I am starting a new post because the previous one on "death hastened by hospice" has so many replies. Do people expect medical euthanasia when they accept hospice? Does hospice staff aim for 24/7 sleep using sedating meds? When did this become the standard of care? When we call hospice should we be prepared to have our loved one be medicated heavily and die soon? Why is the word "comfortable" left so open to interpretation? Why is "agitated" as minor as slight tossing and turning during sleep? What has happened to hospice?
I want to say that these posts are so rational, and Debbie's insight and approach so calm and methodical, that I want to come back, reread them, and gain from them. These aren't the '"hospice killed my mother/father" type posts. These are insightful, analytical and reflect the dilemma of end of life decisions.
They are also written with knowledge and compassion, not based on lack of knowledge and rhetoric.
If the other anti-hospice posts were as articulate and rational, I might have more sympathy for the posters. But rhetoric doesn't appeal to me.
So, thank you all, not only for stating so eloquently your own experiences, but also lending support to the decisions I made when I knew my father was dying, decisions I made to try to avoid the lingering end of life scenario in which he was unable to do anything except wait. Even then, there were agonizing days when I just wanted him to have relief.
Mutual support thread ! Yessssssssss
Guilt, important to have compassion for oneself. There was no clear direction lots of the time, but your love and dedication made you work so very hard to do the right thing.
Any time my father had a doctor who seemed “not invested” in him, or who blew me off, patronized me, I found someone better. Inside, I was mustering all my communication skills, remaining professional, but I paid a price with stress. It is so NOT fun to stand up to a medical doctor with an attitude. There are lots of better ones out there, if you have the option of changing. Many don’t, for various reasons. I was lucky that way. There’s nothing worse than feeling trapped in a bad situation.
All the coping skills and chutzpah I developed the in last 15 years sticking up for my father, I have learned to use for myself. Working now on getting out of the same dangerous health situations that cost my dad so many problems. Pre-diabetic, overweight, heart palpitations. Power eating jars of peanut butter with a spoon was SUCH an unfortunate decision. :-) We probably need a new thread: Recovery Support Strategies.
It was amazing to have time recently to pick out a new shampoo for myself, I was so used to operating like a robot: “Its just hair, wash it, get to the nursing home.”
Hugs to you all,
Debbie1955
Gershun, your experience with the hospital docs is just too awful to contemplate. I would have simply burst into tears at the "skinny" comment.
Yes, PTSD and lack of self care. Someone posted a question the other day about
" what would you do if your LO was no longer here?".
It's not just that they are no longer here. It's the awfulness at the end, it's the bad habits you've developed and the dread of facing one's own decline soon that is paralyzing and disheartening.
Mutual support here is wonderful. Maybe, just maybe we can get through this.
I remember when my Mom was in the hospital dying, seeing signs posted here and there stating how aggressive behavior towards any hospital staff will not be tolerated. It's obvious to me then that disagreements between patients and hospital staff are commonplace. However then can we hope to win?
I think that was the most frustrating thing for me, to be at the mercy of the Medical professionals. And yet, if I had to do it all over again for my Mom, I can't think of anything I could have done differently. I did what I thought was best at the time and unfortunately, it's not like I had a chance for a do-over.
Actually, I was not ambivalent about hospice care. My dad had CHF for 13 years, was diabetic for a long time. I was his sole health care advocate, (15 years) meaning he was a stubborn, crusty old guy with an idea he could beat anything. Mind over matter, he would say. So, I had a very good medical education about his situation from years of being his “medical secretary.” His doctors treated me like a health care partner. He fondly called me “The Enforcer.”
I understood the progression of his comorbidities, his doctors told me how to understand his shifting medical situation as each year passed. He fell in Assisted Living, he had ignored/not reported urinary issues. Hospitalized, he had a UTI, was septic, and had aspiration pneumonia. He had been non-compliant about drinking the thickened liquids, so I knew it was just a matter of time before he got aspiration pneumonia. He was 88 years old. He was having too much fun with his new friends in Assisted Living to be bothered by details (:-)
The hospital doc spelled it all out for me, told me I might want to think about hospice care. The doctor told me I needed to decide how many times we were going to go in and out of the hospital. My dad and I had talked previously (over the years there had been several close calls because of CHF). He did not want to be intubated, he did not want to be resuscitated if his heart stopped. His nursing home had a special hospice floor, but for some reason they were required to contract with outside hospice agencies. So, him being able to live on that floor (more consistency with staff, a private space, good staff/patient ratio) was mandated by enrollment in hospice. I was already on board with that idea, so the extra perk of a special floor made me feel very good. I thought I had created the perfect cocoon for him. I knew we were finally at the end of his long fight to keep living, but he needed time to accept that. Having professionals who specialized in the care of people who probably had less than six months to live was what I wanted for him. I was ready to fall into that nice cocoon of compassion, myself.
The specter of him drowning in his own fluids haunted me. But I had learned from medical professionals about the value of morphine to address “air hunger.” Also, Dad’s heart function was very low, an ejection fraction of 8. The aspiration pneumonia kept coming back, after discharge from the hospital. I elected to let him get oral antibiotics (per the MOLST) to try to combat lung congestion. He continued on a sodium restricted diet, as he had done for the previous 15 years. My hope was that his heart would simply stop before he had to go through gasping for air. I knew that each time his body battled infection, it took another toll on his heart. It was a possibility that he could simply expire from heart failure, so I took that. I networked with the DON of the nursing home before choosing the hospice floor. She set me up with a Palliative Care physician to fully understand the MOLST. His heart failure specialist examined him when he was still on the Rehab floor of the nursing home after his hospitalization. He recommended hospice care, and explained to me all the different dying scenarios that were possible. In the end, I got for my father the most comfortable death I could imagine. He was able to be lucid all the way to his peaceful end. It was a calculated gamble on my part, and I had the full support of the nursing home medical staff. But not from his hospice provider nurse.
You sound like a very good daughter. People live longer now because of modern medical advances. Our generation is thrust into what I call a war zone. Once you and your loved one have to enter into different medical care systems (from home to hospital to rehab to assisted living to nursing home) you find out all are not consistent, all are not run equally well. I sure feel like I have PTSD just from that. Add the grieving process, and lack of self-care for ourselves because we are just so overwhelmed trying to sort it all out and put one foot in front of the other every darn day, to the end. No pressure, eh?
I hope this helps, Barb. Hugs to you.
Debbie1955
I want to mention something for consideration, not as a criticism of you, and not defending the Hospice folks.
Were you ambivalent about having your dad on Hospice? I know I was. My mom was 94 and had multiple heart and lung issues. It seemed to all of us that she was fading last summer, but in a very, very slow way. And as I mentioned, she had been deemed eligible for hospice 2 full years prior to last summer, because her Chf was getting worse and would be the cause of her death, absent something else going wrong.
Death from ChF is essentially drowning, gasping for air. I was determined to avoid that and mom made me promise years ago that she would not suffer a painful, frightening death.
So mom fell in the NH while being assisted by a familiar aide. The aide asked her to hold onto the grab bar, per protocol. My mom had always been able to follow this instruction. This time, mom didn't and when the aide went to pull up mom's pant, she fell against the tile wall, and fell down, smashing her face and breaking her wrist.,
After atrip to ER, put to bed, we expected mom to bounce back, as she had many, many times before. But she refused to get out of bed, forcefully shaking her head no. She developed pneumonia, which was treated. But she still wouldn't get up.
Then came the silent crying and the look of terror on her face, eyes highly shut. She didn't respond to any of our reasurances or questions. It looked to me that she was in pain perhaps, so they doubled her pain meds with no effect.
Okay, should I have said at that point, well , if we just leave her, maybe she'll heal and get over this, too?
But I could not bear to think that she was in some terrible pain, or having mortal fear of something. So we asked for hospice to come in. The morphine gave her immediate relief of whatever awful thing was torturing her. Her breathing became less ragged. I remembered thinking, good, maybe if she can get some rest, she'll get over the hump and sit up again.
Yes, I WAS ambivalent about hospice. I wasn't resolved that my mom's death was inevitable. It would have been a good thing, I think if someone had said to me at that point, Barbara, do you really want your mom on Hospice? If we can get the doctors to prescribe the same morphine, do you really need the rest of the supports? Because we didn't. She was in a NH, not at home. The staff knew what they were doing. She already had an alternating air pressure mattress ( we had to refuse the one Hospice wanted to supply because it would have meant moving her, which we weren't willing to risk)
Is it possible that THAT is what was being asked of you, maybe in a tone that annoyed you or made you fearful, or that you felt questioned or judged? It's a real question, because I still feel residual guilt that I didn't give my mom enough time to recover from her injuries. Maybe having talked it out then would have helped.
Again Debbie, I'm so sorry for your loss. I hope you keep posting here and on other threads. You are sensitive and articulate. Be well.
After he died and I talked with the hospice organization, they asked me why I didn't call and ask for someone different. I told them I did not think I had that option because of how the system between the nursing home and their organization was set up. The nurse they provided had been in charge of their account at the nursing home for many years. The hospice organization said they did like to centralize things that way.
The nursing home staff got me what I needed for my dad, I learned to go directly to them for medical guidance because I did not trust the hospice provider. To be quite frank, I was flying by the seat of my pants. He had many emotional needs and all I wanted to do was protect him. At a time of both our lives when we needed compassion and support, I had to put all my energy into him. I had truly counted on hospice to give me a little TLC, like their website promised. It was a very lonely and stressful journey, made more difficult by that nurse. I felt like she had the power to disqualify him from hospice, since she was very quick in the beginning to suggest to me that maybe I didn't want my dad in hospice. She even had her social worker call me and suggest the same thing. Thanks for your compassion, Barb.
Since my communication with the CEO of the hospice organization and the nursing home DON after his death, I hope both parties will see there needs to be more nursing oversight to their personnel arrangements.
Debbie1955
I get how stressful these EOL issues are! My mom was hospice eligible for two full years before my POA brother would sign for it. Only after she fell and started to become agitated and clearly in pain was J able to convince him hat mom no longer the quality of life she needed to recover.
I'm so sorry for your loss. Hospice is never an easy decision.
The same nurse was assigned to any patients who elected to use her hospice employer in the nursing home my father lived in. She made my life hell. I had signed the MOLST and was quite well informed. She balked at treating him for things that the MOLST agreement spelled out. Her mode was to quickly sedate him with Trazadone after asking him at the first meeting if he was sleeping well enough. He was withdrawn almost immediately, and the hospice nurse would not address my concerns. After two weeks, he told me he thought they were giving him something that made him not care. I had to fight to get him Ativan, a drug he tolerated much better. He only needed .25 mg at bedtime. She did many other things, like suggesting I perhaps did not want him in hospice at that point in time. His heart gave out, 6 weeks into his hospice enrollment. He died peacefully at the end of 2017, without the need for the hospice provider to be called. I was grateful I did not have to be around that nurse at the time of his death.
It is disturbing to read so many judgmental responses to Kathy. It seemed to me that there are hospice providers who don’t take enough action to monitor some of their employees. I believed my hospice nurse had been allowed to operate in a vacuum for far too long. I took action after my father’s death and alerted the CEO of her hospice company about my experience. They were very concerned and addressed it to my satisfaction. But abuses do happen.
Debbie1955
The joking posts were not about hospice. They were not about euthanasia. They were poking fun at the topic of computer trolls. And humor is an acceptable way of trying to reduce tensions on a controversial thread. Not always successful, of course, but acceptable.
Thanks for ruining what, I thought, would be a place for sharing ideas and thoughts about a serious situation into fodder for your amusement. My MIL's medical records already show how serious this issue is, I don't need to participate in a non-discuss with a bunch of childish bullies. Enjoy your life and pray you never need Hospice care when you are elderly. What I've learned over the last 9 or 10 months is that I will never allow my mother to enter any Hospice type care. I will find a way to care for her myself before that happens. (She's a healthy, independent, 86 years young right now.) Neither my husband nor myself will succumb to their ways either. Believe it or not, it does happen.
Thank you, Heather10, for your comments in my defense. I really appreciated that, but I cannot participate in a forum that allows this type of childish behavior. I'm sorry there are so many who share the same experience as we did, and I pray that one day we find justice for our loved ones taken before their time.
Criticism, w/o a solution and/or action, isn't going to solve a problem.
And when someone visits this thread, that they would read the all 121 postings to gain a perspective as to why at times so many of us are frustrated with the dialog. It is ok to be hard on your own facts, but when scientific facts are given, I don't understand the challenge.
It's like the clear sky is blue, but someone will believe the sky is green, thus every one sees the same green sky. Science says otherwise.
Hospice gives 5 mg to 15 mg of morphine, no different than the amount given to a patient who had major surgery. I had morphine numerous times. To actually kill a person, the morphine would need to be 200 mg. Again, this is science. And note that morphine is a regulated drug, every pharmacy and every hospital and every Hospice group has to account for every single mg.
I thought of him as a thing in too tight pants.
Thanks for ruining what, I thought, would be a place for sharing ideas and thoughts about a serious situation into fodder for your amusement. My MIL's medical records already show how serious this issue is, I don't need to participate in a non-discuss with a bunch of childish bullies. Enjoy your life and pray you never need Hospice care when you are elderly. What I've learned over the last 9 or 10 months is that I will never allow my mother to enter any Hospice type care. I will find a way to care for her myself before that happens. (She's a healthy, independent, 86 years young right now.) Neither my husband nor myself will succumb to their ways either. Believe it or not, it does happen.
Thank you, Heather10, for your comments in my defense. I really appreciated that, but I cannot participate in a forum that allows this type of childish behavior. I'm sorry there are so many who share the same experience as we did, and I pray that one day we find justice for our loved ones taken before their time.
The reason I told that story, the complete story, well not even really............I could have gone on. But I just wanted to give my support to the people on here who really do feel like their loved ones were not treated properly. While I know that there are the trolls who love to stir things up, I have reread some of the posts on here and I think there is sincerity there and that perhaps these people do have a legitimate take on the situation. I have, as I stated real issue with the treatment my dearest Mom received. While I never went to the hospital board and started any legal action against this Doctor, I did go on a site here in Canada where you can post public reviews of physicians. I posted mine and I wasn't the first to have an issue with this thing in a white coat. In fact, in future, that's what I'll call him. Cause that's what he is in my opinion.
I think those of us in caregiving and decision making capacities may often second guess our decisions; it's a reflection of the level of responsibility and compassion we have.
Dr. Arrogance does not fall in that category. I had a neuro like him when I had my stroke. What a donkey's posterior! He was soooo impressed with himself, so arrogant, that after a few sentences I decided he wasn't worth listening to and that I would follow up with a REAL neurologist after discharge.
I've read your post a few times, and think that you did take the appropriate action. Your self inquiry as to whether more time would have made a difference is one which I think a lot of us face, and there is no way of knowing. We do the best with the information we have at the time.
That's the only question I had left in my mind after my father died, but it wasn't any professional medical personnel. It was someone from the private duty firm I hired, a firm with a good reputation nationally. But this woman didn't meet that standard, and she lied about her experience with dysphagia and pureeing. Instead of being experienced, she just "knew" that dieticians handled it in the SNF she allegedly worked at for hers. Even that I questioned after I observed her manner.
(As an aside, she charged right into the bathroom just after Dad got up, w/o introducing herself. She was told to "GET OUT"! Dad was NOT pleased - he didn't even know who she was.
I didn't want to hover over her as she was (pretending, as I later realized) to help dad eat his latest pureed meal. Two hours after she left, in a snit and a nose up, snidely glared at me (since I caught her in a major lie), Dad began to go downhill. I still wonder if she did something that neither Dad or I caught.
The hospital staff wasn't the best either, and I was glad when we transitioned to a SNF. But the damage was already done, or rather, Dad was too close to reverse his condition.
There was never any question in my mind that the SNF, at which we also had PC and hospice care, did anything to advance his demise. In fact, I was the one asking for morphine when I saw him suffering so much. That last week was agonizing for both of us; if I was in charge, I would have upped the morphine so he could at least pass peacefully instead of fitfully.
And I agree, have said before and will say it again, the way to address any perceived inappropriate action in the medical community is not to b**** about it on a forum. Pretending to "alert" others is meaningless; go to work and address it legally.
When I was younger I was very politically active, and worked on local and national campaigns, on anti-war and women's right's issues. And I did see changes, through grass roots and lobbying. There weren't any such things as Internet forums then, but even so, I still believe that action speaks louder than words, or in this case, repeated complaining.
That doctor that spoke to Gershun needs to grow some compassion.
If he felt as he did, there were far kinder and far more professional ways to address the issue.
Perhaps you can report him to your state medical board. Likely there will only be an investigation and nothing will come of it. Still it will stay in his file for future reference and it may spur him to learn to acquire a more professional and compassionate beside manner.
Unfortunately, many if not most people who come in here believing their loved ones were murdered - and this goes back YEARS on AC - aren't interested in facts, or in having their misinformation corrected, and never have been, even when it's done with great respect. They just want to believe what they believe and never be questioned, never be challenged, never be corrected. So these threads devolve, yes. That's the internet for ya.
And yes, I did read the article, twice. I would love to have an intellectual discussion with others about the nuances and grey areas discussed in this thinkpiece. Unfortunately, as you have done, people cherry-pick what they want to see and hear, or what has the appearance of backing up their claims and beliefs, while ignoring the whole context, which makes any real discussion impossible.
I reiterate, if you really believe there is murder going on, do something about it. Some of you Americans seem to be obsessed with lawyers and lawsuits, but GO TO THE POLICE. Don't keep saying, "Oh, there's no point," like EVERYONE seems to do. All I ever see are excuses. If ALL of you are just going to make excuses and not take any real action, then no, they're not going to investigate. MAKE them take you seriously. Get a group together and force the issue. Until somebody does something more than sitting at home behind a computer, anonymously bad-mouthing health care workers and whipping up fear and hysteria, then no, I don't take it seriously as an issue.
That's about as much as I'm ever going to say to you. So. Carry on bravely.
I never post on any hospice threads, but read your story about your Mom, and how very hard it was for you.
The azz wipe was a real jerk.
Thank you for posting your story. I am sure it will help others.
I am sorry you had to go through that.
Your mother was lucky to have you there doing the best you could given your circumstance.
She was living in a nursing home where she took ill suddenly and I was contacted by the staff there telling me she had been found unconscious in her room and was being taken by ambulance to the hospital. I had just gotten through talking to her on the phone a half hour before the call. I had thought she sounded funny. I even phoned her back right away cause I was worried about the way she sounded.
So, I rush to the hospital where the attending emergency room physician tells me "we think your Mom is passing" I phone the family, most of us gather and are told it's just wait and see. I say to the doctor, you told me she was passing. He says"I can't tell anyone when they are going to die" They take Mom in for a Cat scan to see if she has had a stroke. So slowly everyone leaves except me. I stay for a while and then leave asking on my way out to keep us informed. Next day Mom has been transferred to a
private room. When I arrive, nothing is being done for her. She isn't hooked up to anything. No fluids, nothing. I go to the nurse's station and ask what's going on. They immediately get into high gear, come scrambling into my Mom's room, hook her up to an I.V., antibiotics etc. Then the head nurse comes in and says to me, "you know our staff here is good, and nobody has done anything wrong" Like I care. I just wondered why nothing was being done for Mom and why she seemed so much worse. That afternoon the neurologist comes into Mom's room and tells us that the cat scan showed no brain bleeds, no signs of stroke but they are scheduling her for another one the next morning. The other doctor had said Mom was paralyzed on one side. The neurologist grabs Mom's hands, both sides and says "See, she has grip strength on both sides, she wouldn't if she was paralyzed" I stay for a while and then leave. My cell phone rings on the way home. It's the first doctor telling me the opposite, That there is nothing they can do for Mom and we should start comfort care. So, I come back and stay the night with my Mom. Longest night of my life. Mom's breathing is horrible. It was a hellish night but I wanted to catch the doctor in the morning so I stayed.
The doctor comes strutting in, in the morning. His manner very cocky and full of himself. He proceeds to throw the covers off my Mom roughly. He says "look at her, why is she so skinny?" Like it's my fault somehow. "Then he pulls her eyes up roughly and says "there is no life in those eyes, and listen to her breathing, that's a death rattle" He says "if I send a person in her condition upstairs for another cat scan they'll think I've lost my mind" "I advise putting her on comfort care immediately" I say to him, well I can't make this decision without discussing it with my family. He says " well, I'm leaving in an hour and I have to sign off on this so you better decide." I tell him I'll phone my brother. I go into the hall for privacy and this doctor is watching me like a hawk. I wake my brother up and ask him what he thinks we should do . He's half asleep, groggy and says "yeah, do it" obviously more concerned with going back to sleep. So there I am alone, with this arrogant doctor breathing down my neck, no family there to support me having to make this huge decision. So, I did what I thought was best at the time and said yes, start her on comfort care, not knowing if I was doing the proper thing, but having no one to advise me differently, thinking about what the neurologist had said the day before and what this azz wipe doctor is telling me now.
Did I do the right thing? I'll never know and to this day it haunts me. I know my Mom was very depressed and had the various ailments that had made us decide to put her in a nursing home to begin with and I know she had voiced that she was ready to go on numerous occasions. This sudden decline had happened suddenly and no one will ever know what brought it on. To this day, I often wonder had she been given more time and treatment, maybe she would have bounced back. My gut tells me no but who knows. My Mom lingered there in hospital for a week. She never really regained consciousness, never spoke again except for one horrible day when she started to moan and cry and I held her and kissed her face and told her I loved her and that it would all be over soon, then they came and gave her more morphine and she never really woke up again after that.
So, I don't feel that my Mom was murdered but I do feel I was coerced into something I was not totally ready for and I have to live with that every day. So, I am not going to draw a line in the sand here on how I feel about the people on this thread and if you really are suffering because of the circumstances surrounding your loved ones deaths, I do sympathize. I apologize for the long story, but I feel I had to tell it in full to make my point.
I do not see the value in the last five comments in response to Bentherdunthat. The self-perceived witty reparte, does not reveal itself in a good light.
This topic is not a joke.
As for those who are insisting that someone who believes a elderly hospice patient was given an overly aggressive cocktail of drugs in order to hasten death, should simply contact the police. ....
....Well, these folk need to do their homework.
It is very difficult to get the police to investigate the death of an elderly and ill person in the care of legitimate hospice workers.
I think most reputable hospital personnel will already know that.
The better person to get involved would be a lawyer, particularly an elder care lawyer. They have horror stories to tell. Or better yet, just go down to the court house and take a look for yourself.
Not every one can afford the high fees such a lawyer would charge, however. So that suggestion is not within plausible reach for everyone.
The problem with hospice personnel and medicare CNAs is that they only require a certificate that is granted after a few months of minimal training. Also they are not highly paid. Some barely make more than minimum wage.
Thus there are many who consider it a calling and yes, those are angels, but there are also many more who only consider it a job.
Since the pay is so low, and since there is a shortage of people willing to do such work, the field does not typically attract those who consider it a calling.
It many times attracts those who only need a job and they may not be the best and the brightest or the most caring or the most patient and kind and honest types.
Also, there are six states that do not require criminal background checks for nurses or hospice workers or CNAs, and that can lead to obvious problems.
As the NYTs article I posted mentioned all the doctors mentioning, the issue needs to be questioned, otherwise we lose our humanity.
There are people who are over medicated and therefore die because someone considers them a burden.
It happens, and it should be discussed, and discussed openly and seriously.