness and straight into unresponsiveness so quick. The nurses did a Great job. I myself don't know how they do it. They treated dad like he was their baby. So gentle and compassionate. I was just wondering if anyone else had the feeling that death felt a little rushed once their loved one was placed in Hospice.
You or someone else if you were not POA can request a copy of Mom's medical records from the hospital, take them to a malpractice lawyer who will have them reviewed by a medical specialist to see if anything improper was done. make sure to request nursing noted and medication orders. Do you have a medical background.
I understand your distress but it is hard to understand the circumstances if you are not there 24/7 and part of the team. i also agree that everyone for their own and loved ones sakes should educate themselves about drugs and other treatments and not allow MDs to go on fishing expeditions when no treatment can be safely given. A few more months as a vegetable is not living.
was a caregiver.There was no choice for being a past caregiver, so I checked the active caregiver. Then I explained a little about how I was a caregiver and told about how my mom needed a caregiver when she was trying to recover from the deadly sedatives, that she was overdosed on. She would start to get better then get complications from the overdoses only to get overdosed as she was in hospital recovering from the previous overdose.
was a caregiver.There was no choice for being a caregiver, so I checked the active caregiver. Then I explained a little about how I was a caregiver and told about how my mom needed a caregiver when she was trying to recover from the deadly sedatives that she was overdosed on. She would start to get better then get complications from the overdoses only to get overdosed as she was in hospital recovering from the previous overdose.
You have every right to express your opinion on any of the threads you choose.
Haldol is a powerful antipsychotic but also has antiemetic properties and 50 years ago when vomiting was the norm following anesthesia it was very helpful. modern anesthetics are vastly improved so vomiting is not usual these day.
Ativan is a very useful antianxiety medication and one of the drugs of choice for treatment of terminal anxiety. Both of those medications have long lists of side effects and should be used with caution in the elderly. Again in the elderly and dying it is possible that they will have the opposite effect to that desired.
Your feelings express that your mother suffered a wrongful death. You have the options to take legal action against the Dr who ordered the drugs and report his/her conduct to the state licencing board (Think Michael Jackson and Propothal) and initiate police action.
You feel you are warning caregivers against using these drugs for end of life care.
I feel you are frightening many people whose loved ones would benefit from the comfort they bring for symptoms Pam describes. FYI Pam nursed her young adult daughter till her death with a brain tumor and was very appreciative of the availability of these drugs to ease her daughters suffering.
You certainly have a right to your concerns and feelings but even if your mothers death was actually precipitated by her treatment by medical staff the anger you are feeling rightly or wrongly would be helped with some counciling.
Now I am sure i have made you very angry once again but that is far from my intention which is to reassure caregivers that the judicious use of certain medications at the end of life are a blessing.
One sits is healthinaging and they also have a foundation. Phillips Lifeline has a piece on the subject here too: . I am not quite finding what I want, but I'll keep trying. I think the main thing is not to just advocate against specific drugs that have legitimate uses - both Haldol and Ativan can be used appropriately in different circumstances and ought not to be off the market - but against an approach that ignores patient's wishes, needs for individualized management including lower doses and non-pharmacologic options.
OK - here you go: check this out, I think it is what you are talking about:
I found the link through patientsrightscouncil. One of the keys is advocating for people to really take care in writing their advanced directives to try to make sure they get the approach to symptoms that they want.
Why am I not surprised?tThere is a great deal of money to be made for from dying patients especially if you admit them when they are reasonably healthy and stop regular medications. They need very little in the way of expensive equipment or staff time. OK so the RN pops in once a week and documents her visit. It certainly makes sense not to have them survive beyond 6 months. Medicare will ask questions about that.
A not for profit hospice relies mostly on Medicare and some private pay depending on the area. True, Medicare only does an inspection every few years but I promise you those inspectors go over the records with a fine tooth comb and accompany the nurses on their visits. Not for profits have to use volunteers for a specified number of hours and much of the ongoing expenses are raised with fundraisers and endowments. Of course there a bad apples in every basket but a nurse would not go to work for a non profit hospice where the pay is about half that of a general hospital.
I have said many times on this thread check things out before you allow your loved one to be enrolled in hospice and if you don't like the treatment you can throw them out.
It is true that strong drugs are used and needed at the end of life and should never be used in such doses that unwelcome side effects are seen.
Many times close to the end pain does get out of control and higher than usual doses of drugs like morphine may be needed. No medication can be given without the Dr's authorization, that would cost a nurse her license. Anti anxiety and anti psychotic drugs are also used when indicated, they will cause drowsiness that has to be understood but the alternative is to have a loved one confined to a mental institution when he becomes too combative at home where he and you want him to stay.
All drugs have side effects on some people and many are not advised for use with the elderly because they are more likely not to be able to eliminate them if their livers or kidneys are functioning poorly (wearing out) for this reasons if the drug is necessary a smaller dose may be tried and the patient closely monitored. this applies to any older adult not just the dying.
No one wants to loose a beloved family member or friend and it is a very emotional and frightening time.
One of the stages of grieving is "anger"
You can not bring them back but if you feel they were wronged it is certainly in everyones interest to bring the perpetrators to justice so they may not harm anyone else.
I can't read one hundred comments back, but why was your mom on hospice in the first place?
The problem I see is that not all hospice providers are going to value every life and every person's uniqueness, and some may take a top-down, cookie-cutter, we-know-best approach to all care and medication. The best care deeply about each and every person and their experience and their family.
If you witness a crime, you call the cops. If you hear rumors from others you keep your mouth shut, because others are known to set people up for a fall.