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 hope you do not have to go on with the image of a nurse just casually and deliberately giving a lethal dose to your mom...but if there was an error or a failure to respect your and your mom's wishes for how alert she may have wanted to be, you are entitled to know and file complaints at the very least.
Currently, the hospice patient I care for is an older brother. But throughout the years, I've lost my mother, a younger brother, my sister-in-law, and two very close friends -- all under hospice care.
Also, I appreciate your sympathy regarding my own loss.
Secondly, I realize that some of my comments could use some clarification, and I'll now attempt that....with references:
Medicare pays for the vast majority of hospice care in the United States. (i)
Hospice care is intended for people with 6 months or less to live if the disease runs its normal course. If you live longer than 6 months, you can still get hospice care,
as long as the hospice medical director or other hospice doctor recertifies that you’re terminally ill. (ii)
In fact, that 6 month period is actually a Medicare rule --
"Your hospice doctor and your regular doctor (if you have one) certify that you’re terminally ill (with a life expectancy
of 6 months or less)." (iii)
Given just the information above, one might conclude that hospices would be quite diligent, when choosing which patients to accept.
Yet, in recent decades, what began as a movement to improve the end-of-life experience has become more of a commercial enterprise. (iv)
In fact, a 2011 Bloomberg News report noted that the growth in hospice care has been fueled by enrollment bonuses to employees and kickbacks to nursing homes
that refer patients. Investigators alleged that this led hospices to accept patients who weren’t actually eligible for the service. (v)
Personally, offering financial incentives for drumming-up more business, is a practice I find quite chilling!
But, jeanne, here's what I believe is the real problem --
Medicare has capped the average amount of money a hospice can make on a patient -- currently around $25,000 -- which amounts to about 180 days of routine care.
This is NOT a per-patient limit, but is AVERAGED OVER ALL OF THE HOSPICE'S PATIENTS. (vi)
Now, can you see why the hospice company might want the highest volume of patients, with the shortest amount of time remaining?
If you've ever worked in wholesale/retail, jeanne -- especially, dealing in a perishable product -- you'll probably recognize the term, "stock rotation."
(i) washingtonpost/business/economy/2014/12/26/a7d90438-692f-11e4-b053-65cea7903f2e_story.html
(ii) hospicenet/html/medicare.html
(iii) https://www.medicare.gov/pubs/pdf/02154.pdf
(iv) http://www.washingtonpost.com/business/economy/leaving-hospice-care-alive-rising-rates-of-live-discharge-in-the-us-raise-questions-about-quality-of-care/2014/08/06/13a4e7a0-175e-11e4-9e3b-7f2f110c6265_story.html
(v) bloomberg/news/2011-12-06/hospice-care-revealed-as-14-billion-u-s-market.html
(vi) washingtonpost/business/economy/medicare-rules-create-a-booming-business-in-hospice-care-for-people-who-arent-dying/2013/12/26/4ff75bbe-68c9-11e3-ae56-22de072140a2_story.html
My husband lived 5 weeks after being admitted to hospice. My mother was discharged when she improved greatly after 3 months. Hospice has to bill medicare for their services. They do not get a flat fee per patient.
I am so very sorry that you view your mother's death as murder. That has to be unbearably traumatic for you.
Please do not spread false information about how Hospice providers are funded for their work.
We asked if they could tell us how long she had, since she was no longer eating or drinking. They said maybe 3 or 4 days. They told my sister Friday night that she was NOT on the 48 hour "watch": she had no skin mottling on her feet, no rattle in her lungs, etc.
Saturday, the remaining family members arrived in early afternoon. Earlier that morning, my sister, who had stayed the night, told me they put a subcutaneous injection port in her arm, so the meds would "last longer". At 3:30 Saturday afternoon, the nurse came in with 2 full sized syringes, not the skinny ones I had used to give her pain and anxiety meds at home. One was half full, the other full. She screwed the full one into the port and injected half, then all of the half full one, then the rest of the first. My mom had never moved, never opened her eyes, never responded at all. There was no reason to give her anything.
I went home to nap, since I was so exhausted. At 6 pm, my daughter called from the hospital. They had told her that mom would probably be gone in 24 hours. I got there about 6:30. My father, sister, and daughter were all around her, each with a hand on her. Mom was laying on her back, a gasping breath coming every minute or so. I laid my head next to hers, listening as her breathing slowed. About ten minutes after I got there, she took her last breath. I have never been so utterly devastated in my life. What a horrible thing to experience. I can't get the image or sound out of my head, nor the look on that nurses face as she euthanized my mother.
I am shaking so bad right now, I can hardly type. I fell apart that night. Totally apart. It wasn't until the next morning that I put it all together. They HAD to use the subcutaneous, because that much morphine in an iv would have killed her in seconds. They had to make it look natural. And how did we go from 3 days on Friday, to 24 hours on Saturday, to dead in 4 hours??
Of course, when I told my sister this, she said she didn't blame them for her dying so quickly. That she was glad it was over quick and that mom didn't have to suffer. I say she should have been allowed to die naturally, with the minimal pain medication. She was murdered, plain and simple.
I won't be able to pursue it legally, but they WILL know that I know what they did. I will never get over this. I will never forget, and never forgive.
Let it be on the conscience of those that take it upon themselves to decide that someone should die. As far as I'm concerned if the patient is asking for help that's different. It's a compassionate act. But how many are blindsided by overdoses? They never saw it coming, or worse knew it was happening and couldn't do anything about it.
But please, do not carry any guilt at signing the DNR. I have seen the way they pressure family into doing just that -- and sadly...worse.
I'm reading so many heart-wrenching posts, here. Many of us, it seems, are harboring varying degrees of guilt -- and all of it, undeserved!
Any caring human being is most vulnerable (I'm using that word a lot, lately) when facing the loss of their loved ones.
Just like in the old days of the traveling salesman -- a foot in the door almost insures a sale!
And certain hospice workers are trained to do just that -- get that foot in.
Their business is death..and some are very good at it.
I'm not saying that most hospice workers are so calloused. There are wonderful, caring people who work in palliative care. I have known a few, and would trust them with my own life.
But there are also stages to hospice care , and workers trained specifically to handle those stages.
Yes, there are "closers," too....and they are the actual "foot in the door" folks.
I recall once watching a group of them surrounding a poor patient's bed. At the time, it appeared to me to be a loving circle of friends and family....attempting to bring comfort to the ailing patient.
I did not know the man they were "embracing," but something about it....something just didn't feel quite right.
Perhaps, it was because the gathered comforters seemed a little too euphoric for the ominous scene?
Years later, while attending a child's birthday party at a well-known eatery, the reality finally hit me.
Here was a celebration of a life.
But what I'd witnessed years earlier was hardly a celebration of the man's life -- but of it's ending!
It takes a particular type of person to do what I now call "The Chucky" celebration.
I'm sure that not all of them are so morbidly enthralled with the job.
But some are. And what better place to seek employment, than in the care of the most helpless?
I'd like to see more stringent qualifications for people who work with the vulnerable.
Psychological testing should certainly be a part of their tentative employment.
And if anyone suggests that many hospice care workers are medical professionals....remember that more than a few errant nurses have been tagged with the moniker -- "angel of death!"
My harsh approach is not meant to slander any particular form of health care provider.
The truly compassionate caregivers are real "angels." Their work is hard, and often unrewarding. And it takes a great deal of strength to work with the ill, the elderly and the disabled, daily....while trying, all the while, to keep your heart from breaking.
But rather, my goal is to anger the rest of us! Yes, to anger us into action, and to force the changes that must be made!
Remembering our loved ones is a good start. Remember, too, that we may someday find ourselves in the same dire situation.
Fight for the rights of terminal patients and their families, that they're allowed to make their own informed decisions, without being pressured.
What better way to honor the memory of those we've lost?
Yet, in retrospect, I do not hold hospice solely to blame. The bottom line appears to be the real culprit -- $$.
Lingering patients are always costly. Exorbitant pricing makes even a short hospital stay, an unrecoverable cost. So, it's easy to see why hospitals and nursing care facilities would embrace hospice care, because it affords them a financial workaround.
The facility may still house the patient, but has essentially subcontracted them out.
Now, the loss becomes a gain -- for both the facility, and the new caregiver.
How?
Well, hospice is essentially "renting" space for the patient.
Still, how can that be a boon for both businesses? (yes, they are businesses!)
Enter government; you know -- the folks who write the laws that protect us?
Yeah, those folks...who can usually afford to avoid hospice care for themselves, and their own families.
(I have yet to hear of any ranking official being put under hospice care. Have you?)
So, government attempts to solve the problem of terminally ill patients, by ordaining hospice to weed those patients out of the healthcare system. Hospice is granted a stipend (our tax dollars hard at work?) purported to cover a dying patient for up to 6 months of care.
On its face, this idea would appear to make sense. And it might work well, IF it were possible to predict exactly how long a terminal patient will last.
However, such predictions aren't always correct. And so, the long-lingering patient again becomes....a financial problem. And hospice services must be very careful about which patients to accept.
We already know that we're all fallible human beings...and doctors are no exception.
So, just because a patient is declared terminally ill....we can't always be sure.
Then too, the hospice now caring for that not-terminal-enough patient is facing financial loss, should the patient's life be prolonged beyond that 6-month funding window.
Conversely, the short-lived hospice patient is a financial gain for hospice, since the unused funds remain in their coffers....supposedly, to go toward the care of the aforementioned lingerers.
But again -- we're discussing a business...with employees, drug costs, rent, etc
.
So, how do you maintain the business...and still make a profit? (an ice-cold term, under these circumstances!)
By choosing the patient most likely to die within the shortest amount of time, so as not to exceed the government funding, and to actually leave behind an unused balance.
Could this setup actually tempt some hospices into hastening their patients' deaths?
Might the contracting hospital/nursing facility look the other way, as their own bottom line is involved, as well?
And finally, could some hospices even resort to other means of making a profit -- like the sale of human organs, for example?
I know that this post will stimulate some controversy. In fact, I'm hoping for it!
It's hard to say how the new healthcare system will effect the "death industry."
My guess -- it will only make matters worse for those who cannot afford to die under their own terms.
as I did everyday, regardless. Anyway, That's when 5 staff members surrounded me insisting I sign a DNR. Four hours later he was gone. I am so angry and stressed!!
For the record, I am opposed to euthanasia, and to assisted suicide, and to anything else it might be called. Just so we're clear on that.
I am also in favour of treating people regardless of their numerical age, medically if they have any realistic prospect of recovery, and palliatively if they haven't.
I don't know exactly what happened to your father, of course; and I am in any case sorry for your loss. The point I want to make is that if you are being advised that there is a possibility that a nurse would intentionally have misdirected your father's feeding tube in order to induce aspiration pneumonia and kill him… then that advice is extremely cruel and deeply misguided.
My father died very suddenly and unexpectedly at 71. Soon after somebody said to me "oh well, he'd had his life then," and I have never forgiven that person; so I understand how hurtful your co-workers' attitude must be. My mother died this year at 90, at home, where I cared for her. I was a tireless advocate for my 96 year old great aunt when poor health care following a fall at home nearly did for her; it took a lot of fast talking to get her moved to a better hospital, after which she lived for four more good years. I come from a whole family of long-lived people, mostly ladies; and I would have loved nothing more than to see them reach 100 and keep going, with their skates on. So believe me, if your father had been my father then I too would have been in the ER doing my best to get him the best possible care and hoping he could recover.
But look. There are two points to consider about his fall. The first is that very often it is a stroke that causes the fall, not the other way about. The second is that, either way, either he had a very serious stroke or it was such a serious fall that he suffered a major head injury. At any age, and whatever the state of a person's body otherwise, that is extremely dangerous.
How long after his admission was it decided to insert a feeding tube? I am a little surprised that this was done, because it is a risky procedure precisely because of the problems you describe. Did the medical staff come under pressure to do it, or was it their recommendation?
Look. You have a choice. You can torture yourself and think ill of the nurse and blame everybody, including yourself, for your father's death. Or you can speak to your own doctor about what happened, and get a clear explanation of the medical issues. The bottom line, though, is that your father had an unsurvivable brain injury unrelated to his age. That's enough sadness to have to cope with, without adding poisonous suspicions to it. Please think this through and don't multiply your grief.
Morphine and ativan are given to reduce suffering and control agitation, not to speed death. Often the trade off is that the person is no longer lucid or aware, but IMO that is better than aware, afraid and suffering.
Food is withheld at the end of life because the dying no longer need food, in fact the dying body can no longer digest the food we eat and eating can cause harm.
I.V. hydration is similar to food, fluids can build up in the lungs and around the heart and cause increased suffering.
Today we have the technology to keep the heart beating and the shell of the body alive, tying the soul to the earth instead of letting it depart. Is this prolonging of life really just??
Yet, the posts predominantly lean toward a "No" answer. So, either that is the real truth, or....a lot of the posters are mistaken.
Given that hospice actually advertises on this site, I find it difficult to believe that bias plays no part in the content thereof.
And having read the "About Us" page, I'd be even more inclined to question this discussion.
As an advocate for life, myself (most likely, because I am alive, and wish to remain so) I do not differentiate between the unborn, and the already here.
The young, the old, the infirm -- all are equal in their right to live.
I do not discriminate....and I do not sanction the premature taking of any human life -- no matter how small, feeble, or presumably insignificant.
Because there is no insignificant human life.
And to take that life prematurely, is an "m" word....but "mercy" isn't it.
Please try again to find someone who can help you move forward with your life, not to forget, but to find a way to live with this 'wound' and find comfort and joy in the future.