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.
The only "positive" of Hospice, were the sweet nurses who took care of her, bless them, and the Catholic priest and the sweet lady that accompanied him.
We have had it up to here with the hospice bashing
Say something constructive if you are going to post.
Comment on something you know about not wild rumors
I'm sorry your girlfriend is near the end of her life. This is a very difficult time for everyone connected to the patient.
As I understand her situation, she was in the hospital then moved to Hospice. Maybe the order to not give Ativan didn't go with her to Hospice. You say you got the Ativan stopped when she got to Hospice. They ARE willing to listen and do what you want. It was just a communication glitch when moving her from one area to another.
I don't understand your statement;
"They are doing one thing after the other to push her closer to death as well as a is pathetic coma due to her liver failure. I hope to get this stopped before it's to late and there is no turning back."
Hun, no one is "pushing" her closer to death. If I understand your statement correctly, she is already in a coma from liver failure. I'm sorry to say there is no stopping the progression of liver failure and there is no coming back from this disease.
I know you want as much time with her as you can but she's not in a good physical state. You don't want her to suffer, do you? Wouldn't you rather forgo the little time you could be talking to her (in excruciating pain) and have her be sleepy and comfortable? You don't want her suffering as she passes. That would be mean.
I know you're heartbroken, anxious, fearful and lost without your soul mate. It's too bad you never got married so you could have the last say with her health care decisions. But that's not important now. You've got to make sure she's comfortable and calm in her passing. Isn't that the most humane thing to do? They aren't killing her, she's dying. At least let her do it in peace.
I'm sorry that you are going through this. Your wife has a terminal illness, is that right? Not clear if her lung disease is primary or if the liver failure is. But I'm assuming that the reason she is on Hospice is because she has a life-limiting diagnosis.
You say that you hope to get "this" stopped before it's too late and "there is no turning back".
What is it that you want to turn back from?
I'm going to assume that you don't want her to be in physical pain or to suffer from the terrible anxiety that often accompanies the knowledge that one is actively dying.
Sue I trained in the UK and we were issued uniform dresses that had to at least reach the knee. We had to kneel so that Home sister could check! Also a clean white apron every morning and a full length cloak, navy blue with a bright red lining. We loved those cloaks. Not to be worn around patients though. And don't forget the cap. It came as a flat piece of fabric and it was so hard to figure out how to put it together
Never saw a pair of gloves except in the OR. They were washed and reused. If they had holes we patched them and the dental surgeons used them. Short hair must be above the collar and long hair put up. No make up , nail polish or perfume. Black stockings and shoes (well polished) I mended my thick lisle (cotton) stockings and made them last four years
Oh and seperate white collars that were starched so they left a red ring round your neck.
We could not be friends with anyone senior to us. I was friends with a young supervisor and she was warned not to go out with me. Did not stop us though we just met outside the hospital.
In 1958 there was only one married supervisor (Sister) by 1963 when I left I was one of four. Due to WW11 there were not many single men around for older girls.
Stacy I am glad you had such a positive experience with FIL. it is so recent I am sure you will miss him for a while.
To the hospice haters. Why on earth do you think they would murder their patients? Why bite the hand that feeds you? Medicare pays a daily stipend for each patient that's it no more no less and it has to cover everything which it often does not which accounts for Hospice fundraisers. They also pay their nurses less than the acute hospitals. Nurses are at the bottom of the food chain as every nurse knows. It's the admins that make the money the nurses just make it possible.
Im sorry for your loss but I'm glad that your FIL had a comfortable passing.
We appreciate your kind words. If only everyone could have a peaceful departing experience instead of harboring ill will against the very people who are trying to make your loved ones comfortable for their transition.
My husband and I just finished Home Hospice Care in our home, after his Dad passed away last Wednesday morning, and I couldn't be more happy with the Wonderful Hospice experience my FIL had!
He Loved all "his girls and Guy Nurses, as well as his lovely bath aide, who always ended his bath session with full body rub down of lovely email entry lotion. And that little pre-filled hair wash system, he thought that was So Cool!
I just happened to be on the phone, with my Hospice Nurse, a little frantic, as my FIL had spiked fever that morning, after being near comatose for nearly 50 hours.
I had no idea his death was imminent, and yes, I panicked a bit, but she was right there on the phone with me as I checked his pulse and verified his death, and Thank God for her, as she kept me grounded, as she raced to our home to comfort us and to verify his passing.
So many times, she bolstered us up, telling us how proud she was of us, "hardly a phone call, you guys are taking such great care of him", she would tell us!
The meds were Always explained, and then left in our hands, and yes, I do have 30 years medical experience so a Medical Assistant, and have also seen my own parents to the grave and with good medical care to the end, so I wasn't exactly "green" on the subject, but still, it is different with each and every experience!
The Morphine and Haldol, Never a dose so high that it could have rendered him unconscious, it was strictly comfort care, and many weeks on Hospice, and his dose barely even changed right to the end! It was HIS BODY, that was changing and shutting down, not the meds, because it was Me who was administering them, and on schedule!
It was a septic infection that took my FIL, and thank God, "the Old Man's Friend", as had his Lung Cancer advanced to intractable pain, I'm not sure that I could have managed him, and he Wanted to stay with us, and die in his bedroom, there with Us taking care of him.
So Yes, I am sad for his passing, but I Thank God he did not suffer!
THANK GOD FOR MY HOSPICE TEAM!!!!
VERONICA, SUE, YOU GUYS ARE ANGELS IN MY BOOK!
I would LOVE to do lunch. And I'm sure we'd be gabbing for hours about the horrible "good ole days".
I was on the tail end of glass thermometers but I remember how violently one had to shake them to get the mercury under 98.6. I always worried that one would go flying out of my hand and hit somebody.
I remember when someone broke one, the little silver balls of mercury were fun to poke around!
How about flat sheets staying put on a vinyl mattress (before the advent of "fitted" sheets)?
We'd lift the head and the foot of the mattress and bend it inward a little and make a knot with both ends of the sheet. voila! Instant fitted sheet. 😝
Oh, bright white uniforms! And white stockings, shoes and caps, hahahaha. They don't do that anymore either. Sometimes you can't tell the nurses from the cleaning staff.
Remember fingernail inspection every morning? No nail polish- it "hid a multitude of sins" I was told! Did your hair touch your collar? Tisk, tisk. No jewelry and minimal makeup? We all looked like prisoners.
And what about, "Always give up your seat for a doctor?" 😆😆😆😆
Gosh, I instantly feel old! 👵🏼
Bring back any memories? 😷🤕🤒🏥
She had CHF, pleural effusion, post stroke, post hip repair.was a happy camper for almost 4 years. Fell in NH and broke her wrist. Taken to ER.
I was very, very glad for morphine. My mom was in pain and agitated. Not the way she wanted to die, and not anything I was going to allow on my watch.
Suffering at the end of life is unnecessary
To the hospice haters out there you are entitled to your opinion and feelings BUT please do not try and influence others from not using hospice services. Let them make up their own minds.
As far as that much debated comfort kit is concerned. I can only say that on a number of ocassions I wished I had had one available Our hospice did not believe they should be placed in the home. Can you imagine being called out at 3 am in a blizzard at sub zero temperatures and on arriving at the home finding the patient in terrible pain. The nearest all night pharmacy was over 60 miles away. When you need those drugs you need them NOW not when the pharmacy opens at 9am.
SueC when you mentined the glass IV set another image came to mind. The tray of glass vials with a glass thermometer filled with mercury sitting in a disinfecting liquid. What a mess that made when they were dropped and the mercury scurried away in little balls. There was holy hell to pay for that little accident.
If he's well enough to post on Facebook, he's alert and well enough to go get something to east! A terminal man, dying in his bed can post on FB that he wants to eat. Wow!
I understand that not everyone has vast medical knowledge. Maybe your head was clouded and you were overwhelmed at the hospice discussion/signup. Also, maybe you didn't understand what was in the booklet, explaining hospice's particular role. So, you just went along with the regimen. But now you don't like how your family member is looking or acting after the medicine was given.
OK folks, I'll go along with your pacivness up to now. But NOW is when you OPEN your mouth and SAY what you don't like! You don't have to have an MD or RN license to see that the effects of the medication is not what you wanted for your loved one. So SAY something!
People, this is the 21st century. We are no longer in the days where doctors are God and their every word followed. You are now allowed, even encouraged, to voice your opinions. The doctor has a heck of a lot more knowledge than you do but YOU have the final say as to how your loved one is treated. For God sake, what are you scared of? That the doctor will get mad for challenging his opinion? To heck with that! These days we have to be PROACTIVE not reactive. Even if you know nothing medical, you know what you see in your loved one and you know what you want. Get vocal.
If I had a nurse waiting with a syringe of Haldol in her hand and I had already told her I did not want it given to my LO and she came one step closer, I would have physically blocked her, told her I will call the police for assault and battery and immediately call her supervisor. Be forceful. YOU are your loved ones advocate.
But, gosh people, you have to join in to get what you want. YOU call the shots. These people work for YOU!
If the family tells me not to bathe the patient, I don't. If they don't want a certain medication given, I don't give it. Threaten legal action if they don't comply to your wishes. Threaten to change hospice companies. Get nasty, after all, the squeaky wheel gets the oil.
As for the supplies and equipment, all of that can be rented through medical supply companies. Too bad you may have a copay from your insurance company but at least you will have things the way you want them. (Hospice rents their equipment from medical supply companies also.)
I can't say this loud enough...GET INFORMED! The more you learn, the more powerful you are. Call meetings with the company if you're not getting what you want. (Do understand, if you want every life saving treatment for your LO, then hospice is NOT for you.) Get a backbone and grow a pair. No more sitting on the sidelines, you need to be the star player in the game. Your loved one depends on it.
If I had chosen not to use Hospice, I would be watching them both wither in pain, and how awful that would be to see a love one go through such an ordeal.
Neither parent would ever recover from their medical issues. Both had Medical Directive legal documents to which I had followed. I know there are times we think our love one can recover, but medical science can only go so far.
Karen.... as for those cases where food and water is no longer given the patient, one has to ask questions to learn why this is the case. It is because the person's body is shutting down. The digestive system is no longer working, food would just sit in the stomach and cause terrible pain. Water would be aspirated and go into the lungs instead of going into the stomach, causing a patient to choke.
Surprise you can advertise in your local paper for a hospital bed . You will be surprised how many people just want to get rid of them. I had e seen them free or up to $100. They may not be the most modern but they do work.
It's all part of their sales pitch because what is really is about is that hospice is a business - a big business. For-profit hospices are proliferating throughout the country.
What I did not know when the "rep" told me that my mom would lose her pressure bed, was that there were other ways to get one - and easily.
I would like to see regulations introduced - they may already be in place for all I know in some jurisdictions, I hope so - that require any professional administering drugs to a patient on hospice to explain what they are doing to any non-qualified caregivers responsible for their patient, and to document as well as the drugs and amounts given the clinical justification for giving them.
But tell me. How would you explain to families that if they revoke hospice, they do obviously also revoke the equipment and services it provides? And they do have to explain that, to avoid families later getting angry and upset when someone comes to collect the alternating pressure air bed or whatever.
"When a patient revokes hospice services, it also means revoking the benefits they may be receiving from the Medicare hospice benefit: home medical equipment and supplies, holistic or therapeutic services, home visits, etc."
I'd like to respond to the following:
"Does everyone know that YOU (the family or at least the POA) has the power to REFUSE any or all meds or services that hospice recommends?"
When I was going through the "hospice experience" I was surviving (or so I thought) on little sleep. It was the most emotionally taxing time in my life. I suspect this is the way it is for lots of folks whose loved one is in hospice. Sure, we can refuse and make changes but it can be difficult when one is completely vulnerable. Most of us like to think that trusting the medical profession is the right thing.
"Yet, I read on this thread that the meds were administered per protocol without any family refusal. Why is this? Is it hindsight? (Gee, we 'should have' stopped the Morphine or 'not given' the Ativan.)"
I told the nurse not to give mom narcotics but she ignored my request and forced Haldol on her (see earlier thread.) Also, please don't be hard on those of us who are not medical professionals. I did not know what Morphine does and I had never heard of Ativan or Haldol before our hospice experience.
"Or is it that you were not present when the regulations were being explained to whomever was there to sign the papers? Or maybe you didn't read the booklet explaining the protocols of hospice. Were you aware you could take him/her off hospice at any time, even get him/her admitted to the hospital for treatment (which automatically stops hospice services)."
I asked about stopping hospice as I was displeased with the nurse and the empty promises. I asked for palliative care. So the first thing a hospice representative told me is that they would take mom's hospital bed away. They are so clever! I've since read some hospice brochures, especially the part where they do indeed say that one can stop hospice. But then they so cleverly point out all the "services" one will lose . . . .
Hospice is BIG business and it preys on the vulnerable. It's only going to get bigger as the baby boomers age.
I'm sorry for your loss. It is such a difficult time.
Does everyone know that YOU (the family or at least the POA) has the power to REFUSE any or all meds or services that hospice recommends. Nothing is written in stone. Anything can be changed.
Yet, I read on this thread that the meds were administered per protocol without any family refusal. Why is this? Is it hindsight? (Gee, we 'should have' stopped the Morphine or 'not given' the Ativan.)
Or is it that you were not present when the regulations were being explained to whomever was there to sign the papers? Or maybe you didn't read the booklet explaining the protocols of hospice. Were you aware you could take him/her off hospice at any time, even get him/her admitted to the hospital for treatment (which automatically stops hospice services).
When you saw that this was not what you wanted for your loved one, did you call their private MD for a consultation? Or, did you sit down with the hospice team to re-evaluate their medicine regime? All these things are tools you could have used to change the situation.
I'm not blaming you. It's a very heartbreaking time and no one thinks straight. But there are avenues open to the family. Most of the time, they don't take advantage of any of them, but then post here that their loved was KILLED!
With all due respect, what was your input? After speaking with the rare disease expert doctor, did you try to enlist his help and change what you didn't feel comfortable with?
I just don't see any family input but I see a lot of family criticism. Get involved with every aspect of their care.
FreqFlyer, I wished I had visited this forum before I brought my mother home for hospice care. When I met with the agency, I made it very clear that there would be no hastening of death. The agency assured me of such, and the hospital discharge papers note "palliative care." (The hospital sent mom home with prescriptions for her heart meds. and her cardiologist told us to give her milkshakes.) The agency said that hospice patients may live longer because they get "attentive" care. I bought into it. Also, the agency promised physical therapy and all sorts of "perks" but delivered nothing except a cold, heartless nurse who, on the first day of visiting mom walked up to her with a syringe and tried to give her a narcotic. My mother, a retired cardiac nurse, lifted her hand and said "No." The agency DID NOT tell me that it would send all sorts of narcotics in what it called a "comfort pack." After we made it very clear that mom did not want narcotics, the "nurse" tried it again on her third visit and this time she was successful. While the aid and I were changing the bed linens, mom said, "Please do let me fall off the bed." With that, the nurse rushed up to mom holding a syringe, saying, "See, she is confused, she is confused." Before I knew it she gave her what I later learned was Haldol, an antipsychotic medication. The nurse FORCED it on mom. There was no medical need to give it to her.
Further, the hospital discharged mom with her heart meds, yet the hospice nurse showed no interest in giving them to her (so I did). She showed no interest in mom's nutrition.
Another nurse - by telephone - convinced me that by giving mom morphine I was helping mom to breath and I gave her two doses over a twelve-day period, the second on the day she died. (Some folks on this forum have assured me it wasn't lethal, but I am not convinced.) I had no idea, and I believed the nurse on the phone.
Each time the nurse visited mom, she announced - in front of her - that she would die by the morning. I finally had enough and planned to replace her, but it was too late. I am thankful that mom did not go into an in-patient hospice and die of starvation yet I am full of remorse for falling for the hospice sales pitch. Had I known this, I would have NEVER chosen hospice.
I had the opportunity to speak to one of the few expert doctors on the rare disease called CJD, and he confessed he did not see the reason why morphine was used in this case. While hospice may be good for people in pain and agony at the end of life, unfortunately there are times where it is handled inappropriately as in our case and it is immoral and unethical to say the least.
What has me so curious is where were these posters while their love one was being cared for, why weren't they on the forum asking for suggestions? Where were these posters when it came time to decide whether to use Hospice or not? The poster only shows up after their love one had transitioned. And their first time on the website they find a thread that has been off-line for weeks without recent comments.
Part of me feels that a person is pointing to Hospice because Hospice was called in very late in the progress. That the love one was already in the dying process, thus Hospice is only there for a week or less. Yes, it will feel like Hospice speeded up the progress, but it didn't. The dying timetable was already set before Hospice even become a subject to discuss.
Mark, please note that the amount of morphine used by Hospice is no different then the amount of morphine used by hospitals after a patient had major surgery. I remember having a morphine pump to help control my post-surgery pain. If morphine kills at those low dosages [same used with Hospice] then hospitals would have very high number of post-surgery patient deaths.... well, they don't.
Your words; "They did that (hastened and murdered) to my Step Father also. He was dying of cancer..."
How did anyone kill him if he was dying of cancer. Cancer is frequently metastatic and can be painful. You can't recover while actively dying. Should he have been denied medication?
Have you, in your 19 years of nursing, ever seen a drastic or dramatic change in an otherwise stable but terminal patient from one day to the next?
In my 39 years of nursing, I have witnessed this over and over. It's actually hard to believe, when you leave them at the end of your shift in a stable state and, by your next shift, they are actively dying or have died. Maybe you've never witnessed this. Death has no timetable.
I'm not sure you've got a handle on the math here.
"Well they gave him Ativan IV 1 mg and morphine 4 mg IV q (every) 4 hours which was an increase from the 15 mgs we were giving him at home!"
Help me out. Four mg. of Morphine is MORE than the 15 mg. you were giving him? Maybe you meant to say that it was IV, which lowers the amount of Morphine needed because it goes directly into the vein.
Check this table of narcotic conversion out;
http://openanesthesia.wpengine.com/wp-content/uploads/2015/03/IV-to-po-opioids-–-Equivalency-table.png
Basically it says that it is a 1:3 ratio for Morphine. If you're taking 10 mg. of Morphine IV, then you would take 30 mg. orally. If he got 4 mg. IV, then, (at a 1:3 ratio), his dose at home would have been 12mg. not 15 mg. You were giving him more at home than the IV equivalent he received through hospice. Also, please factor in that these patients may have been taking narcotics for a while and are not "opiate naive". They can tolerate larger doses because they have built up a tolerance.
Also, since you and your mom were RN's, you should know that you can refuse any medicine that you don't want given. Neither of the medications that were given were in lethal doses. There is a "protocol" in hospice for agitation (Ativan), which is very common near the end of life, and also for pain (Morphine).
"I have seen many die before their time in hospice."
Excuse me, but NONE of us know WHEN our last breath will be. You have overstepped your bounds as a nurse, to predict the time of death. The best a seasoned nurse can do is give a guesstimate. Only God knows the day and time.
"Nurses can easily take care of terminally ill patients in the hospital daily and indeed we do all the time!"
Yup and WHAT do we do for them in the hospital, Mark? We give them pain medication and, if they are anxious or restless, we give them anti-anxiety medication. I don't see the difference in medication administration. Same stuff but the hospice patient can be in the comfort of their own home. If you'd rather keep your loved one in pain and agitation, go ahead. Just don't gripe about how difficult it is to care for them and how exhausting it is. Think how exhausted the patient must be without the relief of meds.
"Again don't even attempt to argue with me."
I'm not arguing with you. You are entitled to your opinion, as I am to mine. Have you ever worked for a hospice? Having been a hospice nurse for the last part of my career, I can tell you that I have never murdered anyone. I have relieved obvious pain and thereby made the patient more comfortable. (Isn't that why we became nurses?) I've medicated patients who seemed agitated, being very near the end and they were able to relax and rest until they breathed their last breath. I've had families beg me to give MORE meds because they didn't think their loved ones were as comfortable as they could be. I could NOT give more meds. I would call the doctor and explain the patients' status. They would either OK it or refuse it. These were not murderous families looking for a Nurse Ratchet to finally finish off their loved one. They were thinking of their loved ones' comfort during their last hours.
"They are a cult." hahahaha
According to Wikipedia; The term cult usually refers to a social group defined by its religious, spiritual, or philosophical beliefs, or its common interest in a particular personality, object or goal.
We are health care providers who do not believe in the needless suffering of the dying.
I saved the best (of your comments) for last. "My Mother can inform also and she is a retired RN from the good ole days."
The "ole" days weren't "good" Mark. If you have been a nurse less than 20 years, you missed all the fun. ( Just like Veronica said.) Glass IV bottles that were heavy and cumbersome and, God forbid, if one should hit the floor! One of the hospitals I worked in had carpet (yes, carpet!) in the patient rooms. What fun cleaning up diarrhea or vomit when the patient didn't "make it" to the bathroom. The needle and syringe choppers put us at risk, not like the sheaths on the syringes that now protect the nurses. I remember when gloves were only worn for "dirty" jobs and there was no such thing as Universal Precautions. Did you ever have bedpan cleaning duty in the "hopper"? I could go on but won't. Don't glamorize the days in which you've never worked.
I wish everyone would pass away in their sleep but that doesn't happen. It's also not moral or ethical for anyone to be in pain or severe anxiety as they pass from this world. Maybe you'll change your mind when you are passing.
Veronica; I'm with you. ;)
But with any business - there are good and bad ones out there - and this includes Hospice businesses.
My mother now qualifies - and did qualify for Hospice - four years ago - under the diagnosis of Dementia. She has Vascular Dementia, actually. The reason why I haven't put her on Hospice is she's not experiencing pain as she's holding steady and not in a rapid decline yet. Also, I want options for in-home bloodwork and in-home x-rays for monitoring which I can't get on Hospice. I'm not aggressive on the bloodwork because Mom is a difficult poke; she gets full labs every six months to one year, just like I do with my PCP. Mom is a DNR so I have absolutely no intention of - any aggressive care. She has no quality of life. I've been waiting for something to take her - quickly. Her Old World genetics just keeps her body going!
As many of know, Dementia can go on for years, obviously, the gift that keeps giving, so whenever I read of patients on hospice - for several years - this is a major red flag to me - but it's a flag that I can live with. Hospice is a big-time money maker according to my mother's now doctor so of course providers are happy to readmit a patient if a patient qualifies. He stated years ago Medicare would give Hospice just one lump sum, like 20 to 30K, for the patient and no more and Hospice decides how much to use - of course stretching out the dollars as much as possible - because Medicare didn't require (and still doesn't) the leftover money returned to them after the patient dies. Now, Medicare is paying out daily, like $140 to $160/per day and continues to pay as long as there is a qualifying diagnosis. How does Hospice stay in business if everyone really does die within six months? I understand the business side of signing up patients who "qualify" for Hospice and readmitting these patients who continue to "qualify" to keep the Hospice business alive. Just imagine if there was no such thing as a Hospice service, then how would our loved ones get the services they need, particularly pain management, in the end stages of life? No one wants to see their loved one suffer. At this point, nearly all of these patients are physically unable go to their doctor for pain relief and PCPs don't prescribe morphine. I don't want to suffer in my end of life stage - load me up on the morphine - please! Also, many of us want our loved ones dying in their home, so Hospice provides this option for us. I don't want my mother dying in a hospital. I want her last memory to be of me and our pets at her side - in the comfort of our home. She feels safe in our home and this where she will die.
I'm fully aware of the money-driven side of our healthcare system - but this also gives us choices in options for care.
Of course there are bad apples in every basket and this primarily applies to some for profit hospices.
Why kill the hand that feeds you? A hospice ceases to exist if they don't have patients. The more they have and the longer they stay makes the income increase. A three day patient costs more than a six month one because of the heavy investment in having to provide equipment for a new patient and the use of staff which increases at the end of life.
Your mother may be a retired R N from the good old days but I started nursing in the 50s and only retired ten years ago and I can vouch for the fact that it was not better in the good 'ol days. Geriatric patients were housed in big open wards with 24 other patients. All they had was their bed and clothes pulled out of the communal pile each morning which may have sort of fitted. No TV and no phone (just a portable pay phone that could be wheeled from bed to bed)
No sitting in unchanged Depends, they had not been invented. They were sat on a 12" X 12" gauze and brown wool pad made every night by the night nurse. the only thing that may have been better is that in addition to the standard three meals a day they also had morning tea (at 5 am) mid morning coffee and a late night hot drink.
Did your mother work under those conditions?
Do you even believe what I am writing?
This was the state of affairs at a major London, UK teaching hospital in the late 50's The unit I worked in was the location of the Dicken's work house with the graveyard right outside the windows.
I finshed my career 10 years ago working as a hospice nurse at a not for profit US hospice. I don't need to tell you how I would wish to be treated. Thank goodness there is little restriction on the use of medications in modern day hospice.
If there is pain and anxiety it is treated (not forced) and often large doses may be required to help the patient and a side effect is frequently drowsiness but that is common close to the end of life.
What ever your views it is not mandatory to use hospice so bear that in mind. if you don't agree with the philosophy stay away that is your right. I was working in London when Dame Cecily Saunders started the modern hospice movement although it had existed in one form or another for centuries. Think of the work Mother Theresa was doing in our own life time.
As far as modern day nurses treating dying patients my personal experience has been every effort is made toil elderly patients. I was admitted to a US teaching hospital with acute appendicitis and the surgeon decided to try treating with IV antibiotics. By the next morningI was in septic shock and my appendix had burst. From there on in I was not fed for ten days and massive amounts of IV normal saline pushed me into heart failure which they ignored for 2 days. Eventually it was noticed that i was severely malnourished and i was offered an NG tube which i refused. They then started TPN and a few days later put in an GJ tube .
Six weeks later I was discharged still in heart failure with fluid in the base of both lungs and a clot in my right ventricular appendage. One of the residents admitted she did not expect me to make it.
I was lucky in that I had an advocate in my husband a retired MD..
I was readmitted to another hospital two days later and after two more weeks was fit to be discharged again.
Would I have preferred hospice of course not but that is just to illustrate what can happen when regular nurses are taking care of you in a hospital. Not that i am blaming the nurses there is so much protocol that has to be followed these dys that they are prevented from making rational decisions.
May I ask why you are contributing to this thread?