I'm not sure if any one else is experiencing this but I hope they are not. My mother receives Hospice Care at home usually 1x weekly a nurse may or may not come by to take vitals. I live in a different state than my mother and my sister lives locally to her but works full time and has young children. My mother has stage four COPD and an eating disorder along with mental health issues (Depression/BPD/Severe Anxiety). Shes had triple bypass in the past as well along with fibromyalgia and several other uncomfortable ailments. My sister is her medical POA in this scenario since she is local however my mother really isnt of sound mind to make any medical decisions on her own in my opinion.
Today being a great example of neglect within a hospice program, my mother began texting me incoherent letters earlier. I called and was able to get her on the line after a few tries and she told me she was having a heart attack/severe chest pains and needed help.
I called emergency dispatch because regardless of heart attack, panic attack or even an unintentional O.D from pain medication the fact that she weighs 80lbs any of these things could result in death. The EMTs said they were required to call her hospice care and ultimately her hospice care said they would dispatch a nurse immediately instead of her going to the hospital despite the fact that she clearly needed a blood panel and/or EKG.
My mothers aide that she gets twice a week arrived and noted that she was very disoriented. My sister left work and sent videos of her state which was devastating. She called emergency dispatch again. The second EMT spoke with her hospice center(3 hours after they said they would send a nurse) and they said they were "too busy to send anyone". The EMT noted that they were rude/abrasive and dismissive and that he had never experienced that kind of exchange before.
Once we got my mother to the hospital the misconduct continued. They contacted her hospice and relayed to my sister that they think she probably just overdosed and that she has a DNR so there isnt much they can do. They put her in the waiting room. My sister relayed that my mother isnt of sound mind to be signing DNR's or anything medically which is why shes power of attorney and that she never agreed to a DNR with hospice or the hospital system and they behaved like thats irrelevant? They are treating her like absolute scum. My sister is sending me videos of her in the hospital waiting room falling over herself and screaming "help" and then forgetting where she is.
I'm just sickened. I googled it and there are so many articles about neglect. One even showing a study of hospice in which over 400 facilities surveyed had 1/3 of their patients die without having seen a hospice nurse for over 48 hours prior.
How is this legal?
The client was getting all of her care needs met and then some. We took excellent care of the client. Far superior to anything she would have received in a care facility. Even a high-end one.
The hospice at home social workers were beyond useless. They were supposedly there to help me. Yet, the one thing I actually needed this fool's help with, she couldn't do.
Sit with the client while I go to the store. Or take the list and go to the store for us.
Sorry, but when you're the person a hundred percent responsible for the care of a total invalid and their home, one does not have the patience to entertain useless social workers and make them feel good about themselves. If anything these people were just in the way.
This social worker was there three days a week and at my disposal. For what? All she did was sit on the couch and look at social media on her computer. That was it. Nothing else.
No, your client according to your own words WAS NOT getting good care from hospice.
Not getting needed supplies falls under bad care.
Your problem is you take everything said as personal and quite frankly, that's arrogant. It's not about you.
You're spot on about hospice and APS walking hand and hand. I was flabbergasted when one of the nurses threatened to call APS on me. That was absurd.
I remember them being very hot about there being 24 hour care at the client's home. They were extremely intrusive and rude to not only myself and the second shift caregiver, but to the out-of-town family as well. They are of the belief that everyone owes them an explanation for anything they ask. No one does.
Dealing with them got to the point where I had to throw down the gauntlet with my client's son. I told him either they go, or I would and my girls follow me. He dropped hospice at home. His mother lived another three years after they'd gone.
Please don't insult me by insinuating that I left off telling the hospice people to get on with the diaper and Boost ordering. These were the most important things in the house.
My client was completely incontinent and diaper dependent. The Boost nutrition shakes made up about 85% of her diet too. We all knew that these things had to be stocked up. Since the hospice people only came in the daytime hours and weekdays, they only dealt with me.
The nurses always claimed they put the orders in, yet the diapers and Boost wasn't getting delivered. I had to make a care decision. I could have just left it alone being Friday it wouldn't be my problem until Monday. Leave the CG after me with no diapers and no Boost but I figured that would be a lousy thing to do to a co-worker, especially one who's a friend.
The hospice nurses were quick to get on my case and threaten to call APS. Not too quick to make sure the supplies were in. For some asinine nonsense reason or another they kept sending a social worker who was evidently there for me to make sure I was coping. That jacka$$ had to be paid as well. I told her to stay out of my way because I had plenty of work to do and couldn't entertain her at the same time.
AlvaDeer is right. A hospice patient at home with good insurance is a cash cow. Imagine that. A social worker being sent three times for me. Very useful. She wouldn't go to the store if we needed something and wouldn't watch the client while I went. Completely useless.
Maybe, instead of insulting the SW, you could have engage their assistance to ensure the client was getting their needs met. Because it is never about the paid caregiver.
My sister wasn't provided any food or nutrition through hospice, that wasn't part of their services.
We did have to make sure someone wasn't dropping the ball occasionally, they do after all have more then one person they are caring for and we all make mistakes or get overwhelmed on occasion and need a friendly reminder.
Take it however you choose burnt.
You well may be looking at the end here, bubs, and I feel awful telling you that. I hope doctors are leveling with you. I think a ventilator may simply prolong your Mom's torment.
You and Sis have hard decisions coming I am afraid. I would make them the best you can knowing what her overall opinion was of how hard she wished to fight, of what she was willing to go through to buy more time, given that she is not recovering well, and with COPD she may never be able to do so. In fact, with the smoking, I can say she will not.
As a nurse I fear death NOT AT ALL, but the torment involved in trying to live but a bit more time in torment? That I fear with all that's in me.
I am wishing you good luck and thanking you for the update and am so sorry for all you are enduring, and your poor Mom as well.
As of now the doctors have determined that my mother has sepsis and have moved her to the PCU. Her medication came up in blood panels (Methadone/Xanax) but levels were not provided to determine if she took more than what hospice was prescribing. She is more lucid than she was yesterday but very much pushing the narrative of wanting a DNR/Hospice for her meds. The doctor relayed that he did not believe based on his discussions with her that she grasped what a DNR means (she thinks its strictly life support/ventilators) or what hospice is.
We are in a tricky transition period where my mother has several days where she is fine and can be independent but slowly and surely more recently there are days that are indicative of what is to come. (Shes 62). I caretook for my grandmother but she was not on any programs like these and ultimately she ended up with C-Diff from a hospital visit and was in rehab centers for the last 7 months of her life when she was at her worst.
I feel pretty helpless in this situation. I am in my early 30's and own a home with my fiance in a different state where we all grew up. My sister relocated over a decade ago and a few years ago when my mother was in better health after my grandmother passed she decided to move down there to get to know my sisters children better.
I feel a deep moral responsibility mixed with my real adult obligations and commitments I've made here. I love my mother and have dropped my life many times in the past to accomodate her needs. Financially, this doesn't seem to be an option as my spouse cannot afford to manage our mortgage on his income alone and my job is very demanding and centralized here. Long term I could find something more accommodating near her to try to help but my spouse would not be able to come and I have a commitment with him also. I'm very conflicted about what to do.
We live basically pay check to pay check. My sister does as well and while she is local to my mother her job is not remote, she has a 45 minute commute and a 4 year old and 13 year old child. Her husband is not very supportive or helpful but she loves and does as much as she can. She goes there every day after work. My mother has a "roommate" who was an old friend of my Aunt who passed away. Their relationship is rocky but she refuses to evict her despite the fact that she will absolutely not help in anyway financially or physically. The whole situation is very unfortunate.
With limited incomes and limited availability it feels like one or both of us will need to sacrifice our lives to accomodate future disintegration. My mother has COPD and still smokes, which we loathe. My sister has offered to move in or stay with her more often if she would quit especially with an oxygen concentrator in her room but she refuses and my sister is fearful of bringing her daughter into that environment often.
I know NONE of what I am saying has to do with misconduct or elderly abuse any longer I just feel very overwhelmed. I told my sister and my mother I would relocate her back up with me (something im sure my fiance internally wouldnt love) because I am confident that if she was in my home I could provide her with a better more comfortable life than what she is experiencing there, but she refuses because I am more firm than my sister is and she knows she wont get away with the negligence here under my care.
I really wish this wasnt such a red tape scenario to be able to have insurance and social security cover someone to come out more consistently to administer her medication as this is the main issue it seems.
This could account for the ups and downs.
Niether drug you listed can be cold turkeyed without serious withdrawal issues. Feeling like you are having a heart attack being one of them.
I would question whomever is helping with the meds, because the levels could be low right now because she has run out. Taking to many earlier in the month.
Sometimes we have to step away for our loved ones to get the help they need.
I recommend that you and your sister stop bailing her out of her consequences. She needs professional intervention at this point.
I know that is hard to do, especially when you don't really know what is going on because of all the gaslighting your mom is doing.
Best of luck getting this sorted out.
PS: your mom isn't elderly, maybe she's worn her body out but, lots of posters here are older then her caring for their loved ones.
I think like any other business, there are good and bad. There are good and bad Nurses and aides too. Sometimes you wonder why they chose healthcare because aides make nothing. Nurses...my daughter has done well.
Thanks for the update. I too wondered why the EMTs called the Hospice. And as you said the DNR can be overridden. The consequences are, Hospice drops you. I would fire this Hospice and ask the Hospital for some recommendations. Hospice can be a God send for some. Especially when Depends and precriptions are included.
The one thing that bothers me is the aide maybe dispensing medication. Certified Nursing Aides (CNA) are not medically trained. In my State they cannot do pill planners or hand the client medications. They can remind or maybe hand the client the pill planner but they cannot hand the client the pills. They are certified thru the Nursing Board. There are medtechs that can hand out pills. I worked for a VNA and the Nurses were the only ones who could do the planners and hand out the meds. My daughter as an LPN could to. Every State has there laws. So this would be a question for the next Hospice, are their aids trained to dispense meds.
Hospice at home is another other story.
I've been an in-home caregiver for almost 25 years. I've had many clients get put on hospice at home care. I cannot recall even one positive experience working with them. The best I can say about hospice at home is sometimes you'll get nurses and social workers who don't get in the way and make it harder for the people who provide actual care to the patient.
Here's how they can be dangerous.
I was working a full-time private care case for an invalid with advanced LBD. I had been with this family for many years and even brought in some additional help when it became necessary. Top-shelf, experienced CNA's that I personally vouched for to the out-of-town family.
I went away for five days and my girls had no problem covering my hours together. I had not had more than a two-day weekend off in over four years. During this time the family allowed hospice to set up in the home. I came back and my client who never took anything stronger or needed anything stronger than a Tylenol, in five days time needed to be pumped full of morphine, liquid lorazepam, halidol, and klonipin. Hospice having "instructed" my girls to start giving the client these drugs. These serious drugs. I was the only caregiver on the job who is trained to handle medications. I called her doctor and son. Her doctor was enraged and rightly so. Her son was indifferent. His concern was saving her money and Medicare was paying for hospice and for whatever hospice brought in.
It was their job to keep the house supplied because hospice decided I was no longer allowed to supply the house with the things we've been using for years. This was an even bigger joke.
The client was diaper-dependent incontinent and pretty much lived on Boost nutrition shakes. These two things had to be there at all times. They ran out. Hospice assured me that they ordered it. What to do in the meantime? Let the patient starve and mess the bed ten times a day? They don't think. A neighbor came to stay with her and I went to the store. Hospice came and threatened me with APS. I handed that b**ch the phone and told her I'd dial the number if they'd like to explain who's putting the client at risk here. They never called, but this is what you deal with when hospice comes into a house and there's no one there to keep them in check.
To many people think they can let items get to the last one and expect hospice to provide it right now. Then when they aren't able, hospice is the bad guy.
We had to call a couple times for a few items, we knew that sometimes people are busy and mistakes can happen, so we took the responsibility to make additional calls before it was a crisis.
Not every hospice is run by incompetent boobs. It is our responsibility to ensure our charge or loved one is receiving the best care possible and not being left without items they need. If they aren't stepping up and taking care of business then a new hospice provider should be found.
Hospice is not the same everywhere it seems.
My experience with DH aunts hospice is somewhat different from what is described here. I’m not sure why my experience is different but it could be that you and your sister were not given the information the other posters all seem to agree on. Nor was I.
My DH Aunt has dementia. She is on hospice for dementia. Anything else she or I, as her POA, want treated is fine to treat. She can go to the hospital, urgent care, her geriatrician etc as needed. If she goes to the hospital for dementia, she is off hospice. But, can go right back on. All it takes is a phone call.
She has been on hospice for over two years. I was asked by the social worker if she had a DNR. She does. I was told AFTER she became bedfast (probably a year later) that she needed someone with her 24/7 which she already had. It was never mentioned before that.
My reason for placing aunt on hospice was for extra baths not because she was dying. It was explained to me that since aunt had a terminal illness she was eligible for these services.
I am surprised that the nurse from your moms hospice didn’t respond. Horrible. That the EMT seems to be in touch with the hospice. My EMTs would not know aunt was on hospice unless I told them. Maybe you or sister told them? But you shouldn’t have to keep that secret. If your mom has not been declared incompetent it may be perfectly legit for her to be home alone. In your case, it doesn’t sound like a good idea as while mom may not have been treated for dementia she clearly can’t make good decisions for herself. But to be refused service because hospice said so. Hard for me to comprehend.
I have never been told that hospice = DNR. It makes sense to me, but again, never told that. In fact I’m reading that Medicare does not require a DNR in order to receive hospice but some hospice companies do require it.
The action of this hospice does not sound like a group committed to keeping your mom comfortable. I would change hospice organizations. Obviously they are not all the same. You have to remember that these are private businesses and while they receive their compensation from Medicare they are not government owned or ran. I’m sorry she went through all this. She needs someone to watch after her and I know that can be very difficult to arrange. Also remember that your mom is in decline. What she is able to manage on her own one day can be totally different the next. Your sister needs help managing your moms care.
Hospice seems to me to have broadened their scope of care. I say this because of the difference between what I have experienced and what is reported on this forum which I’m sure is their experience. It is no longer only available to people who are in the last six months of life. It seems more like it is for people who COULD die within the next six months. I don’t think there is any altruistic motive on the part of Medicare but an awareness that it is less expensive to take care of those who are in their final days at home rather than multiple trips to the ER and hospital when their condition is known to be incurable. This hospice you describe Bubs doesn’t sound like they are operating in the spirit of the intention of hospice.
My uncle, who lives a couple of hours away, is on hospice. Not the same one as DH aunt. During July, 2020 he went into the hospital twice for COVID. Because the hospice organization didn’t have a contract with the hospital (their words) uncle went to, he was taken off hospice each time he was admitted and placed back on when he was discharged. It just took a phone call. They said If uncle had gone to a different hospital, one they had a contract with, he would not have had to come off hospice. No one said don’t you know that you will be dead in 6 months and shouldn’t go to the hospital! That will be two years ago this July. Uncle is still on hospice and still alive.
She told me for a time, not all that long ago, the program did allow patients that had no 24/7 support into the program, but it became rife with problems.
First was the logistics of being able to gain access to the residence, especially as the patient progressed towards transition. For a time, they were allowed to use a realtor-style key lock box to be able to gain access. But that led to problem two, which was allegations by family members: allegations of abuse, neglect, and most often theft. The program was being sued so often by family that it became untenable.
The third issue was really the one that drove them to change policy. The staff was walking a very fine line between providing services, and their responsibility as mandated reporters to APS for vulnerable seniors living alone. As I remember her putting it: "you're not much more vulnerable than when you're dying." At times, just to cover themselves, they had to report to APS, and when APS responded, often the dying person was transported to the hospital - which is exactly what having hospice is trying to keep from happening. She said that a lot of the staff were having some serious moral dilemmas in this process, with some feeling like they were "betraying" the client and their family, while also feeling like they were failing in their duty as mandated reporters. She said that insisting that there was 24/7 support took that onus away from the hospice staff.
Actually, in all of the home health services that my mom received, hospice notwithstanding, there was always the rule that another adult had to be there at least for the duration of the patient receiving the services. At the beginning, I figured it was just a sort of CYA scenario, until the LPN gave me all of the background.
Vitas is part of Chemed. Their other division is Roto-Rooter, which pays their employees literally zero for drive time or estimates or callbacks on other people. It's mostly commission and the big payday comes when the employee gets a customer to pay more and more so that the employee can eat. By that time they are done feeling bad about it.
Injecting the Roto-Rooter attitude--this was Chemed's first business--into the business of caring for dying people is frankly scary.
You guys will be in my prayers.
Granted she needed a POA far before, it was just something we had a difficult time getting into place. My sister was not vetted and her hospice care (Vitas) never vetted either of us on anything despite many attempts to get clarity on the circumstances. They have changed nurses on her so many times we literally could not tell the EMT the new nurses name today when they arrived. We have had weeks go by where they do not dispatch a nurse to come out.
My mother has been in this program for well over a year and I believe in her eyes mentally she assumed it was more like an at home care program as opposed to hospice... I implored her when she began the program to get off of it. While she is very sick and uncomfortable her time is difficult to gauge as her vitals are usually pretty stable despite the ailments.
I appreciate all of the information and absolutely agree that I was misinformed when I wrote out this post. I do still believe that the practice in which they have a hospice patient suffering at home and uncomfortable, and don't dispatch someone to make her more comfortable is still misconduct.
I am seeing many comments that are saying that a DNR is always in place with hospice- however my issue was once my mother arrived at the hospital with my sister who is power of attorney and acknowledged that she wanted to revolk the DNR if she was having a heart attack as my mothers only wish is to not be put on a respirator, the hospital said they would consult with hospice as opposed to cancelling the DNR. From what I've researched thereafter my sister would have the legal authority to cancel it without the review or consent of the program.
My sister and I will review and try to find her a smaller hospice program or get her out of it entirely and move her to at home care. The hospital has since performed tests and said that much of her behavior is brought on from what they believe is an overdose but she was only given her normal prescribed dosage according to her aide that was there today. Her aide did mention that hospice changed her meds this past week so this could be the issue. They also mentioned that they shouldnt have her on oxygen 24/7 because she isn't exhaling enough of bad CO2 after getting results of blood gas back.
To receive Hospice a DNR needs to be in place. A doctor signs off on it as does the client or their POA. In your situation, thats your sister. On Hospice you are told no extreme measures will be taken so no hospital. If you do opt for a hospital, Hospice can discharge the client.
If you nor sister can be with Mom 24/7, then you either hire some one and that would be at least an LPN because CNAs cannot distribute meds unless Medtechs. This Hospice should have trained a family member on how to distribute meds. You can place her in a NH under Hospice care or place her in a Hospice house. But, the cost of the facility falls on the client. Medicare only pays for the service.
I just reread your post. If your Mom had complained of chest pains while a nurse was there nothing would have been done but give her morphine for the pain. When someone is receiving Hospice its because the doctor's have said there is nothing more that can be done. The person is dying and now comfort care is needed and Hospice is recommended. The person has agreed that no extreme measures will be taken to keep them alive. If they stop breathing, they will not be resuscitated. If they have a heart attack they will not be rushed to the hospital. Hospice means the person has chosen no life giving measures and is ready to die. If you are not ready for Mom to die then take her off Hospice.
The hospital was right in what they did and so were the EMTs. There was a DNR in place. It looks like you nor your sister understood how Hospice works and I am sorry for that.
There are no life-saving measures once a person is enrolled in Hospice. Life is taking its natural course. By enrolling a loved one in Hospice, the family is taking them home to live out their final days/months. Hospice will provide comfort care to ease the patient and their family through the end-of-life transition. An in-home caregiver (often the family member) may need to be present at all times to help with meals, medication management, toileting, etc.
When you see your loved one suffering, it is natural to panic and want to ‘save’ them. But that is contrary to Hospice care. Nevertheless, the POA can revoke the DNR (and Hospice) and demand medical attention. The patient may be suspended from the Hospice program but can reapply later as circumstances change.
The rudeness of your Hospice on-call medical team added to your stress and concern. A 24/7 nurse should have been dispatched but keep in mind that the nurse visit is subject to availability. Your sister, as POA, can file a report about a rude employee, but I don't see any abuse in what you've stated. Contact the patient advocate of the hospice agency or tell a Medicare beneficiary ombudsman that you'd like to file a complaint, and he or she can help you.
Hospice, I am sure you know, is END OF LIFE CARE. That is, Hospice comes in when the end of life is expected any time, and almost certainly within the next 6 months. Hospice comes in only when it is recognized that the end of life is the expected outcome, and that no further treatment is wanted. This is/must be signed by Mom's MD with her accepting (if she is capable of decisions) and the family aware. MD and Hospice explains all this to patient and to POA and signatures are done. Hospice patients are ALWAYS DNR. They may be treated for comfort care (low oxygenation, choking, painful UTIs, pnemonias that cause choking and distress and etc.}
It is very unusual to ever transport a patient who is on hospice to the Hospital unless there is a great deal of suffering that cannot be alleviated by administration of hospice medications.
I am afraid that both you and your sister don't fully understand Hospice care and it is time now for a zoom call meeting or something other. Your Mom and the two of you need to understand Hospice Care. It is an option. No one forces someone to accept hospice. But if you DO accept hospice it is with the realization that the next step is not further testing, further treatment, further hope of a cure. Hospice is end of life care.
I wish you the very best. You will have to communicate with all best you can. I recognize how hard it is not being there. There is often a lot of misunderstanding.
And yes, many hospice patients die without an RN there. RNs would be there only to administer meds. In most cases family is trained in the administration of hospice medications such as morphine, and etc.
So sorry for all of this pain and frustration. You must discuss with hospice, if you choose to keep the service, what to expect in future.
And no, there was nothing illegal in what you explained to us.
My best to you. Clearly Mom is very ill and you and your Sister in great pain. I am really very sorry, but it is crucial you communicate with and understand Hospice, and whether to keep them, or to keep DNR Status.
In its most basic terms, Hospice = DNR. They are there to help with end-of-life, not to treat emergencies and prolong life. If you go to the hospital, they take you off hospice, because that's contradictory to what hospice is for.
I would definitely get another hospice company lined up (choose a smaller one if you're with a large one, or vice versa). Once you decide on another company, they should take over contacting the first company and arranging the transfer of your mom to their care. The first company will take all the medical equipment they provided (bed, commode, etc.) and the second one will bring all that stuff back in, ideally within the same time frame.
I had to change companies with my dad because Vitas (big company) was TERRIBLE. To their credit, though, they worked with the new company (a small one), and I only had to put my dad in his old bed for 45 minutes while everything was changed out. He wasn't inconvenienced at all.
Nevertheless, you and your sister (especially her, since she's the POA) need to understand how hospice works. All three hospice companies I worked with (I used them for my mother as well) had lengthy conversations with me to explain how hospice works and answered all my questions. Do not sign anything you don't understand, because you need to understand what's going on. Take advantage of the social workers they provide, as well as the support for the family, because it truly helps.
That said, who was with mom when she was signed up for hospice services? Since she isn't of sound mind, this was not something she would have been able to agree to of her own devices; her POA/DPOA would have been the one. Was it your sister?
Hospice should have explained to you that, while the patient is using hospice services, unless the patient is in a hospice facility, the FAMILY is 99% responsible for the patient's care. At home hospice DOES NOT provide 24/7 care. Does your mom live alone? If so, I'm actually surprised that hospice even agreed to take her on as a patient within her own home, if there was no 24/7 home support. My mom's hospice was extremely clear about this - without 24/7 support in mom's house, she would have to either move into a hospice facility/nursing facility or in with a family member in order to receive services.
I think you - or your sister - is either getting conflicting information, or didn't understand the mission of hospice. You say: "My sister relayed that my mother isn't of sound mind to be signing DNR's or anything medically which is why she's power of attorney and that she never agreed to a DNR with hospice or the hospital system and they behaved like that's irrelevant?" When mom was signed up for hospice services, they almost assuredly had her/POA sign a DNR. I strongly doubt they would have taken her as a patient if one was refused.
Hospice is for patients at the end of their life. It is to make them comfortable, keep them free from pain and anxiety, and keep them home if it is at all feasible. It should have been explained to you that, while in hospice, the patient/patient's representative is agreeing that they don't want any life-extending procedures. It should also have been explained to you that AT ANY TIME the patient/representative wants to terminate hospice services, that is 100% ok; the patient/representative can seek life extending procedures after they leave the program if they wish. And if they then decide to come back to hospice, they will be accepted back into the program.
If you are unhappy with the current services, you have the option to switch hospice providers, or to stop the services altogether. But regardless of what you choose, it doesn't sound like it's safe for mom to be living alone anymore, if indeed she is.
I hope you can come to a decision that is best for mom and brings you all some peace.
Understanding this will help you understand why your mom has a DNR and EMT wouldn't respond without speaking to hospice.
I would definitely find a new hospice provider. One that isn't to busy to respond to their patient.
It sounds like your mom isn't able to self medicate anymore, which means bringing a caregiver in or going yourself to be there and administer medication.
If there is one thing that was reinforced to me while reading this thread, is that Hospice is very different from location to location, agency by agency. In Florida when my mom was dying of Lung Cancer, they only came in when it was determined she had reached the end stages, meaning today, or next week. It was less than a day. Looking back, by the end we had found amazing private care givers who lived in home and my sister and I were able to be there with my mom in her last hours. My mom went from diagnosis to death very quickly. Perhaps the "perfect way to go". She was able to make amends with some people and be surrounded by loved ones, but did not suffer extensively for months or years.