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 know when my Mom [98] passed, I was so glad Hospice was there to help her smoothly pass into the next life without any pain. I was there when she passed and it was very peaceful for her. The Staff at long-term-care was wonderful, and later came in to pay their respects.
Sometimes people think that taking morphine or other opioids is akin to giving up or admitting defeat. However, the primary aim should be to make the patient's final days as pain-free as possible. This isn't giving up -- it's giving comfort.
If every attempt to relieve pain fails, a doctor may suggest palliative sedation. A large dose of drugs will put the patient to sleep, with the goal of helping death to come painlessly. This procedure is rare, and it's never done without full permission of the family and, if possible, the patient. Palliative sedation is not euthanasia, and it is not intended to cause death. It is designed to make the patient unaware and unconscious as the disease follows its natural progression to death. The decision to allow palliative sedation is never easy, even when, as Dahl says, "the alternative is unacceptable suffering."
The hospice RN will still visit the patient as she would in the home and the 24 hour service is still available to the facilities nurses patient and family. Hospice is informed of any changes in condition and the need to change medications. The hospice nurse does not however have any control of medications as she would in the home and has to rely on facility Drs for changes in medication needed which is very frustrating for the hospice nurses when their orders for home care are written with discretion to increases doses.
The hospice also has to have a contract with a facility before they can be part of the care team for a resident.This means a patient on hospice at home may have to give up that service if no contact is in existence. They can of course still go ahead with their admission and if discharged continue with hospice at home.
Terminal sedation while often requested by the patient or family is a really hot button and very difficult to arrange. The patient must be an inpatient and be constantly monitored as the dosing is very sensitive for each person. Most Drs are very reluctant to authorize it.
Another issue is the so called "comfort kits" If the policy of the individual hospice is to provide these kits on admission they will consist of very small doses of medications that can be used in an emergency and will include such things as morphine, anti nausea medication and other commonly used end of life medications. The hospice will have standing orders that allow a RN to administer these drugs without contacting a Dr. I must stress that the amount available is only sufficient to keep the patient comfortable for a reasonable number of hours till a Dr can be contacted and a pharmacy is open. In many rural areas 24 hour pharmacies are a wishful dream.
Some families are very upset by the provision of these kits when the patient is admitted because it perpetrates the myth that hospices kill patients. I can not tell you how many times as a hospice RN in the middle of the night I wished we had them. We did have a couple of Pharmacists who were kind enough to open their stores in the middle of the night. However it usually took at least an hour before the patient could receive their medication.
Not for profit hospices are run by an Executive Director who reports to an Executive committee of lay people from the community. I don't need to describe the frustration this causes. One example was that we wanted laptop computers.
New desktop computers were purchased! A few months later a big local company donated their caste off laptops that all needed new batteries at $1000 a pop. These being purchased it became apparent why the donating company had given away the laptops. Nice tax write off for them. After many months new laptops were provided for the nurses. In the meantime $13000 was found to re-carpet the entire office building. All the while there were still loose electrical cords running across the floor of the nurses' office. So be kind to your hospice nurses they are at the bottom of the food chain!
"Here are the FACTS. Hopefully, this information will settle the subject that hospice nurses DON'T kill their patients by giving Morphine.
According to Wikipedia; A large overdose (of Morphine) can cause asphyxia and death by respiratory depression if the person does not receive medical attention immediately. The MINIMUM lethal dose is 200 mg. TWO HUNDRED MILLIGRAMS!!
We [Hospice Nurses] start the patient on 5 (FIVE) mg. every 4 hours. More Morphine can be added for "breakthrough" pain (pain not received with the 5 mg. routine dose). The breakthrough pain dosage can be 5 mg., 10 mg., or 15 mg. every hour. So, for every 4 HOUR period, IF you give the maximum dose, the patient could receive a maximum of 65 mg., a far cry from the 200 mg. minimum lethal dose.
So, for the accusers, do the math. We hospice nurses deserve an apology."
I rest my case.
Honestly, a lot of times it seems like 2 different groups talking at each at each other. Some of the grief I see on here is overwhelming. I also get the feeling there is a unspoken political agenda with the one hit posters
Well, some very smart and compassionate folks, many of them quite religious started thinking " what does it matter if dying folks are given levels of pain control that might be addictive? These folks are Dying and don't deserve to die in agony.
Thus, the Hospice movement began. Yes, sometimes there are Hospice facilities, but those are few and far between. Most folks who go on Hospice remain in their homes, or in the nursing homes or Assisted Living places that are their residences. Hospice folks are trained medical professionals.
Please acknowledge in return that not only are these individuals not the norm, but they are also actively pursued and weeded out by their supervisory bodies. Regulation is not as effective as anyone would like it to be; but then neither is law enforcement.
We still need to find ways to care for and comfort the dying, and it isn't like we have the luxury of waiting for improvements in practice before we decide which route to pick. The hospice movement is the state of the art as far as it has been possible to develop it thus far. It's better than hospital. It's better than families having no support. But no, it can't stop death often being a terrible event; and no, it can't give us the comfort of certainty in every decision that we make for our loved ones.
My FIL was admitted to A Hospice, as in the organisation with its own building, though. He had oesophageal cancer, non-operable, and had been discharged from hospital. He was in his late eighties, had had serious heart disease for many years, was diagnosed with MS at about 80, and had already rejected the option of chemotherapy to prolong his life.
Had he been returned home for care, he would have been under pressure 24/7 from family members to reconsider his decision. Two of them found it impossible to accept that he could not endure further treatment; and their constant distress would have given him no peace at all.
I think there are people for whom the seclusion of a good hospice is vital in helping them accept and prepare for their own end. Others will need the security of their own home. The only thing I can't think of is what sort of person would want to be in hospital; and yet until hospice services are more widely available that will continue to be where the majority end up, like it or not.
What "bean counter" was involved? It sounds as though your sisters, with whom you don't get along, had PoA for your father. Was your father able to participate in the discussion about hospice? In general, patients themselves need to sign off on the hospice decision.
Doctors need to certify that a patient, untreated for an incurable disease, has a projected life span of 6 months or less. Some folks die soon after entering hospice because they've waited until the very end of an illness to sign on. Others improve on hospice and "graduate"; they become ineligible because they improve.
I'm sorry that you don't accept the fact that your dad had a terminal illness, and that your defense against your grief is to lash out at your sisters and the hospice that cared for him. Unmedicated death from lung cancer is a terrible thing. Perhaps having your dying parents at home was simply not feasible. Please look a little more dispassionately at your dad's end of life desires, and get some help with doing the necessary grief work.
Oh why won't they just kill the whole thread.
Comfortable but comatose. Comatose I said? Yes we have her on drugs for the pain. What pain I said my mother had no pain. Oh well, heavy breathing as she is close to death, it can be hard on them. I received a call a few hours later. Mother was dead.