Did Hospice rush your loved ones death?

Thanklessjob Thank you for your comments. I have a decent understanding of the system. The disappointing part was the NH PCP did not notify me, it was the head of ICU. He was adamant to get her off life support and went as far as to make mention that she was "dead" when she was readmitted to ICU 5 days prior. The day I did go to take her off life support he made sure to be around, then quickly left. The nice nurse, Nancy,really was the saving grace. I wish her the best. After my mom was taken off life support she passed 7 minutes later. Nurse Nancy, not the NH PCP, or even her first PCP,who she had been seeing for several years, called. to let me know she had passed.

I feel bad for Carol, since she did not get a chance to say goodbye to her sister. I have seen and know about the patients medical privacy.

Momlover, I'll reply to each sentence you wrote, (being a hospice nurse).
"It's extremely difficult to cope with if you have no say in the POAs decision." Yes, it is, but the dying patient has a right to have whomever they choose to be their POA.

" My mother passed in 2 days on hospice, alert with strong vitals." Your mother must have been very close to passing when put on service. This often happens. Are you aware that "vital signs" can stay strong up until the very end? I have had patients that I knew would be passing THAT DAY with blood pressures of 110/60. All vital signs don't have to go wacky as death nears.

"IMO hospices are being abused with overdoses of morphine and need to be investigated." The medication regimen is fully discussed with the patient and family. We have a standard routine medication sheet. It contains Morphine 5 mg. (a nominal dose) usually ordered every 4 hours., more Morphine for 'breakthrough' pain 5,10 or 15 mg. (up to the nurse's discretion, depending on the patients weight and pain level.), a medication to dry up excess secretions (in case the patient has a large amount of mucous), a laxative (if needed, to aid in relieving the constipation caused by narcotics), an anti-anxiety medication (to help with the agitation that can be present near the end or with dementia), and any other med that might be needed to make the patient more comfortable (Tylenol suppository for fever, anti-emetic to control nausea,etc.). I will agree that Morphine can make patients sleepy, to the point of being difficult to arouse, but it's not enough to kill an adult.

"A church member who was family friends with hospital administration convinced my sister (POA) to put my mother on hospice and tried to force me to agree by yelling and pushing in on my head, "Your mother's going to die!" ,to cover up for malpractice of my mother's thumb having to be amputated." I seriously doubt that the church member wanted your mother dead so she wouldn't sue the hospital. Your mother designated your sister as POA to make her medical decisions. I don't think she would have done that if she didn't think your sister would have her best interests at heart.


"Still waiting for a good lawyer to take my angelic beloved mother's nursing home neglect for ruptured colon and hospital malpractice for cutting off my mother's circulation"... Yes, by all means, contact a lawyer and see if you can get the nursing home and hospital charts and make a case, if you really suspect foul play.

" but, by all means, I thank the hospital for saving my mother's life"... So they DIDN'T plan to kill her!

"until the conspiracy to end her life on unnecessary hospice (that) her primary Doctor didn't recommend." Then which doctor did? I'm sure it was discussed with your sister, being the POA. This is the problem we see in hospice, where the family members don't communicate with each other.

"...as ICU and the imposter church member ended her life while my mother was making a miraculous recovery with strong vitals and improving white blood cell count from 3000 to 1600 ridding bacteria or sepsis as she died from respiratory failure and psychosis but she was alert during her recovery." Oh my! Your mom would not have been on hospice unless she met the Medicare guidelines. Most often that means the person has 6 months or less to live. If the doctors would have thought she was making a "miraculous recovery", they would have made discharge plans. PLEASE get a copy of the information sheet outlining the treatment from the hospice that took care of her or from your sister. A person can have improving lab values or good vital signs and pass away from cardiac failure, renal failure, cancer, stroke, etc. A normal WBC count for a woman is 4,500 to 11,000. (I'm assuming you forgot a 0 at the end of your lab values) At 16,000, she was still septic. Also, people don't die of psychosis, which is loss of contact with reality.

"MY MOTHER WAS KILLED UNDER THE GUISE OF HOSPICE IMO. Please set up an hospice investigation or request it if you have true love for the aging and elderly and their right to quality of life and aging in place. Please help resolve my mother's murder."
You and your sister should talk to the hospice that cared for your mom. As the POA, ask your sister to ask for copies of her records or to read the files they kept. It has everything documented. Hospices aren't in the business of killing people. Really, it would be more profitable to keep them alive to continue to receive government money. We are in this business to HELP RELIEVE suffering at the end of life. Would you have preferred to see your mother writhing in pain? Or severely anxious as she neared the end? Or vomiting uncontrollably? I don't think so. I don't kill patients, I make them comfortable so they can live their last few hours on this earth in a medicated peace. Your mom died when God took her (IMO). If you want to blame someone, talk to Him.

I'm going to say this as a person who signed the Hospice papers. Carol, he didn't tell you because he wanted to avoid you going to pieces while she was dying. The last thing a dying patient needs is an emotional outburst from the bystanders. They want a peaceful departure, not a room full of sobbing relatives fighting with one another.

Zytrhr, it really helps IF you know a bit about "the system".

You posted; "Her NH PCP, "ditched" her 2 days before this happened. He did not come back to see her after this."
When a patient is put on hospice, the PCP (primary care doctor) or doc in charge of the NH, TURNS OVER the care of his/her patient TO the hospice doctor. I doubt that her doctor "ditched" her. He referred her to hospice and failed to inform you that he would no longer be the head honcho. His mistake. Usually the hospice informs you of that, but maybe they thought that he had already made you aware.
You also posted;
"You're a family member, the nurse could have told you what was going on."
I'm not sure which country Carol is in, but here in the U.S., there is a law about how, when and with whom to share a patients' private and medical information called HIPPA, Health Insurance Portability and Accountability Act. It's designed to provide privacy standards to protect patients' medical records and other health information given to insurance companies, doctors, hospitals and other health care providers, (like nurses.) Basically, that means that the ONLY people who have access to the patients medical information are the ones that the patient designates (her husband) and the immediate professionals taking care of them. Usually, there are only one or two family members listed, normally just the closest of kin, in Carol's case, her sister's husband. We nurses sign binding documents, at any nursing job, that we will NOT give out patient information to anyone but the authorized POA or Custodian. I could loose my job if I was caught doing so. THAT is why the nurse didn't share the information with her sister. Most probably, her sister's husband was the only one on the list with whom the nurses and doctors could divulge her medical status. The nurse was following the law. Surely, you would want her to do the same with you and your loved ones.
And lastly, you said; "Carol567 is probably upset she died, not in the comforts of home surrounded by people she loved, but in the "cold" place where hospice was administered." I think Carol is more upset that her sister's husband kept the truth from her and she wasn't allowed to be part of her sister's dying process.
P.S. Hospice can be administered anywhere... the patient's home, an actual hospice building, a nursing home, the home of a family member, a memory care unit, a hospital room, etc.

It's extremely difficult to cope with if you have no say in the POAs decision. My mother passed in 2 days on hospice alert with strong vitals. IMO hospices are being abused with overdoses of morphine and need to be investigated. A church member who was family friends with hospital administration convinced my sister POA to put my mother on hospice and tried to force me to agree by yelling and pushing in on my head "Your mother's going to die! to cover up for malpractice of my mother's thumb having to be amputated. Still waiting gor s good lawyer to take my angelic beloved mother's nursing home neglect for ruptured colon and hospital malpractice for cutting off my mother's circulation , but by all means I thank the hospital for saving my mother's life until the conspiracy to end her life on unnecessary hospice her primary Doctor didn't recommend as ICU and the imposter church member ended her life while my mother was making a miraculous recovery with strong vitals and improving white blood cell count from 3000 to 1600 ridding bacteria or sepsis as she died from respiratory failure and psychosis but she was alert during her recovery. MY MOTHER WAS KILLED UNDER THE GUISE OF HOSPICE IMO. Please set up an hospice investigation or request it if you have true love for the aging and elderly and their right to quality of life and aging in place. Please help resolve my mother's murder. My God may all who read put their burdens in your hands at the altar in the name of Jesus Christ our Lord and Saviour.

staceyb

Carol567 is probably upset she died, not in the comforts of home surrounded by people she loved, but in the "cold" place where hospice was administered.

carol567

You're right, something fishy is going on. You're a family member, the nurse could have told you what was going on. Seems like a CYA situation with the place your sister was in.

fredflyer

Hospital can place a patient in Hospice as well. I know this, because they did this for my mom. Her NH PCP, "ditched" her 2 days before this happened. He did not come back to see her after this.

Carol567, it sounds like you BIL, was given a very sad and unfortunate diagnosis /prognosis, that your sister would be dying very soon, and being that he was probably her MEDICAL POA, the recommendation and decision was made by him to have her in a care facility with Hospice care, and though you were sadly not given clear information, it probably was the best place for her, and certainly for him, as dealing with the intense sadness of losing someone, especially in your long term home together, is so so dificult. Believe me, I've been there.

Imagine if you will, receiving this sort of information about your life partner. Sometimes it is very difficult to wrap your head around, that you WILL be losing your Loved One within 2 weeks, due to her terribly difficult ilness or disease process.

He may well have felt that he could not manage her alone at home, by himself or even with the help of other family members and Hospice there helping to care for her, or perhaps he couldn't face her dying in their home. Hospice comes several times per week, plus their awesome support staff, but they are not there 24/7, and very likely in those last hours and minutes, you are alone with your LO dying in your arms, and not everybody is able to manage this sort of pain, and some people are often terrified of going through it alone.

So much goes through your head when you are faced with these life ending decisions, and depending on your family dynamics, relationships, closeness, his own fear, personality, or even what thay well may have discussed Privately over the course of their marriage, sometimes couples want to keep things private to spare others or their own feelings.

I understand how saddened you are and losss you must feel, to be left out of that loop, being that it was your sister, when it could have been so very different had he confided in you. I do know, that Hospice in No Way, nor would any Dr, allow your sisters life been taken in haste, that is against the law and against all of Hospice's intentions, to ever take someone's life, before their time. They are only here to help with end of life support and to keep people comfortable and in as little pain as possible, in the event of a life ending illness or disease. I imagine his decision was difficult, painful, and obviously a very private thing that he did, keeping others out of the loop.

Your sister has now passed away, and for that I am very sorry for your loss, but if I were you, I would give it a little more time before trying to figure out the reasons why, but instead, celebrate her life as best as you can. Perhaps when he is in a better frame of mind, he will be able to discuss his decisions that he made on her behalf, but please know that it was probably very difficult for him, and he is grieving just as you are, maybe more so. If the situation is handled correctly, he may in time discuss this with you. Again, and you may understand his reasonings. I am so sorry.

Carol, it is my understanding when a person's body is starting to shut down, that food and water is no longer given because the body can no longer process, and instead of food/water going into the stomach, it will go into the lungs which is very painful.

As for dying alone, you'd be surprised at the number of patients who wait until their love ones have left the room before they depart.

By the way, only a doctor can place a person into hospice. It depends on the medical condition and if the person is within 6 months of passing. Sounds like your brother-in-law didn't want to communicate with the family what was medically going on with your sister. He must have had his reasons.

My brother in law put my sister in a hospice. She requested that all methods be used to preserve her life. He told her she was in a nursing home. He told us the hospice was a temporary situation. When all of her food and medicine was stopped, I asked the nurse why she wasn't being fed. She told me she couldn't tell me, but to discuss it with her husband. He told me the doctor told him her body needed to rest. When she didn't wake up, I asked if she was in a coma, I was told, "No." He called the nurse while I was there and the nurse then told me she was okay, she just appeared to be comatose. She died 6 days after she entered the hospice. He told me he left at 8. She died at 1 am alone. I wish he would have been honest with us, we would all have been there with her. Right now, I am going to hire a lawyer because I want to see her hospital records. I just want to know why she was in a hospice, and what her prognosis was. This will give me some kind of closure.

Motherof5,
I don't know why your post showed up on my "wall" (whatever that is?) instead of on this thread. Your question was;
Since your mom seems to be doing better, can she come off hospice?
Usually, that is determined by the RN assigned to her case. The nurse's decision is based on Medicare guidelines. If she doesn't meet the requirements set by Medicare, she would be discharged from hospice.

It's not a bad thing to stay ON hospice because the hospice pays for many things, with no cost to you. The hospice is reimbursed by the government. The hospital bed/mattress and air or foam topper mattress, the medications, the diapers and bedpads, wipes, urinals, bedpans, any suction equipment, oxygen tanks/or concentrator and tubing are all covered free of charge. All of these benefits are not available if you cancel hospice.

You have a doctor visiting occasionally, an RN overseeing the care, an LVN for treatments, a Home Health Aide for bathing, a social worker for any information/services you need for your mom, a chaplain for spiritual needs, our hospice employs 2 music therapists for patient relaxation/comfort and a dietician, if needed. Our hospice even sends nurses for crisis care-when family can't handle the caregiving or when the patient has intractable pain or vomiting. We cover 24 hrs./day UNTIL the crisis has passed. (That's the job I do!)
All these services are available through one company and all without cost to the patient/family.

Talk to the RN assigned to your mom's case. If you really want her off hospice care, she would be the one to speak with. Of course, you would be able to put her back on hospice if you needed to. I'm glad she's doing better.

Windy town,
Thanks for the kudos for hospice. Nice to know we're appreciated by some.
It sounds like your FIL is clear in his mind, (without dementia). Given that, he has a right, as we all do, to call his own shots. If he has been properly informed of his conditions AND what the outcome CAN be and he still chooses to be at home, that's his choice, however poor we believe it to be.

Since he has made his desires known, would he be receptive to have a caregiver help him in the house? Would any family members be able to take turns being there throughout the week? Can a neighbor check in on him? You could offer a bedroom in his home to a college/university student (rent free) in exchange for being there at specified hours.

He probably has visions of the dark, urine smelling nursing homes he visited relatives in when he was younger. I remember how awful the conditions were. Dear Lord, I wouldn't want to end up like that either! That's probably why he says no to any facility. He's not aware that we have progressed by leaps and bounds in facilities for the elderly/ incapacitated.

IF he would go, take him on a tour of whatever facility would be appropriate for his care needs. Maybe he'd change his mind. Many elderly also think they'd be abandoned by family if they lived there. I'm not sure you'll be able to erase his perception of what a care facility is like. It's part of his generation.

I would suggest in investing (very little money) in a push button alert system. I had one for my mom when she lived alone before her dementia got bad. It's around $20./month. The person wears either a necklace or bracelet (waterproof for the shower) and can push the button if they fall, chest pain or any other problem. An ambulance is sent. There is a key to the house in a lock box somewhere on the property, so they can go in and get him. It sure gave me peace of mind. It connects through the phone lines and can be heard all through the house.
I wish you all well and hope it all works out.

You said it in your last sentence. FIL does not want to go to NH. He would rather run the risk of a potentially painful death at home, then a NH. He has probably thought this through and has come to the decision to stay at home. Good for him, seriously.

Hi Thanklessjob, Just wanting to pick your brain right now regarding my father in law. Also, should add you hospice nurses were a godsend when my own father died of brain cancer. Bless you and all you do! I am truly thankful for your service to others.

Anyhoo, my poor husband is 'blessed' with five sisters who are in varying degrees of denial regarding FIL's condition. Background: 85 year old, morbidly obese, with prostate cancer with bone mets throughout his body. Has had a few fractures. Last weekend he suffered a mild heart attack and subsequently discovered a tumor on his spine from the MRI for his heart. He declined an angiogram but accepted targeted radiation therapy on his spine - once a day for three weeks. Have in home PT for him three times a day, but that is it.

My husband and I think he should move to respite care or NH for his treatment plan. Sisters are bullheaded, idiots or who knows??? They think he can live alone. They say they are respecting his wishes not to move to a NH. They are delusional in my mind. He could die in excruciating pain from a bone break or his unresolved heart issues.

I guess I answered my own question. It's just extremely frustrating having what I view as a not wanting to be the informed person in charge. She has no idea of his finances which is her responsibility as executor of the will. Child of the 60's, darn it. Still in the smoke cloud. Gah! I'm known on here for taking care of my own mother. It's tough, but I'm responsible.

From what we have gathered from hub's dad, he could afford respite. Medicare would pay for transit to radiation. Girls don't want to do it because dad wouldn't want it. Time to parent your parent girls. No one wants nursing home.

Motherof5,
Here's what I found from Alz.org. Hopefully it will explain the differences.


Vascular dementia is a decline in thinking skills caused by conditions that "block or reduce blood flow to the brain, depriving brain cells of vital oxygen and nutrients" (my italics). In vascular dementia, changes in thinking skills sometimes occur suddenly following strokes that block major brain blood vessels. Thinking problems also may begin as mild changes that worsen gradually as a result of multiple minor strokes or other conditions that affect smaller blood vessels, leading to cumulative damage. A growing number of experts prefer the term "vascular cognitive impairment (VCI)" to "vascular dementia" because they feel it better expresses the concept that vascular thinking changes can range from mild to severe. Vascular brain changes often coexist with changes linked to other types of dementia, including Alzheimer's disease and dementia with Lewy bodies. Several studies have found that vascular changes and other brain abnormalities may interact in ways that increase the likelihood of dementia diagnosis.Vascular dementia symptoms may be most obvious when they happen soon after a major stroke. Individuals at highest risk include those who have had a stroke or a transient ischemic attack (TIA, also known as a "ministroke").


Alzheimer's is a type of dementia that causes problems with memory, thinking and behavior. Alzheimer's worsens over time. Alzheimer's is a progressive disease, where dementia symptoms gradually worsen over a number of years. In its early stages, memory loss is mild, but with late-stage Alzheimer's, individuals lose the ability to carry on a conversation and respond to their environment. Alzheimer's is the sixth leading cause of death in the United States. Those with Alzheimer's live an average of eight years after their symptoms become noticeable to others, but survival can range from four to 20 years, depending on age and other health conditions. The most common early symptom of Alzheimer's is difficulty remembering newly learned information because Alzheimer's changes typically begin in the part of the brain that affects learning. As Alzheimer's advances through the brain it leads to increasingly severe symptoms, including disorientation, mood and behavior changes; deepening confusion about events, time and place; unfounded suspicions about family, friends and professional caregivers; more serious memory loss and behavior changes; and difficulty speaking, swallowing and walking. It's the "destruction and death of nerve cells" (my italics) that causes memory failure, personality changes, problems carrying out daily activities and other symptoms of Alzheimer's disease.
(Me speaking) So in vascular dementia there is a loss of blood flow to the brain cells, in Alzheimer's dementia, there is a loss of nerve cells in the brain.

(Alz.org) Anything that damages blood vessels anywhere in your body can damage blood vessels in your brain, depriving brain cells of vital food and oxygen. Blood vessel changes in the brain are linked to vascular dementia. They often are present along with changes caused by other types of dementia, including Alzheimer's disease and dementia with Lewy bodies. These changes may interact to cause faster decline or make impairments more severe.

I'm sorry this couldn't have been better news. How sad for all of our loved ones and ourselves.

don't know why I started to not get notices for this post. I do need to follow.

My mother has been on hospice for about 3 weeks now, started out in hospital as she was transferred from ICU to Hospice, not sure if she would make transition home or not. As I said that was about 3 weeks ago. I have been giving Morphine for turning/cleaning purposes as she has too much pain when moved. I have not yet opened the ativan but it is available in comfort pack. today I gave her benedryl for severe itching and morphine when visiting nurse came. She has been pretty much sleeping all day, rousable, but declines to eat or drink. I keep watching to make sure she is not having any distress or difficulty with breathing/pain. I know as a nurse what these meds can do when used incorrectly, but in hospice comfort is comfort and we have to do what is necessary. No one should beat themselves up thinking they hastened anything.

To thankless job..thanks so much for your thoughtful words..so now hospice is saying that my moms got vascular dementia..also plus Alzheimer's..what can I expect now..

I've been through end of life with both of my parents, a very simular experience to many of you, and Never a good feeling when all you really want is your Most Wonderful and Loving parents alive and free from pain, but that wasn't to be according to God, or just plain biologically. Death was imminent no matter what we, or the Dr's or Nurses could do, so the best thing that we as their adult children, who knew our parents and their wishes best, was to at the very least, leave our selfishness on the table, and agree to having the Medical professionals treat their pain and discomfort, period! All 6 of us agreed, no questions that this was best, even if it might hasten their deaths by minutes, by God they would be comfortable and pain free to the best of their abilities. I know that we made the best decision, the biggest and hardest decision of our lives, but we are at peace with it. Never did we ever feel that the professionals coerced us in any way, and neither of my parents were ever without one of us there with them at all times, and both times when they did pass, all 6 of us were able to get back to the hospital to be there with them as they did pass away.
To me, there was of course great sadness, but also a sort of feeling that they were there bringing us into the world, and we were there seeing to them as they left this world, it just seemed appropriate, maybe a Religion thing. Maybe just having us all together and able to comfort one another, made that difference. I do realize that this is not always the case, and I don't believe people should feel bad or guilt for not being there, maybe it just worked out that way for our family. Losing a LO is difficult and sad, but death comes on its own terms and sometimes unexpectedly.

I am so sorry that some people have a hard time finding peace with this. The medical system is not perfect, it is not always clear or simple to put a finger on specifics, but know that hospice is only ever meant to comfort the patient, and thier LO's.

should have read at the time. Mother had 2 serious falls.....GIVE US AN EDIT BUTTON

Couldn't agree more CM and I know that what I did was right for us ...but there again the niggle sits there from time to time. But others would and have argued that that type of medicating hastens a death, that the hospice killed their loved one. It drives me nuts that people don't understand the role of hospice care/palliative care/ end of life care. Yes it would be lovely if everyone passed peacefully in their sleep but then the hunger mongers would say that they were suffocated or some such nonsense.

The role of everyone involved in care of their loved one is to monitor what happens. If the care is bad speak out shout out yell it from the rooftops till someone hears you....just don't whine after the event because you could and should have done something at the timeshare had 2 serious falls while in hospital and I went straight to the sister and told her that this was not acceptable. She hadn't realised that Mum was such a high risk because the first fall had not been documented properly

Result within 5 minutes the bed had been lowered, crash mats all around in case she thought she could vault the safety bars again! and a person engaged to cover the hours when I wasn't there and I was doing 16 hour days to make sure she was safe. 2 Days later the UTI dissipated andepsis improved and it wasn't needed but I saw that as my role in her hospital care. I don't just take it for granted all will be well.

The sister asked if I wanted to make the complaint formal and I asked what outcome was as it stood. She had reprimanded two members of staff one for not recording and the other for not informing me and they both had to undergo further training. Good enough for me.

Phoenix, there was a Scottish doctor on the radio not long ago discussing this issue who made a point that I think should be dwelt on more. He said: "if we had a drug that relieved pain as effectively without hastening death, we'd use that instead. But we haven't." The intention *matters*. I don't see you had a choice.

Absolutely cannot Nasmir and is why it is critical to have an end of life plan that covers as many eventualities as you can. I went through this with Dad who had terminal and metastasised cancers. The day before he died I was told to prepare for him to come home. He was sat up, quite lively in between the morphine was a low dose. He went to sleep about 11 and I went home to sort out a bring home plan. By 3 it was done and back we went to the hospital - he was cheerful and looked forward to seeing his beloved cats. He had tea and was really quite jubilant he was coming home then in the space of less than 10 minutes he went from that positive place to terrifyingly in pain. Nothing was given to him other than what had been given to him previously. Nothing was not given that should have been there ...I know.

The doctor was called immediately and it was clear that whatever they had been doing to help him sustain life (NOTE SUSTAIN NOT PROLONG) had suddenly and without notice stopped working. His lungs were filling from the drip which he had to have to combat the dehydration from the morphine which he had to have for the pain. It is cyclical at that point and there is no point continuing a treatment that will prolong what would eventually be a painful ending. He deserved to die peacefully, free of pain. It was explained to me that an increase in morphine would hasten death, but to deny him would caused him pain....tell me what option is there? In MY BOOK and I am being very specific here I mean my opinion for my father not for anyone else, I did the best and worst thing. I agreed to the morphine and in doing so I hastened his death which I have to live with. Could I have lived with letting such a very very special man die in agony - absolutely not - I would rather kill myself than do that. So let hospices do their work accept that it is the final path and that people do have a right to be free of pain and to die with dignity not distorted in agony.

Dear Mother of 5,
Thanks. If I can enlighten one person to the truth, then I'm happy. There is so much misinformation out there. Please feel free to contact me, or your hospice office for any questions you have. Really, any time of the day or night. If you are well informed then we can focus our attention on your mom to help her be comfortable. I'm sorry you have to be in this situation. My mom is in Stage 6, so it's coming for us one of these days too. Lord help us all.

To thankless job wow what you said makes since..thanks..my mom is in stage 7 the doctor want me to put on hospice..so I did..they are taking her off the Alzheimer's meds slowly..she seems to be doing good..everything that you said in your post was so helpfully and made me understand a little more..I know there no way of knowing how long stage 7 last..but thanks for the comments

Now, for the comment on hospice "killing" your loved ones. I am a part time hospice nurse (the other time Home Health). Often, the patient's doctor will make a recommendation for hospice if (s)he feels that they probably won't be alive in 6 months. There are criteria that the patient has to meet (from Medicare) to be admitted to or be kept on hospice service. These rules are explained to the patient (if cognizant) and family, along with the whole admission process, when the patient is admitted to service. If the patient (or POA, if patient is unable to speak for themselves) wants any "life saving or prolonging measures", they will not be a candidate for hospice. Usually, the patient is in a "terminal" state, unable to recover from illness (metastatic cancer, end stage Parkinson's, end stage dementia etc.), also, end stage breathing problems (COPD, lung cancer, emphysema) or they have suffered health issues from which recovery is not thought possible. Hospice is a free service through Medicare, the patient/ family is never charged. The patient (or POA) must agree to not take the patient to the hospital for life saving treatment. There ARE allowable visits but for "facilitating comfort" only. Many family members, not directly involved, that have their loved one receiving hospice care, often aren't informed of these rules by the other care-taking family members. (we can't talk to ALL of the family members) and they don't understand the reason/rules for hospice. I recently had an 89 year old grandmother as my patient, who was dying, and she had a visit from her adult granddaughter from another country. The young woman
was asking if grandma had eaten breakfast. I said "No, she's not able to eat anymore." She seemed confused and asked why not. I tried to gently explain that her grandma was not going to be able to eat, drink, etc. because of her "condition". The house was full of family and I hope one of them was able to break the news to her. This is an example of poor family communication. Grandma passed away 6 hours later, comfortably. I'm sure there are good hospices and not so good but before you judge us, please talk with the patient or POA about what THEY agreed on with the hospice care. My company has a service that most other hospice's don't called "Continous Care". If the family is emotionally falling apart, if the caregivers are exhausted or if the patient is in unrelenting pain or vomiting, we send 24 hour nurses to care for the patient (and family) in their home. MOST people don't want their loved ones to suffer in pain or discomfort. We give Morphine for that, usually in a round the clock basis like every 4 hours. It keeps them comfortable. There is more Morphine for "breakthrough" pain that we give if the patient asks for it or if we notice signs of pain, (frowning, moaning, rubbing a particular area frequently, increased heart rate, moving back and forth, etc.) The families need to come to grips with the fact that their loved one won't have too much time in life left. Sometimes patients get somewhat better and we need to discharge them from hospice because they no longer meet Medicare guidelines. I had a patient the other day with intractable vomiting. We got it under control and she was discharged 24 hours later. Her caregiver was very thankful she could call us anytime.
Also, most family members have no idea about death or what stage their loved one is in. They may think they'll have Dad for another month but the nurse can tell you it'll be a matter of hours. Many are in denial. That's where we're referred to as "killers". Obviously they have never seen a patient "go sour", their condition can change in the blink of an eye. Please don't condemn the professionals trying to help your family member depart this earth with the least amount of pain and suffering possible. And read all the literature that your loved one or family caregiver has been given. It explains it all.

Veronica91 commented on Mar 31, 2015
"LPNs should not be handling the narcotic doses." In reading through some of the posts, I found this and had to comment. Veronica, I've been (California's and Texas' version of an LPN) an LVN (V for vocational) for 37 years. When I was in school, the LVN's had more bedside and patient care nursing hours logged than the RN's (who focused on administrative nursing). We were taught the same nursing calculations to give meds and to regulate drip counts in IV bottles. (Wow, that shows my age, since all IV's are put on pumps (machines that count drops/minute) now!) The state has recognized that we have successfully completed and graduated from an LVN program and, if we pass the state test, we are able to give medicines within our scope of practice. Usually LVN's do not administer IV meds but there are exceptions. The "N" in my title stands for nurse. I have been successfully administering all kinds of meds, eye drops, ear drops, intranets all meds, skin creams, oral liquids/pills, subcutaneous injections, intramuscular injections, intradermal injections and even rectal meds. There is no reason why an LVN/LPN would not or should not be able to do what the state has licensed him/ her to do. I'm sorry you have that bias but your opinion is not from fact. I will agree that there are good and bad nurses, both LVN's and RN's. I've worked with a few RN's that I wondered how they passed the "boards" (state test). Please don't judge all of us if you've had a bad experience with one.

Hannan, you made an excellent point as some patients are placed on Hospice only days prior to passing, thus it could feel like death was rushed, when in fact it wasn't.

My Mom [98] who had a serious head injury due to a fall and could no longer communicate or think for herself, was placed on Hospice probably 4 weeks prior. With my Mom's condition, I was really surprised she had lived as long as she had as her body was shutting down on its own. I was ready for her to transition as I had studied up on her condition and knew there was no reversal. My Dad was surprised when Mom passed but he was in denial, he thought she would be coming home, which was wishful thinking :(

I'm sure that there are some bad hospices but I think an issue that is overlooked is that people go into hospice much later than they should have. Hospice is for death expected in 6 or less months but many don't enter until the week before death. I think that could add to the feelings that hospice killed them because everything happens so fast that you don't have time to come to terms. The lady I care for is nearly a year into hospice, the 6 months isn't a hard and fast rule as long as they have some decline. Anyway, I'd say that what they said at the beginning has held true, they don't do anything to hasten or slow down death. They just provide comfort via oxygen, pain meds, etc. they definitely aren't doing anything to kill her. I'm not really sure what benefits they have from speeding up death because they make quite a bit of money for very little work (imo). I can understand the difficulty in accepting that you can't give loved ones their regular meds or call an ambulance, etc. it would be hard for me to do.