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.
Why am I not surprised?tThere is a great deal of money to be made for from dying patients especially if you admit them when they are reasonably healthy and stop regular medications. They need very little in the way of expensive equipment or staff time. OK so the RN pops in once a week and documents her visit. It certainly makes sense not to have them survive beyond 6 months. Medicare will ask questions about that.
A not for profit hospice relies mostly on Medicare and some private pay depending on the area. True, Medicare only does an inspection every few years but I promise you those inspectors go over the records with a fine tooth comb and accompany the nurses on their visits. Not for profits have to use volunteers for a specified number of hours and much of the ongoing expenses are raised with fundraisers and endowments. Of course there a bad apples in every basket but a nurse would not go to work for a non profit hospice where the pay is about half that of a general hospital.
I have said many times on this thread check things out before you allow your loved one to be enrolled in hospice and if you don't like the treatment you can throw them out.
It is true that strong drugs are used and needed at the end of life and should never be used in such doses that unwelcome side effects are seen.
Many times close to the end pain does get out of control and higher than usual doses of drugs like morphine may be needed. No medication can be given without the Dr's authorization, that would cost a nurse her license. Anti anxiety and anti psychotic drugs are also used when indicated, they will cause drowsiness that has to be understood but the alternative is to have a loved one confined to a mental institution when he becomes too combative at home where he and you want him to stay.
All drugs have side effects on some people and many are not advised for use with the elderly because they are more likely not to be able to eliminate them if their livers or kidneys are functioning poorly (wearing out) for this reasons if the drug is necessary a smaller dose may be tried and the patient closely monitored. this applies to any older adult not just the dying.
No one wants to loose a beloved family member or friend and it is a very emotional and frightening time.
One of the stages of grieving is "anger"
You can not bring them back but if you feel they were wronged it is certainly in everyones interest to bring the perpetrators to justice so they may not harm anyone else.
One sits is healthinaging and they also have a foundation. Phillips Lifeline has a piece on the subject here too: . I am not quite finding what I want, but I'll keep trying. I think the main thing is not to just advocate against specific drugs that have legitimate uses - both Haldol and Ativan can be used appropriately in different circumstances and ought not to be off the market - but against an approach that ignores patient's wishes, needs for individualized management including lower doses and non-pharmacologic options.
OK - here you go: check this out, I think it is what you are talking about:
I found the link through patientsrightscouncil. One of the keys is advocating for people to really take care in writing their advanced directives to try to make sure they get the approach to symptoms that they want.
You have every right to express your opinion on any of the threads you choose.
Haldol is a powerful antipsychotic but also has antiemetic properties and 50 years ago when vomiting was the norm following anesthesia it was very helpful. modern anesthetics are vastly improved so vomiting is not usual these day.
Ativan is a very useful antianxiety medication and one of the drugs of choice for treatment of terminal anxiety. Both of those medications have long lists of side effects and should be used with caution in the elderly. Again in the elderly and dying it is possible that they will have the opposite effect to that desired.
Your feelings express that your mother suffered a wrongful death. You have the options to take legal action against the Dr who ordered the drugs and report his/her conduct to the state licencing board (Think Michael Jackson and Propothal) and initiate police action.
You feel you are warning caregivers against using these drugs for end of life care.
I feel you are frightening many people whose loved ones would benefit from the comfort they bring for symptoms Pam describes. FYI Pam nursed her young adult daughter till her death with a brain tumor and was very appreciative of the availability of these drugs to ease her daughters suffering.
You certainly have a right to your concerns and feelings but even if your mothers death was actually precipitated by her treatment by medical staff the anger you are feeling rightly or wrongly would be helped with some counciling.
Now I am sure i have made you very angry once again but that is far from my intention which is to reassure caregivers that the judicious use of certain medications at the end of life are a blessing.
was a caregiver.There was no choice for being a caregiver, so I checked the active caregiver. Then I explained a little about how I was a caregiver and told about how my mom needed a caregiver when she was trying to recover from the deadly sedatives that she was overdosed on. She would start to get better then get complications from the overdoses only to get overdosed as she was in hospital recovering from the previous overdose.
was a caregiver.There was no choice for being a past caregiver, so I checked the active caregiver. Then I explained a little about how I was a caregiver and told about how my mom needed a caregiver when she was trying to recover from the deadly sedatives, that she was overdosed on. She would start to get better then get complications from the overdoses only to get overdosed as she was in hospital recovering from the previous overdose.
You or someone else if you were not POA can request a copy of Mom's medical records from the hospital, take them to a malpractice lawyer who will have them reviewed by a medical specialist to see if anything improper was done. make sure to request nursing noted and medication orders. Do you have a medical background.
I understand your distress but it is hard to understand the circumstances if you are not there 24/7 and part of the team. i also agree that everyone for their own and loved ones sakes should educate themselves about drugs and other treatments and not allow MDs to go on fishing expeditions when no treatment can be safely given. A few more months as a vegetable is not living.
In many ways the stroke and heat attack were blessings in disquise because they saved him from a much worse death and final quality of life from the pancreatic cancer. It was a great shock and will take a while to get used to the idea of this but my best wishes go out to you
You have every right to be here and express your opinion of course and if it helps to express anger, if that is what you truly feel I actually support you doing it but I have to counter with a positive perspective of Hospice care and can’t agree you saying things like Hospice Doctors and easy money, it just wouldn’t be right.
I am in the UK which probably does make a big difference but I obviously don’t know for sure.
My father’s hospice Doctor was nothing short of incredible in terms of professionalism but genuinely one of the nicest people I have ever met. Personally I will always be grateful for what I perceived to be incredible care shown towards my Dad but most importantly that he eased his suffering. That is after all what we all most fear for our loved ones and ourselves I guess. I can’t speak highly enough him and am not embellishing in the facts in order to make a point when I say I witnessed tears well up in his eyes whilst talking to my Dad two days before he passed. They had developed a really good friendship during those last week’s which was by no means an easy feat, my Dad being the way he was (often cantankerous and very particular about who he did and didn’t warm to) but it was the Doctors persistence and efforts to go over and above what was required of him in my opinion that won my Dad over. He knew he liked sports for example so he’d always know the latest news about Dad’s soccer team when visiting with him and so on.
He also struck up a very good friendship with my Mom which she now speaks about with fondness and immense appreciation. She will always be grateful for the amount of information he gave her, how accurate it was, the way in which he explained everything, and the obvious care he had for my Dad and that he did not suffer unnecessarily.
I can speak equally has highly in fact more so of the many Hospice nurses their professionalism, care and friendship they gave my Mom and Dad in the last weeks of his life.
You mention your Mom’s agitation towards the end which I know only too well to be a particularly distressing thing to witness. It seemed cruel to me that my Dad should be agitated at all in what were his last days of life. A highly intelligent man I found his sudden bouts of confusion and the struggle to keep him bedbound and safe which seems such a strange thing to say, heart breaking. I was and will always be forever grateful however that this was dealt with quickly and his anxieties eased ‘all be it’ via medication. Whereas I acknowledge these drugs might well have sooner bought about his death I cannot imagine prolonging what I now ‘rightly or wrongly’ believe to be one of the stages of the dying process.
I allowed myself once or twice to contemplate what if but my Dad was terminal, beyond treatment. When considering the what ifs you have to take on board all the facts and the one fact staring you right in the face is that… he is dying. No matter how much I didn’t want that to be true it was. If you find yourself in this position I believe you must try as quickly as possible to accept it to because once you do you might stop beating yourself up. You have enough to deal with without guilt. Your loved one would not want it, you don’t need it. It’ll become another obstacle to get over, something that will get in the way of you starting to move on which you must.
If you loved them and believe that they loved you do not do them or their memory the disservice of saddling yourself with guilt. Lashing out or placing blame at or with others who are ultimately guilty of nothing but trying to help ease their suffering won’t in the short or long term make you feel any better or change anything.
Whatever you believe a life lived however it ended should be celebrated and remembered with love and affection. Tinged with sadness yes, always but that is all. Inevitably that love is all we are left with and it is that love, that last gift that will keep them with us, always. Accept it by allowing it to fill your heart free from anger, guilt, vengefulness, bitterness and hopefully eventually sadness.
They did not want to suffer and they don’t want you to now.
Again I offer my sincere condolences for your loss and hope you find peace.