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.
I believe that a lot of people want to have somebody to blame, when their Loved One dies, and especially on Hospice, when they are the ones who "Signed Up" their dying parents in the first place!
Did these people not read over the forms they signed, read over the information and the many pamphlets they were given to them, to help them to understand exactly what the role of Hospice Care is there for in the first place?
I know, that when our own Mom was placed on Hospice, we were given precise info on what to expect, and not to expect, and soon found out, that it would be "all hands on deck", in the care and comfort of our Mom, who was dying of Cancer, and the Hospice team was a GODSEND! And it took 15 or more family members to make the team work like clockwork!
The most important thing was that our Mom not suffer, and that is exactly what they did! Our Mom was on Hospice for 5 months, and it was only the last 8 days or so, when she was Actively Dying, that she became incoherent, and began sleeping and "out of it", but it was clearly explained at every step of the way, that it was Not due to the Narcotics or anti-anxiety medications, but because her body was Shutting Down! Our Mom had been on some pretty heavy doses of IV Dilaudid (narcotics), the entire time, to aid in the excruciating pain of her eroding Cancerous pelvic bones, from the spread of Uterine Cancer.
If the family fails to communicate with the Hospice team or their Dr's, then they are confused into believing that Hospice is to blame, and that their parents were dying and or were expected to die soon (6 months or less), in the first place!
I think people are trying to place blame, where there isn't any, and need to give up the guilt, that they had any control, on when somebody passes away in the first place, as nobody ever knows for sure, when it's their time to die.
After all, shouldn't they be glad, that their family members were given the chance to be relieved of the pain and anxiety of the dying process? I know that I wouldn't wish to die, thrashing and gasping for air, if it were possible for those symptoms to be eased? Yep, you Betcha, sign me up!
I've been in the room, and at the bedside of both my parents, and my MIL when they passed, and while only my Mom was on Hospice, the other 2 were in hospital, and when offered the option of making their imminent passing less frightening to the parent, we agreed, and are glad that we did. Nobody ever wants to see someone who they love, panic, while dying. It's very dificult to even be there knowing that it's the last moments of someone's life, but I'm glad for the opportunity to have been there to comfort them, and to say our goodbyes.
Sue, thank you for all you do as a Hospice Angel, we need more people just like you!
How unusual for an autopsy for a hospice patient. The doctor knew she had a terminal illness, so I'm thinking that you ordered the autopsy/toxicology reports. That must have been expensive.
It's mind boggling that they found more than 2400 mg. of Morphine in her system!!
(200mg lethal dose times 12 people=2400 mg.)
"they did that to my mum i questioned it and toxicology showed she had enough to kill 12 people there"
With my hospice, there is never that much Morphine at the house. All medicine has to be signed out, so you could have the records audited to see how much she 'actually' received.
You said," sad and very wrong way to save money when they claim to give dignity in dying." Hospices are paid by Medicare only. It doesn't make sense to kill patients if the hospices want to get paid. They are only paid if the patient is alive.
"forcing people to die is wrong my mum told them not to do this even."
We CAN'T give a patient medication if they refuse. It's called battery and the nurse could go to jail.
I'm sorry for your loss.
It's imperative that the family members who don't want hospice communicate their wishes to the family members that have power of attorney.
I'm not giving you an opinion, I'm giving you fact. I don't care if you want it or not. It was for all the readers who believed your statements, so they would be properly informed.
SINCE so many of you have had bad experiences with hospice, why don't you all get a petition going to outlaw it. I'm not being sarcastic. Really.....do it. Make hospice illegal. Then no patient ever again will suffer at the hands of a "killer nurse".
Then we can finally let this thread die.
I did not ask for information or for your opinion.I shared my experience and no one can disagree with someone's experience.I do not like hospice.They shorten peoples lives with medication.That is my experience.I did not ask for hospice nor did I initiate it.I was against it ,unfortunately I did not have legal rights to dismiss what was already set in motion and my mother suffered for it.You have no idea what she or I went through so please keep your comments directed to someone who wants them.
Just to let you know, opiates tend to have short half-lives, meaning that they leave the system quickly, though effects can last for several hours. How long each opiate can be detected by drug tests varies, depending on many factors, including the type of ingestion. Prescription opiates typically come in pill form. Taking a drug orally means that it has to pass through the digestive system first, so it can take around an hour for the effects to begin.
Other factors affecting how quickly an opiate leaves the system include:
The individual’s metabolism rate
Body mass and weight
Body fat content
Health of the liver and kidneys
Age
How often and how heavy opiate use is
Quality of the drug
Amount of water in the body
Of course, the type of opiate also factors into how long it can be detected by drug tests. The most commonly used opiates are heroin, hydrocodone, morphine, and codeine.
Morphine takes longer to work and the effects tend to last longer. Despite this, blood tests can only detect morphine for the first 12 hours after the last dose, and urine tests only work for up to 3 days. However, saliva tests are more effective, being able to detect traces of morphine for up to 4 days. Again, morphine stays in the hair for 90 days.
However, due to the fact that opiates will build up in fatty tissues after EXCESSIVE use (2-4 times a day for years), these limits will extend beyond the outer limit if the individual is a HEAVY, LONG-TERM user. Hospice patients are not considered excessive, heavy or long term users. They do NOT die from an accumulation of narcotic in their system.
I believe you might be thinking of toxic accumulation caused by heavy metals or arsenic that can't be cleared from the body's tissues and can pose serious health risks or death.
Again, hospice patients are not given anywhere near lethal doses. It's JUST ENOUGH to diminish pain or ease breathing or anxiety. Look at the dose for MomtoMom's mother, barely anything (2.5 mg.) compared to a hospitalized surgical patients' pain regimen (15 mg.).
Folks, 200 mg. would be a lethal dose. No doctor would ever prescribe over 15 mg. Stop thinking that the Morphine kills them. They were ready to die and they can go from alert, talking and eating to lethargic, non eating, etc. in a few days. Everyone has their own time table. Some are lucky enough to pass away in their sleep, others linger and go down hill over days, weeks, months.
IF YOU DON'T WANT YOUR FAMILY MEMBER MEDICATED (for whatever reason) THEN DON'T SIGN UP YOUR LOVED ONE WITH HOSPICE.
YOU manage their symptoms as YOU see fit. But please re-read Mom2Mom's experience and how her mother benefited from a tiny dose. THIS is what we hospice nurses do.
(Information in the first 3 paragraphs provided by American Addiction Centers.)
How wonderful you could see the benefit of using Morphine to alleviate pain, ease difficult breathing or anxiety for your mom.
A 2.5 mg dose is practically nothing.
I've given 15 mg. every 4 hours to my post operative (after surgery) patients. Fifteen mg. is 6 times your mom's dose and is nowhere near lethal. You kept your mom comfortable as death slowly took her. I'm glad she could pass comfortably and you had the tools to assist her in her journey.
She told the doctor at the hospital that she just wished to go home. He made it clear to her that if she went home, it meant going home to die. She just kept saying she wanted to go home.
respecting her wishes, we brought her home under Hospice care on April 29.
Since Hospice does not provide 24 hour in home care, I split the duties between her three at home caregivers from 7:30AM-8:00PM M-F and I did all of the rest of the shifts.
These caregivers are not hospice workers and had difficulty changing modes between helping her live and helping her die. They would beg her to eat a little and take sips of juice or water and then celebrate every success.
I didn't want my mother to suffer from hunger or thirst so during my turns at watch, I would offer once in a while and then leave her alone if she shook her head no. I did not push eating or drinking.
We were given morphine and told to administer it (and several other meds that I can't remember right now), for discomfort or pain. The dose was 2.5mg every six hours but to call if we thought she needed more.
We did Morphine twice on about the second or third day and then nothing until the last.
She had no idea who we were, she had no idea that she was home after that first day. She spent the week hallucinating and talking to dead relatives.
Every morning, she was in a soaking wet bed despite her catheter (fluid from the bowels?) and had just vomited so her head and neck were wet. It could not have been comfortable. I had to change her sheets and clean her alone - or at least start until the morning caregiver arrived. It is hard to be gentle when you are changing someone's sheets alone. It was torture for both of us.
By day 6, Friday, the caregivers had figured out their mission and were no longer begging her to take sips of water or milkshake. But, her breathing had taken a horrible turn and it sounded as if she were drowning. At my direction, they resumed morphine. I sat death watch late into Friday night and gave her her final 2.5 mg dose of Morphine. Saturday morning, I was relieved to find no wet bed, no vomit and the horrible breathing had stopped.
No, hospice did not rush my mother to death. They took too long. I wish it would have been legal to hurry her along. She had died the previous Sunday. Her body just didn't know it yet.
I am so very sorry for your loss.I had a horrible experience with hospice.Once you begin giving an elderly person morphine,it hastens their death.Elderly already have renal impairment.Kidneys do not function like that of a young person therefore medications are not readily cleared from the body but accumulate which is one of the reasons why elderly may suddenly develop changes because their meds are building up at high levels in their system.Hospice claims they are there for comfort care with their little toolbox of medications.I say they are there to bring about a speedy end.I am all about supporting life for as long as humanly possible which means I will go to any lengths to make sure my elderly loved one receives all the medical care they deserve to get better if at all possible but once hospice is called in...beware! They will resist you on any further medical care from a medical Dr. and they keep reminding you that hospice is only there to keep the loved one comfortable...not to get them better.That is not hospices goal.I will never recommend hospice to anyone.My mother was sent to a very early grave.She was less than a month away from her June birthday and they made it impossible for her to reach it.She died in my arms as she breathed her last breath.I will miss her everyday for the rest of my life.I am sorry for what you have gone through.I wish I knew how to start some organization that fights against what hospice does to elderly people.The best way to fight it is to not initiate their services and make sure that no outside organization initiates their services either.In my case there was a legal guardian making all my mom's decisions.My sister had her declared incompetent and put in a facility.My mom was as alert as you or I.It was so sad.She lasted two years in the facility and then hospice took her with all the various drugs. The best you can do now is take really good care of yourself and share your experience,strength and hope with others.Bless you.
All of the hospice protocols are explained to the family members THAT ARE THERE with the patient. I know it's a difficult time but you need to know what you are signing up for. Hospice's MAIN function is to make the patient comfortable. Sometimes that means being medicated to relieve the discomfort or anxiety and the family can't interact with their loved one. This stresses out families. But what would you rather have, your loved one uncomfortable or stressed out trying to talk to you or have them resting quietly and comfortably?
As a part time hospice nurse, my suggestion is, inform everyone in your family with hospice protocols. If ANYONE in your family has reservations with hospice using Morphine, (or any other medicine for that matter), I strongly suggest you NOT use hospice. That way hospice will not be implicated in your loved ones death. You will not be able to say they overdosed your family member and were responsible for "killing" them. You can manage their pain and/or anxiety (or not) yourself and know that your loved one died "at the right time".
If, however, you want to make sure that your loved one does not have any suffering or anxiety during their dying process, I recommend hospice wholeheartedly, knowing your family member will pass in comfort. I hope that's how I go.
Yes, morphine can be deadly if misused, like using over 200mg in each dosage. No Hospice Doctor would ever script for such a high dosage.
Hospice only uses 5mg to 15mg for each dosage, which is a safe amount. Probably no different that what hospital patients get after having major surgery. using a morphine pump to help control the pain.
And it is not unusual just before a person starts that final journey to rebound, be talkative, happy, eating, and even wanting to walk. That's nature's way of letting everyone say their good-byes. That has happen to many of us with our love ones.
Thank you,
One lost friend
My mother passed three weeks ago. The morphine is for pain and the Ativan for anxiety.
It's so difficult at this stage.
Yes, they are comatose because they are dying with or without the drugs.
I'd prefer my loved one be pain free.
I struggle to sleep, i keep asking myself what i could i have done differently.
I appreciate the hospice nurses and the aides. I feel, heck i don't know what i feel.
My research has led me to understand that this is a widespread problem. This research includes my research online as well as to talking friends, including several doctor friends, who said this stealth euthanasia is a deeply troubling trend that is going on. So there is the rogue nurse practitioner issue as well is the hospice issue here. As you may know recently an indictment came down on 16 people running a hospice in Texas that was also overdosing patients resulting in death or serious harm. http://www.dallasnews.com/news/frisco/2017/02/28/frisco-man-15-others-indicted-medicare-hospice-scheme-used-human-life-vulnerable-stage
I don't understand why the national media is not covering this very troubling trend. I feel it is so important to make the public aware of what is going on which I believe is a sub-level of something in a gray area. I believe it is going on with the hopes that it will just become accepted into the main stream. It is stealth euthanasia. Forewarned is forearmed and I would have given anything if someone had made me aware before my father was in this situation as at that point I was too distraught to research or stand up to this bully nurse practitioner. Whether someone has 2 weeks, 6 months or two years to live no one has the right to take that away from them and hasten their death. It is more time they have to spend however they choose. They have not only destroyed my father by killing him, but they have left me deeply troubled by the whole horrendous act. Losing a loved one is hard enough, but under these conditions it is unbearable. We cannot stand for these killings
The doctors and nurses can tell if someone is in pain where us, the non-medical people, are not familiar with the signs, especially if one is semi-alert [due to prion disease, a disease that is rare].
My Mom was on Hospice and I was glad she was given this care. Her dementia wasn't causing her major pain, her back was from lying in bed as she could no longer sit up, and being oh so painfully thin.
Please note there is little data to support the belief that appropriate use of opioids hastens death in patients.