How can hospice be so certain a person only has two weeks or a month left?

You're overattentive watching every reaction of your mother, because you don't want her to die, and keep hoping for a "miracle" that will allow her to stay longer with you. You're caught in a turmoil of emotions and can't expect to be objective and realistic. That is understandable and many families go through the same unpleasant experience. Hospice's staff deal with people dying every day, so they have become experienced at that. Like nurses in the delivery room of a hospital, who can predict pretty well when a baby will be born. I'm sorry for your impending loss. Sooner o later it affects everybody. It's something we all have to learn to live with.

They predict by scientific knowledge for the most part. The breathing you mention has a name and they will explain it to you if you ask. It is called "Cheyne-Stokes breathing" and there are deep breathes, then a period of apnea when the patient isn't breathing, then another deep breath, and in a repeated pattern. Signs a life is in last stages are online if you are interested, including cooling and mottling, discoloration of lower extremities and so on.
Morphine is given to both assist in breathing and to medicate a patient to a level below the level at which we feel pain, even below the level of breathing, so that the bodies seeming struggles for breath and so on are not felt by the patient. That's the blessing of hospice. While hospice medication may mean an earlier death by some minutes, hours, even days, or not can't be known, but there certainly is less struggle for the person.
I am sorry for your loss. No matter the number of year, the amount of a good life, it is still painful to lose those we love and we all grieve differently. Only time can heal our loss and make our memories fond and happy rather than sad.
Continue to speak with Hospice. They are generally very good to answer questions. If they tell you things like "She is transitioning" then ask them to explain to you how they evaluate these things scientifically.
For myself as a nurse I am grateful you have given your Mom this relatively peaceful death; I hope in time you will recognize the great gift this is.
As to how long your Mom can go on like this, that is as individual to her as her own thumbprint is. No one can be certain; we read the signs we have learned and we make "educated guesses" and that doesn't really address grief and loss.
I wish you the best. I feel my Mom and Dad with me throughout my life, and I am 80, still seeing the world through their lives, still celebrating them. Your Mom will be with you always while you live. I know that doesn't address the grief; allow yourself this grief, for a life is worth grieving as it passes. Your Hospice can guide you in seeking grieving support and health ongoing. Their job doesn't end at the end of your Mom's life. They will contact you. Ask them for support.

Speaking for the four hospices I’ve become familiar with, there has never been any predicted time or date.

My present LO has been “on hospice” for over a year. She was placed on hospice because her level of care warranted it.

My mother was placed on hospice when she began to refuse food or water, and soon afterward lapsed into agitated semi consciousness and then morphine was administered.

No morphine so far with my current LO. She is peaceful and relaxed, in spite of general physical deterioration.

I am totally in sync with your question. Those of us who love her expect “the call” at any time, painful to us for sure. Sometimes it seems as though nothing is easy in this world.

Hope it helps just a little for you to know that even if your question can’t be answered, at least it can be compassionately shared and u derstood.

Pnemonia of any kind is serious in a person your Moms age. Its one of the 10 top causes of death in the elderly.

"she is not responsive, not eating, taking in very little liquid" this means her body is shutting down. The antibiotics were stopped because once on Hospice no life prolonging medication is given. Hospice is for comfort. Morphine is given for pain and ease of breathing. Aspiration pneumonia is caused by not being able to swallow correctly. The food and liquids go into the lungs causing pneumonia. Not being able to swallow can be a sign of the body shutting down.

Why do you notice these things and no one else seems to...I have no answer to it. Why when my Mom was in the Hospital with a UTI was she sitting up and talking one day and the next she couldn't eat her breakfast because she was out of it, why didn't someone notice that. Why didn't the nurse coming on duty after 2 days off read Moms chart and think "this woman can't be released today because she has done a 180." This nurse actually asked me what I thought she should do and I told her call the doctor and tell him Mom has done a 180 and in no way can be released. It was found Moms antibiotic had penicillin in it she was allergic to which was in the Hospital records.

You Mom is 93, her body is giving out and it is a long process. Mom started shutting down 2 weeks before her death. I suggest you don't sit with her all the time. Get out of the room. Go home to rest. Because...you may go to the bathroom and when u come back they are gone. With my Mom it was bringing my nephew to visit. We sat with her for a while. He held her hand and talked to her. I sang her favorite hymn. We left at 1:30 pm. She was pronounced at 1:50pm. Nurse asked if nephew was the last one to say goodbye, I said yes. She said she sees it all the time, they wait for that one person that hasn't said goodbye and when they get there or hear their voice, they pass.

Take this time to tell Mom you love her and you appreciate everything she did for you. Tell her is allright to let go, you will be fine. If she has faith in the hereafter, tell her she is going to a better place.

Hospice takes a more 'matter of fact' approach to the signs that end of life is approaching, which you call 'cold'. To hospice, they see this day in and day out. Versus you, who sees this once, twice or three times in your life. To them it's old hat, to you, it's your mother who's dying. I feel your pain, b/c I just went through this very thing with my mother who was on hospice for 2 months and 1 day before she passed away kind of 'unexpectedly' at 95 years old. Which sounds rather idiotic, to say she died 'unexpectedly' at 95, but really, she was laughing and talking to the other residents, and eating her meals, too, the day before she went into her bed, and became semi-comatose,. And then she passed away on the 8th day thereafter, without further ado, it seemed like. She was in no pain, I KNEW that, b/c if she was, her blood pressure would have been very high, she would have been grimacing, and things of that nature, which wasn't happening. That's the signs of pain & struggle; if your mother is not having those signs, then you know the morphine is working and she's not feeling pain.

They are half on the other side and half here, when they're transitioning, is what's happening. I've heard the hospice nurses tell me that twice now, when mom was dying and when dad was dying. We are struggling more than they are, by listening to their breathing and watching their every movement. I remember when my father was transitioning. I was looking at my watch and timing how long it was between breaths.......and I was holding MY breath waiting for him to take his next breath. Needless to say, I was about ready to collapse by the end of his journey myself. When my mom passed in February, I was more familiar with the mechanisms of the end of life journey, so instead of looking at my watch & holding my breath, I was rubbing her arm and speaking to her about how much I loved her and what a great life she'd led instead. I spoke loudly enough to drown out any struggled breathing sounds she was making. I knew that her soul had already transitioned to the other side to be with her family members who had all passed long before her.

I think we daughters know our parents best, which is why we can tell when something about them is 'off' a lot quicker than the staff can in the SNF or the Memory Care. I was practically begging hospice to take mom on before they actually agreed to, b/c I KNEW she was approaching the end of her life, even though hospice insisted she 'wasn't ready' yet in November. Meanwhile, she passed in February, meaning she sure WAS 'ready' in November!! It would behoove the 'experts' to listen to the family members more often than they DO, wouldn't it?

I'm sorry you are going through such a gut wrenching experience with your mom. I know how difficult this truly is, no matter what anyone else has to say on the subject. I also know that your mother will soon be at perfect peace, if she's not already, and for that you can rejoice and know that her suffering here on earth is over. For that I was extremely grateful on behalf of both of my parents; dad who had an aggressive brain tumor, and mom who had advanced dementia, CHF and several cases of pneumonia herself (one of which was aspiration pneumonia).

Sending you a hug & a prayer for peace.

No one will live long without hydration. Nurses know this, and based on her appearance and urinary output can estimate how dehydrated she is. At some point her kidneys and other systems shut down. This is how they estimate. Mom may know almost to the end that you are there but her thinking won't be clear and her ability to respond will diminish.

Mom isn't suffering, but you are. This is exhausting for her but should not be painful. It's just very hard for her to breathe, much less talk and move. Yes, it is hard to watch but it also gives you the time to talk to her, sing to her (if you are so inclined), confide in her, anything that will give you both peace.

She may also be very worried about leaving you. If you know she can't recover, she might need to be told that you will be OK and she can move on. Even if it isn't true it would be appropriate to tell her if you think this is the case. I had to tell this to Dad, and promise him I would take care of Mom. Then I kissed him goodbye and watched while he slowly took his final breaths.

Hospice is not alarmed by interrupted breathing or lack of response b/c this is part of the dying process. They will not be alarmed when she stops breathing completely. Dying becomes very real when you are watching it happen. It is distressing but it not something to be "fixed."

Once she stops eating and drinking, if she is not getting nutrition and hydration any other way (like through an IV or feeding tube), she will go.

The medical professionals are not always right, but are speaking based on statistics and their experiences.

The morphine will keep her comfortable physiologically and emotionally.

i am sorry for your pain. Stay near her if you can. Talk to her while you can. Even if she is not fully aware, you will be glad that you were nearby.

I experienced almost exactly the same situation with my sister on Jan1 this year. Aspiration pneumonia, sepsis and groin IV for antibiotics. They also said she may not make it through the night. She did. Back at ALF she wasn’t eating, drinking or taking meds. She was accepted into Hospice. Placed on fentanyl patches for pain, morphine every 3hours. That lasted a few months. Then She rallied. She is still bedridden, incontinent, has no idea of what’s going on, daily questions about our deceased parents. She said she has phone conversations with them often. Hospice now says she is no longer near death. She is moving into MC this week.

What a miserable disease. Thank God for the many great Hospice employees and all the good they do. They see death and dying and help us through that final journey. Only God knows exactly when.

If she is not breathing sometimes that is often a sign death is imminent. I’ve watched 3 of my loved ones die in hospice and death can be a struggle. It doesn’t always happen so fast. The hospice people have seen it so much they know the signs to look for. Usually they give you a lot of written information on what to expect so you can be prepared. I think once they have lost consciousness their suffering is minimal. And hospice is all about making them as comfortable as possible with the use of drugs. Sorry you are having to experience this. I found going through this with my loved ones actually helped me to be more prepared for my own death someday and fear it less. Also, please seek grief counseling or attend meetings such as GriefShare. It’s very helpful.

Witnessing the transitioning from life to death, especially of your mother, is terribly difficult. My heart goes out to you.

My mom died almost a week ago at age 96. Her ALF had recommended hospice about a month ago while she was still more or less ambulatory. She'd fallen a few times and was wandering some. Within a short time, she went sharply downhill, then within a week it was more like off a cliff. I got the call that she was transitioning and that it would be 2 or 3 days. It ended up being 4.

I've been through these several-days' transitions twice before, which really prepared me for what I experienced with my mother. The gasping breaths and the "wet" sounds made it sound like she was suffocating or drowning, and were hard to listen to at times. But because I'd seen this before, I knew it was part of the process of letting go and I was more able to roll with it. She had to do that work, and I'm enormously grateful that I could be there to help her with it: make sure all comfort measures were fully taken care of, talk to her, tell her I love her and that everything is okay, she doesn't have anything to do but rest, and hold her hand.

There are some specific signs that are very reliable indicators that the body and brain are unraveling. Hospice workers see it all the time, that's what they do for a living. I hope their delivery of this news was not what was "cold" - that would be unusual but not unprecedented. If the person speaking to you was uncompassionate, it might be worth letting the director know. The person might have compassion fatigue or be going through a personal difficulty, and need a break.

Shari49, I hope you're able to find comfort in some of these responses, whatever the current situation is. Grieving can start even before the loved one has passed; I hope you have plenty of support.

I have talked to nurses who want to recommend hospice for my wife. Yet when I see her doctor they are determined to make her healthy at any cost no matter how miserable they make her remaining life. She is confined to a bed and needs to be spoon fed and diapers changed. When does the insanity stop.

The role of Hospice is to provide comfort for an easier death. If you want heroic life saving attempts, your mom needs to be in a hospital whose goal is to prolong life with treatment like IVs and non life threatening doses of morphine. But that makes an inevitable death a drawn out painful affair.

What do you want for your mother?

Im sorry your mom and you are going through to this.

Other signs death is probably near, are cold limbs (fingers, arms, legs) and cyanosis ( blue purple color of extremeties, fingers, toes). This means oxygen is not getting to these parts. Also, decrease in urine,. Which can mean kidneys are shutting down.

Yes - they know because they do it “all the time “ as people have said here. They also know because the meds they give are helping to “ease the way” . I’m my moms case - she was ready to go - they took her off the meds that she was taking to help support her heart and her other infirmities and just had her on the ones to supposedly handle her pain and suffering . I don’t really know which exact medications and doses she was on because hospice only ever spoke with one member of our family .. and yes she was Medical poa but so was I . It was dual . I asked about having a meeting. The last I saw my mom she was sedated heavily - couldn’t open her eyes or speak to us , yet when she moved her legs and turned a bit my sis gave her some medicine which she said they had instructed that this movement was a sign of pain .(?) she was on morphine and I think Valium so not sure if that was both . One thing is also that my mother had always been very sensitive to any kind of medication such as pain killers or anesthesia which also generally made her nauseous so required antiemetics that didn’t always help. And she’s be very lethargic . Also , prior to hospice , she was only ever complaining of pain when she had pneumonia and her ribs hurt from the coughing - so I’m not sure what pain when was actually in. Also these meds depress respiration and they had reportedly been given pretty often . Anyway- her hospice also said that she was getting close to death one day - and that she likely had only a day or two . I live hours away - so had to pack , make hotel arrangements and pack for a stay to include making funeral arrangements - also a line of Severe thunderstorms moved in so the normal 4 hour drive was extended. Well , not only did she pass before I arrived (unclear but seemingly continuing to get doses of morphine)
, the mortician had taken her AND she had been picked up by the medical research firm that she had specified . So no opportunity for me to say goodbye though I had visited just that week , to no response from her. I have been told that she did actually have some coherent times but not when I was there. This haunts me and I feel that Hospice is at least partially responsible . They should have been aware that one child was not within short travel and not have given so much morphine . I can NEVER get that back . Yes I told her I loved her that last visit but I was not “saying a last goodbye . I think often giving of these medications is mostly a way of putting these elderly to sleep just a slower form or how they do for pets

As a nurse & caregiver, once your LO stops taking in food/fluids it's just a matter of time. Some of the signs we for are their level of consciousness, vital signs, urine output, & the beginning of agonal breathing (abnormal, irregular, gasping, labored breathing). The time frame depends on individual's health, it could be a few days to 2weeks. If on meds for diabetes, heart conditions, respiratory issues, the time is less because it caused earlier complications. Hospice will visit & provide you with meds (unless in a facility) in order to provide comfort, drying of secretions, & personal care to your LO. During this time, spend time with LO telling them that you love them, etc. as they may still hear you. Have family come to say their goodbyes. Spend time going down memory lane about your LO. This provides comfort to everyone. It will take time to deal with grief. Speak with family, friends, counselors, grief support group, pastors/priests, rabbis as needed. It doesn't go away, but you learn how to make it part of your life. I miss my parents and the recent loss of my nephew so much; they hold a special place in my heart. I was with all three in the time leading up to & at the death of my mom. Very difficult, but I'm no longer dealing with the severe grief that I felt at the time of their death. 🙏🙏❤️

I, too, am horrified that we show so much mercy to putting our pets down when they have no quality of life and yet, we do very little to show mercy to humans. I have looked into the "Death with Dignity" program and feel it will be the appropriate solution for me. I watched my mother die of lung cancer and my best friend die of esophageal cancer. No thanks, that stuff is not for me.

The short answer is they don't. It is difficult to watch because usually morphine is not needed. And some patients progress into dying better without it. At least that's my opinion and what I've witnessed. She could linger for awhile or she could go any minute. The key is to say your goodbyes and realize she's not long for the world. She probably will have one day or a few hours where she 'snaps out of it' and it seems like she's headed back towards living. Don't let that fool you. You're the only one noticing because you're closet to the person. And she could live awhile, but usually people don't. And it'll come when you least expect it.

When a loved one stops eating and drinking and does not get them through artificial means, those in medical care have a pretty good idea of how long until death. The body systems will start to shut down. The person will be less aware of their environment. At some point, a vital organ stops functioning and death ensues. How can they know? From so many statistics of those who have already passed from life this way. Since she has morphine, the gold standard of pain medication, she should be comfortable.

Shari49: Pneumonia is very serious in an elder. When the elder is not consuming food nor liquids, it is not a good sign, although a person can sometimes rally.

The hardest thing for me is when you cant talk to the dying person about the future.

theres no hope. Only loss. No “we’ll do” … only goodbye.

but these are the things WE face . Not the other person.

keep in mind your mother may be able to hear you, just not able to respond.

so talk to her about good memories of times together. Tell her before you touch her so she’s not startled. Kiss her goodnight and tell her youre going to bed. Tell her … anytime … that you love her.

When my father was put on hospice care, we were given a pamphlet describing the stages of death. He passed through several of them, and then suddenly died. Please speak honestly and fully to the hospice organization about these stages so that you will feel less afraid. From your description, it sounds as if your mother IS passing slowly through the expected stages. There is a lot of comfort to be had in knowing what they are.

Hospice can predict from past cases, but God and only God, has the final say. Enjoy her while you can. Suffering in slow motion is so difficult to witness. Hospice provides meds to ease the pain and provide comfort.

It is the job of hospice to help prepare patients and families for impending death. That can come across as cold and unfeeling, but they are generally pretty accurate in forecasting when death will occur, there are certain things that happen to people when they are going to die. Its not a perfect science and there can always be a miracle but this is there job so they are familiar with what it looks like. Death is a natural part of life. I like to compare it to a baby being born, imagine how scared that baby is when it enters the world, confused, brights lights, etc. But it has to be born to start it's new journey. Death is the same, it's something we will all go through but the ultimate step will be done alone. It's hard to know she may be leaving you soon and it's scary. This is a journey she must take, though. You know this or she wouldn't already be on hospice. Morphine can depress breathing but it's also helping her pain. Let her die with peace, love and acceptance surrounding her as she leaves this world and goes on to the next. We just borrow people for their time on earth, we dont get to keep them forever.

UPDATE: mother passed this morning. A true blessing. Thank you everyone for all your advice in walking me through this. I did sit all day with her, let her know how much I loved her, and I’m certain she is with those who went before her.
this forum has been invaluable to me, and will be, I’m sure, with my 97 yr old stubborn MIL I also care for.
Blessings to all

You were not the only one noticing her symptoms.
They are symptoms commonly seen just prior to death... including the irregular breathing. The purpose of hospice is to ease the dying process when death is imminent and unavoidable.

Morphine is given to the dying primarily to ease respiration (as well as for pain). Hospice should have explained that to you.

One is hardly ever willing to say a final goodbye to ones mother, ...no matter what her age. I'm so sorry to hear what you are going through.
Hospice will stay as long as needed. NO time limit. And they should be explaining to you the purpose of their care (comfort when cure is not possible) and emotional support for you at a difficult and often confusing time.
My condolences.

At some stages of hospice you really don't know how long it will be, but hospice workers are trained to recongize the stages of transition. I would trust their judgement in this matter. With morphine, your mother is probably not suffering. Do you know her advance medical directives? Does she want heroic measures to stay alive, or should you just allow her to pass peacefully in a natural way? Keep focused on your love for her and try to stay calm and help her transition peacefully and with positivity. Tell her that you love her and try to soothe her if she seems anxious. Generally when someone is in hospice, they want to transition peacefully in place, rather than in a hospital. Get grief counseling for yourself if you are not able to face that death is a natural end to life. Be brave and strong. All the best to you both.

Im not much help except to say it's difficult. My father was diagnosed with CHF October 2015. He had hospice care&passed 2/10/2016 on his 97th birthday.

Shari, I am so sorry for your loss.

I know it is a comfort to know she is with those that have gone before.

May The Lord give you grieving mercies, strength and comfort during this new season in your life

I'm so sorry for your loss.

Your mom is at peace