My 93-year-old grandmother who has all timers and dementia has spent the last seven years of her life in a nursing home. My mother and her sister take turns visiting my grandmother daily. Other family members visit my grandmother as well. I visit my grandmother every other Sunday with my mom. My grandma's health has been diminishing because of her loss of appetite. She's always been a little bit chubby but she has been losing weight drastically because of her loss of appetite. My mom generally feeds her fresh fruit Jell-O and thickening liquids that the nursing home provides. We've all discussed that my grandmother probably gets no other nutrition besides when someone comes to visit and spoonfeeds for lunch or dinner.
A few weeks ago a hospice representative approach my mother and told my mother that their services would provide comfort for the family and my grandma as my grandmother's health continues to deteriorate.
Last week when I went to visit my grandmother I noticed that she had a brand-new chair that seeded her a lot better and she seemed more comfortable.
today when I arrived I thought my grandma was dead. I've never seen her look so poor and not in control whatsoever of her body functions.
We proceeded to the nurses station and found out that hospice has been administering morphine since Friday at midnight every six hours but the nursing staff could administer more every two hours if they felt my grandma was in pain. I asked the head nurse how has this happened that the family has not consented to morphine yet my grandmother has been given morphine for the past 48 hours... The head nurse said that hospice is supposed to contact the family to let them know but in order to stop giving her morphine they would have to have a doctors order faxed to them immediately... Where they would have no choice but to give her the dosage. I am mediately called hospice and left a message on their Emergency number. My mother said by the time she got home hospice had already called she return your phone call and they agreed they would call the nursing home and tell them to stop. This evening around 630 we were called by the nursing home letting us know my grandma's blood pressure was 74 and they said she may not have much time left to get to the nursing home immediately. Grandma was itching her skin and hair... The majority of the time she seemed disoriented and confused and still highly medicated. Her mouth was wide open and it looked like she desperately needed water or something moist to quench her thirst. A hospice care worker was there as well and said she would be willing to meet with me in the hall to discuss my grandma's condition. I told her I was not interested in speaking to her about my grandmother's condition and they have already caused enough problems. Miscommunication could be detrimental to my grandma's condition... And no one in the family had consented to my grandmother given morphine.
My question is do you think my grandmother will survive after having morphine in her system for more than 48 hours? The nursing home also told us that hospice had change the doses of some of her medicines and in fact she was placed on another medicine for anxiety; one that is not recommended for Alzheimer's and dementia patients- we were told the drug makes patient very lethargic.
Seroquel 25 mg -- is the drug and dosage.
My grandmother hasn't had food or liquids for several days now. I'm actually ticked that hospice could be so negligence and not inform the family about the morphine and we had to find out through the nursing staff at the hospital.
The nursing staff knows my grandmother for seven years -- it's not like no one came to visit her-- family was constantly surrounding her-- now hospice has come in and in within one weekend has caused her to be incoherent, non-responsive in a coma like state.
Hospitals are traumatic places for most patients and especially the elderly. This is well-known and documented. But sometimes I think we don't acknowledge how stressful and traumatic they are for loved ones as well, particularly. My husband died on hospice care too. I am so glad it was in our calm and familiar bedroom!. My heart goes out to you.
You know what? I think that nurse who explained the reason for rushing your husband out didn't do you any favors. And why would we assume that she was accurate in her opinion? Was she in on policy-setting decisions for the hospital?
Actually, statistics about death rates in hospitals include deaths within 30 days of discharge, so sending someone off to die elsewhere doesn't really improve the rating.
Hospitals are not supposed to keep patients beyond the point they are able to help the patient. To do so gives the appearance of milking the insurance for all they can get. It is a fine line they walk.
After the hospital determined that there was nothing else they could do for my mother they were eager to discharge her to her nursing home and strongly suggested we consider hospice care. We were also extremely eager to get Mom out of the stressful, traumatic, confusing ambiance of the hospital.
Hospice is for people who are expected to die within six months. For a hospital to allow patients to remain there to die could really take up beds where no benefit was being delivered, for weeks. In your husband's case it was only a day, but this is very hard to predict. (In my mother's case, she did not die by the end of the week as the hospital expected, but in fact is still with us (and not of hospice) more than a year later.
I am sorry that not only were you in the stressful environment of the hospital but also that you were forced to make decisions about hospice without knowing anything about it. How uncomfortable.
My husband had a terminal disease and so I looked into hospice long before it reached the end stage. I was well aware of what we were signing up for. My best friend's husband has stage 4 cancer. She has explored hospice care. The most recent episode that had her husband in ER and then admitted for a few days, she asked his doctor if her husband was actively dying. He assured her that it wasn't time yet for hospice.
So, sdnbishop, poor dear, you not only lost your soul mate but experienced it in a stressful environment with little knowledge of what to expect. And someone you would naturally respect gave you a cockamammie explanation that did not value your husband's comfort. No wonder you have an uneasy feeling.
It is hard enough to deal with becoming a widow without all these extraneous bad feelings thrown in. Please accept that your dear husband died when it was his time. Medical facility policies may seem heartless but they are not generally based on a disregard for human comfort and safety. I hope you can discard these bad feelings, focus on your sadness over the death itself, and proceed with the slow healing process.
The nurses said later they did not say anything about her being in the dying process because they did not want us or her to lose hope. We were still trying things 3 days begore.
Please do not be afraid of Hospice or morphine. If she is actively dying, it's best she be comfortablem
forbes.com/sites/michaelbell/2013/01/10/why-5-of-patients-create-50-of-health-care-costs/
which states, "According to one study (Banarto, McClellan, Kagy and Garber, 2004), 30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with 1/3 of that cost occurring in the last month of life."
AND from this link:
cbsnews.com
"Every medical study ever conducted has concluded that 100 percent of all Americans will eventually die. This comes as no great surprise, but the amount of money being spent at the very end of people's lives probably will.
Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients' lives. That's more than the budget for the Department of Homeland Security, or the Department of Education. And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked."
I sympathize with you for your loss, but you must come try to come to terms with the fact that your mother could not live forever and is now in a better place.
And no one needs to be told to read anything before signing. This is in fact one of the problems with online shrink wrap agreements; people don't read the terms and conditions of websites they use.
If you were pressured, all you had to do was tell them to take a seat and you'll sign only if and after you've read everything. You have no legal obligation to sign w/o reading, and in fact it is your legal obligation to read everything you do sign. It's called "informed consent.
I do it every time and make people wait until I've read everything, regardless of whether they like it or not. If they make a remark about the time required for me to read everything, I hand them the papers and tell them I won't sign without reading.
We each have rights but won't enforce them if we allow ourselves to be pressured into signing something without reading.
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When my father died I knew that it was what he wanted. To resuscitate him would have been cruel. OTOH, my mother does not seem to be ready to let go of life. The trouble with advanced directives is that they are signed before the reality of the situation is at hand. People can sign them for a future time without giving it a thought. So there is the big question, if there are advanced directives that read no one should be able to contest them, should we try to go against them if we don't think it is what they want.
I guess we could just not tell the hospital that there are advanced directives unless we are sure.
to me watching my Mom, knowing in her lucid moments which at the time were very few, that she was probably thirsty and so on. I would imagine her thinking why are they doing this to me. But in retrospect I don't believe she was thinking much of anything. However I was suffering big time watching someone I love wither away.
There is no easy way to let go of someone. She has been gone almost six mths. now and it still feels like it was just yesterday. I think they should have courses that teach people how to let go.
They used to just show rosey pictures of childbirth, too. Life, death, birth; they are all messy and painful. I'm all for making things better through science.
When my Mom was in the hospital during her last days I was amazed how a person could linger for so many days without food or water. As was explained to us if they gave her fluids she would be like a bag of water cause her kidneys were shutting down. She could not swallow and her living will had specified no feeding tubes or any artificial means to keep her alive.
So it seemed cruel and inhumane not giving her food or even water but what was the alternative. The morphine was probably the most humane thing they did give her at that point. At least she was not aware that she was starving.
I think it was harder on the people who loved her than it was on her. When deciding what to do for our loved ones maybe thats something to keep in mind.
What would you want if you were them, not what you want.