I think this is the beginning of the end.

I am a hospice physician. I would like to say that you are not eligible for hospice services unless you have a prognosis of less then 6 months. We consider the patient and the patient's family as the unit of care. We provide the a nurse, nurse's aide, chaplain or spiritual counselor, social worker and a physician to each patient and their families. We provide 24 hours day, 7 day a week access to care through a phone number you can call and any of the previously mentioned providers can be called to come out and see the patient or the family. We also provide 13 months of bereavement care for the family. Hospice comes to wherever the patient is located nursing home, home, personal care home, or assisted living centers. We are an extra layer of care. A RN nurse is assigned to visit the patient at least once a week and then a LVN nurse usually comes a second time in the week (At least in our hospice). Then a home health aide is assigned to come out and bathe a patient at least twice a week. Most want at least 3 times a week. If the patient is having a hard time they can receive a RN or LVN visit daily especially in the last few days of life. Also there is a free to the family 5 days of respite care for putting stable at home patients in a nursing home for five days of rest so family members can rest. The there is continuous care for uncontrolled symptom management and in patient hospice care for symptoms that can not be managed by in home continuous care. The last two mentioned are for very specific symptom management and it is highly regulated by Medicare. It is not to be used for normal end of life care. You also get a social worker to help you with end of life care from anxiety in family and patient to planning a funeral or placement in a nursing home. They make an initial visit and then as needed visits. The spiritual care worker helps patients and families deal with spiritual issues around the end of life. They meet you where you are and can sit and pray with the patient and his family or coordinate spiritual care with your chosen faith. They visit initially and then as needed and you can refuse their visit. All medications related to the primary hospice diagnosis are covered by the hospice as well as medications related to pain, constipation, nausea & vomiting, anxiety & agitation. Most people who are in the last 6 months do experience pain and so yes we are aggressive at managing pain because it is not fair to die in pain even if you can not verbalize that you are in pain. The elderly often express pain in worsening delirium which means they see, hear and react to things other people can not see, hear and react to. As you age all your organs age including your stomach and your ability to metabolize medications in your stomach decreases. So giving your loved one more medications actually makes the patients stomach work harder at digesting them. So this means that a lot of the drugs and vitamins actually are not getting metabolized and are diminishing the amount of any of the drugs that are getting into the patients blood supply. It has been shown with study after study that the elderly medically fragile (anybody in a nursing home and almost anyone who is older then 65 depending on the person) need to be on less then 9 medications and that means over the counter medications and vitamins too. And most people in the last 6 months of life have lost enough weight that they no longer have hypertension and diabetes type II and therefore either need less of those medications and/or no longer need those medications. Most people who initially come on hospice have a "honeymoon period" when we stop excessive medications and the patient actually wakes up and is more cognizant and aware of there surroundings. We do not start pain medications unless there is some symptoms or source of pain. Most people in the last few weeks of life have pain as their body start to shut down and their muscles contract. We do not want you loved one to die. We just want to make sure your loved one is actually cared for appropriately. If you do not want to believe that I will talk about the economics of hospice. We actually do not want to kill your loved one because that would mean we can no longer be reimbursed for their care. (Medicare pays a set amount for every day you are on hospice. It covers the pay of all the caregivers, the director of nursing, the administrator, the pharmacy costs, the secretaries, the answering service, the physician etc. ) We have patients with varying length of stays some come on and die with in a day others come on and die 3 years later. Our hospice (Silverado Hospice) has a physician visit the patient with in 7 days of admission, to make sure the patient is appropriate and indeed has a life expectancy of less then 6 months if the disease was to run it's normal course. (This visit is not required by healthcare law) After the first 6 months patients are seen by a physician ever 2 months to re-certify that the patient's has a life expectancy of less then 6 months is the disease was to run it's normal course. (these visits are required by law) If the patient's illness has stabilized then the patient is discharged from hospice for extended prognosis. (life expectancy greater then 6 months) Our hospice location in and it has a census of about 150-160 patients with about 50 admissions per month and 50 deaths per month. We usually have 3-4 patients that we discharge per month for extended prognosis. We are happy to readmit them when their illness progresses again and that happens quite a bit, usually 3-12 months later. Medicare has strict guidelines that must be followed so the patient has to show decline each re-certification period (within each 60 day period). So that is what hospice actually does. We do not hasten death in anyway.

GA I think the husband is going to be fine. He is angry about what happened but does not plan to do anything about it. As far as the bleed was concerned if she was being monitored properly there would have been an indication that something was wrong. Rapid pulse, low BP, restless, pale , thirsty. A bleed would not be normally anticipated with a simple procedure like that but of course anything unexpected can happen. You glance at a patient and see a change so the first thing to do is feel the pulse. This seems to be ignored these days but the feel of a pulse can tell you an enormouse amount. Bleeds tend to occur soon after the surgery for any case as the blood pressure returns to normal after being lower. The other time is about ten days after any surgery.

This is one time when I think there is some negligence involved.

I would think that protocol is never to ignore a cardiac alarm. I'm not sure about the internal bleed and what could or should have been done to ensure that there wasn't internal bleeding, but the cardiac alarm should have been addressed.

However, to pursue a case for a wife with MS might cause the surviving husband so much distress that it would only make his life unpleasant, bringing back sad and unsettling memories.

Still, I feel badly for him. I'm glad he has you and your husband's friendship to help him through his loss.

Such a sad story, Veronica. I hope your friend finds peace, and that you too can come to terms with it.

Heard some sad news last night. A man we have known for a few years came over to help hubby set up his new printer. The first thing he shared was that he lost his wife in Jan from a medical mistake. She had mid stage MS and was in the hospital. They had just placed a feeding tube and she was on a floor where extra care was provided. She was hooked up to a cardiac moniter and the alarm went off. Her nurse was in the room next door and ignored it because there had been other false alarms. When the nurse finally checked Mrs P was in full cardiac arrest from an internal bleed caused by the surgery to place the tube which apparently had been a simple procedure. Naturally it became a full code but she never regained consciousness and was brain dead for the next three weeks before she finally passed. Mr P seemed to have accepted his loss well but felt the hospital had been negligent.

I felt that in many ways he was relieved because he had been caring for her for many years during the slowly advancing MS. he shared that he felt the hospital had not tried hard enough because she was an MS patient, but he said she was still reasonably functional and probably could have lived several more years.
I have been thinking about it all day and it has made me feel very sad even though I had never met her.
It was the same with my own patients. Some of the deaths I just breezed through and others I cried all the way home

Stacey, that's such a touching story and post.

Dear Barbara, I am so sorry for the loss of your Dear Mother, but I'm happy that she is finally released from any pain, and that you will not have to suffer through a long and sad goodbye.

I love that you had some comedic relief there in the end, we had some of those with both my parents too, which is all so important, as life isn't all just suffering and sadness. I'm sure your Mom appreciated all you did for her always, and especially there in the end.

One thing that happened as my Mom was Actively dying, was that my 2 brothers had concert tickets to see Peter Frampton, and us 4 girls had to practically Force them to go, as they feared missing our Mom's last moments, but I'm so glad they did, as they heard a New "Frampton" song, and not at all a ROCK song, but one of loss and berievement as Cleary this old Rocker had been through the loss of someone close, and wrote about it. So our brothers came back from the concert with the CD and the song with them, and asked if we could play this song at her funeral. The boys played the song for our Mom, there in the Hospice Hospital, and it was so beautiful and appropriate, called "Not Forgotten". I had them burn the song onto CD for me, and I often play it in my car, when I'm all alone, so it is Mom's song to me, and I miss her, and will never forget her.

I know that you are extremely busy right now, funeral planning and dealing with your own loss and pain, but please know that I am thinking about you my friend, and praying for you and your family, and wanted you to know that I so appreciate your friendship, and hope that soon things will be better, as you find your new normal without the constant worry over Mom's wellbeing. I promise that you will eventually be able to remember her in the earlier years, before the Dementia and the pain and sufferings of old age. Take Care Love!

Wonderful idea to play music! I'm going to make a list and start getting CDS together; I think I might be facing a similar situation by the end of the year.

Strauss, Saline Fiddlers, Big Band and Mariachi music will be for starters.

Barb, it is so comforting to know that you were able to find peace for yourselves as well as for your mother. And use that music therapy for yourself over the next weeks and months, whenever you feel the need!

Go Team Mom, indeed! Ok, that story made me cry. I could only wish for loved one's to be so thoughtful when it's my turn. Well done, Barb. Truly well done.

Well done Barb. Go team Mom!

Dear all, please know how much comfort your words are bringing me today.

I need to tell you two stories, just so you all remember that life is a comedy that doesn't stop for death.

As my mother's breathing slowed yesterday, starting around noon, my cell phone rang. Ikea, which had promised to arrange a pick up of some recalled dressers wanted to come. In an hour. OmG!. I called my husband who was resting at home from his procedure yesterday. I now have three dressers worth of furniture on my bedroom floor.

Returning to my mom's room, my SIL (who you may recall, was not on board with hospice at all till earlier this week said " why is this taking so long? Pop ( my dad) it's time to come get mom!". I started playing my mom's favorite arias, from La Boheme, Norma, Turondot. We played Glenn Miller, Benny Goodman. Carousel, South Pacific. SIL'S phone and my tablet were blasting out Big Band, American Songbook, Puccini and Broadway by turns. We sent mom out on a cloud of song.

And after she was gone ( it was just SIL and I in the room at the time) and we had a good cry and a hug, we separated and said in unison "Team Mom!" and high fived each other. And of course, that's when my brother and our family friend walked back into the room.

They're going to be telling that story for years.

Barb,

I'm sorry for your loss but I'm glad your mom is free of her pain and suffering. My mom passed away in May and my 15-year caregiving journey came to an end at that time. I know I did the best I could for her, so I am at peace with her passing. I hope you can feel the same about your mom. You did your best and I'm sure she knew and appreciated that. {{{{Hugs}}}}

No more pain or fear for her. It doesn't make you miss her any less, but it's the main consolation. Hugs, and condolences to your family.

Barb,
So glad you had the day in the park with your grand baby to help carry you through the magnitude of mom's passing today - as Glad mentioned, so many losses recently and your words and counsel always a shining example

We sit with you in grief

Barb - my deepest condolences on the loss of your mother. I am glad she did not linger in pain or discomfort. My heart goes out to you and your family. You all have been a wonderful example of how to pull together in caring for a parent. Please be gentle with yourself in the next days, weeks and months. ((((((((((hugs)))))) Do come back when you are ready to. You will be missed.

The funeral was today for Phoenixdaughter's mother.
Thinking of all the caregivers who have lost their loved ones.

Barb,
My Condolences.

Barb,
SO SORRY for your loss of your dear mother today.
Sending comfort prayers and love to you and your family
during this difficult time!

Love,
from Sendhelp

Hello, similar history here except mom now refuses to walk or stand as she is afraid of falling. Palliative care doc is coming next week, see what doc suggests and will pass it along.

Barb, I am sorry for your loss. But, at least your Mom's ordeal is over.

Take extra good care of you. *hugs*

I wish you peace and strength as you take the bereavement journey. There are bound to be bumps in the road, but you'll surmount them. You are used to bumps! Reach out for help when you need it.

I hope you'll stay around on AC. You have valuable insights to share. And perhaps you'll have some questions on your new journey.

Barb, I am so sorry for your loss. She is now free of her disease, and dancing with the angels. She knows and appreciates how much you did for her. Thinking of you and your family.

So many deaths this year here! And many of us around about the same amount of time.

I too offer my condolences, and support for you and your family. Even though we've never met and probably most of us haven't, I felt close to your family and feel as if a close friend has lost her mother. Peace be with you and your family.

"Hugs" Barb

💜Bella

You have my deepest sympathy, Barb. May your mother's memory be a blessing to you. xoxo

So sorry, Barb. I'm wishing you lots of love and comfort at this time. Your mom is at peace and pain free. (((((hugs)))))

Thinking of your, Barb. I am so sorry to read about your mother.

((((Barb))))

Just so sorry Barb. With love across the miles.

Dear Barb, I'm so sorry to read that your mom has passed on.....

So sorry to hear your mom passed. My heart goes out to you. But know that she is no longer suffering and is looking down at you from heaven, knows you love her and were there for her. It is so hard for us to get our heads around it when we lose our mothers. For some reason we picture them always being there.
Perhaps it is a blessing your mother did not suffer for long and passed quickly and peacefully.
We lost our mother last year. She had fallen and fractured her hip (and arm) but at 101, there was nothing to be done for her except morphine and keeping her confined to bed. She lived 3 long months and the rapid decline and the side effects of being bedridden were horrible and we felt helpless, knowing that she would never have chosen this. Prayers for you and your mom.