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'm standing by what I wrote, because it was true. I did give consent to have her taken off life support when I paid my last visit and saw that the blood in her fingertips was bluish in color. "
I'm glad that you were able to consent to taking her off life support when it was clear that she was actively dying.
Regarding what you wrote, head of ICU did call me before I went to see her and subtly suggested pulling the plug. He seemed sort of "pissed" when I stated to give it one more day and maybe she would improve. He may not have been ecstatic, but when I went to see her, he made sure to be in the room, only to be told by the Hospice doctor, thankfully to leave. As I may have mentioned, the Catholic priest and the nice lady who was with him, were literally Godsends.
Until you agreed to Pull the Plug, she was his patient. In my world view, he was seeing her through until you decided not to pursue treatment.
Insurance did save money, as evidenced by the last insurance statements. Non hospice personnel visited her and billed her insurance up until the last day. The GI even visited, and billed the insurance, even though the feeding tube she was on had been removed.
So the doctor billed for visits and services he made. You hadn't agreed to give up trying to get her through one more day. Which is it? If you wanted the doctors not to bill, then you sign on to hospice and the "treating doctors" go away.
With regards to the 3 days of her dying, the same ICU head when I talked to him, said she was dead when she was bought back to ICU from the LTACH on the 9th floor. I don't blame Hospice for her death, just was giving a story of how it went for her. I have come to terms with her death, knowing she is reunited with her wonderful brother who will have been dead for 10 years Jan 2018.
She needed to be resuscitated? Did you agree to that? Then clearly, they need to bill for that.
The hospital did not not death in the discharge, so they sent a survey to ask how they were doing. This hospital is a branch of the 2nd highest rated hospital system in the country, The Cleveland Clinic, if that means anything to you. Thank you for you comments to my post.
I'm very unclear about what you mean by "did not death in the discharge".
Zam, I'm glad that you seem to be doing the grief work.
it is difficult for you to understand that she could be alert and talkative one day and dead two days later. It is not unusual for a patient to appear to rally one or two days before they pass and stay be the case with your sister.
With time you will be able to understand that you did do the right and loving thing for your sister
Just for your information;
The blue color in your mom's fingertips was from cyanosis.
(Wikipedia) "Cyanosis is defined as the bluish or purplish discolouration of the skin or mucous membranes due to the tissues near the skin surface having low oxygen saturation."
The blood itself wasn't blue, it was that your mom wasn't circulating the oxygen around in her body and it turns the skin at the end of the fingers a bluish color.
The Cleveland Clinic is rated #1 in cardiology and heart surgery, #3 in diabetes and endocrinology, #2 in gastroenterology and GI surgery, #2 in nephrology, #3 in orthopedics, #3 in pulmonology, #2 in rheumatology and #1 in urology. They are not listed at all in 8 other specialities, according to US News and World Report.
I have an acquaintance that was being treated there for a brain tumor. He was not progressing well and transferred to Stanford Hospital in California. They did immediate surgery that has been successful.
I would like you to understand one thing. Doctors in the hospital visit their patients every day. (What kind of doctor would they be if they just left you there?) And they bill for their visits, even if it's only for a few minutes.
If you're over 65, your monthly health insurance premiums are paid by Medicare. There is usually 20% that they don't cover. Many people have secondary insurance to cover the remaining 20%.
You seem preoccupied with this fact. Are you paying the bill out of your own pocket? I don't understand why this is so important to you. I'm assuming your mother had Medicare. Don't worry what the insurance gets or saves.
I paid out of pocket for a 1 month ICU stay (in Mexico) for my husband. I was kept informed of what he needed and what the charges would be. If you are paying privately, you should have asked about charges as her condition deteriorated.
When my time comes I'll keep the morphine option open, thanks.
Mom's NH was getting 12K per month, private pay for her bed. I can't see that they made any money at all in the deal. If she had lived longer on Hospice, the hospice organization would have been paid each day that she lived.
I'm not sure I follow your mathematical logic.
HOSPICE DOES NOT GET PAID FOR DEAD PATIENTS. They do however get paid everyday that the patient lives. I visited patients in all weathers, at any hour of the day or night, in remote villages and farms in Upstate NY. Gosh it would have been so convenient to give them an overdose and be done for the night. Instead I remained at the bed side holding dying hands and giving comfort to exhausted caregivers. Yes I did give a lot of morphine but only for pain relief. I was also only paid about half what acute care nurses recieve in a hospital.
It is very simple if you don't believe in Hospice don't call them in.
I thank you for sharing your very personal experience, as well as your insights into the alternatives of the situation.
CM, I think I'll go out into my garden when my time comes. And I don't intend to drag it out; when it's time, I'll go, hopefully peacefully and not in agony. Fortunately my niece is a nurse and I'm sure she'll ensure that the right decisions are made at the right time.
Mark, your post is so full of anger. I hope I never reach the stage of being so hateful.
But I think you might want to spend some time studying the financial dynamics of the industries you're criticizing. "Killing people off" doesn't drag out the financial payout; it ends it.
And if you really believe that economics are driving hospice, why don't you state where you obtained your research? Provide some stats for support. Or are you merely sharing your own personal observations as foundation for "facts"?
Barb, no one can follow "logic" that doesn't exist. My point as well. Someone needs to take a course in hospice economics.
From a mission of mercy, hospice has evolved into a $14 billion industry, increasingly run by corporate chains, and nobody gets more credit, or blame, than the Reverend Hugh Westbrook. He invented the very idea of the corporate hospice, when he and a couple of partners opened the first for-profit program, in Dallas, in 1984—right after the Medicare law he was instrumental in crafting began to pay for hospice services. Over the next two decades, he grew the company into VITAS Innovative Hospice Care, the largest hospice chain in the United States—or anywhere, for that matter, because hospice chains do not exist abroad. In the process, Westbrook proved the unthinkable: A business can make a fortune caring for dying people.
Dying for Dollars: The Corporatization of Hospice Care
A wave of mergers, acquisitions, and investments made hospice another Wall Street commodity to be traded, with one goal: maximizing returns.
By Fran Smith and Sheila Himmel / Cleis Press
July 1, 2014, 7:25 AM GMT
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28 COMMENTS
Photo Credit: CandyBox Images
The following is an excerpt fromChanging the Way We Die: Compassionate End-of-Life Care and the Hospice Movement by Fran Smith and Sheila Himmel. Copyright © 2014. Reprinted with permission of Cleis Press.
From a mission of mercy, hospice has evolved into a $14 billion industry, increasingly run by corporate chains, and nobody gets more credit, or blame, than the Reverend Hugh Westbrook. He invented the very idea of the corporate hospice, when he and a couple of partners opened the first for-profit program, in Dallas, in 1984—right after the Medicare law he was instrumental in crafting began to pay for hospice services. Over the next two decades, he grew the company into VITAS Innovative Hospice Care, the largest hospice chain in the United States—or anywhere, for that matter, because hospice chains do not exist abroad. In the process, Westbrook proved the unthinkable: A business can make a fortune caring for dying people.
Certainly he did. He had yachts, a Florida beachfront mansion, and a mountain home in North Carolina. He invested in a string of companies. He wrote big checks to Democratic candidates—his name would turn up on an infamous list of donors who received an invitation to sleep in the White House Lincoln Bedroom in exchange for a minimum $50,000 donation to President Clinton’s re-election campaign. And all that happened before he made the really big money, by cashing out to Roto-Rooter, a publicly traded company and a longtime VITAS investor.
A wave of mergers, acquisitions, and investments made hospice another Wall Street commodity to be traded, with one goal: maximizing returns.
By Fran Smith and Sheila Himmel / Cleis Press
July 1, 2014, 7:25 AM GMT
54
Print
28 COMMENTS
What Hospice and sometimes your OWN relatives, will not tell you, when signing your love one into Hospice. My mom, passed away, in 2009, her death was hastened while in the care of (Vitas-HOSPICE) (Pembroke Pines Florida).
Unfortunately, animals have much louder Advocates for inhumane treatment against them (although they’re not human). Why is the abuse of animals a much more sensitive issue in America, and more important then inhuman, treatment of real human beings. Specifically the Terminal, the Sick and the Elderly?
These groups of people are targeted and funneled into Hospice (the silent killer) to cut Medicare cost.
The public has a right to know the truth about the (silent) practices used by the Hospice Organizations working in and through, our Hospitals, and Nursing Homes working in conjunction with Medicare.
Medicare’s sole agenda is to cut cost by any means necessary. Medicare’s idea of cutting cost is referring your love ones (the elderly, the terminal, and sick) to Hospice. Where the patient supply of medication is cut off. All except the morphine/methadone used to administer a quiet, rapid exit into eternity (someone is saving on their water bill as well because they are dehydrating their patients and not turning to the I.V drip).
Medicare’s idea of cutting cost is to withhold administering medication to the feeble (including blood thinners which prevent blood clotting for non mobile patients), diabetes medication is withheld, cholesterol, and high blood pressure meds are withheld too.
This is Medicare’s idea of cutting cost – writing addictive prescriptions, over medicate you, and then abruptly drop you from the excessive synthetic drugs; they hooked your body on. Then down the line tell you, they can not longer do anything else for you. By now your visits to the emergency room and hospital are so frequent (from the side effects of lifetime synthetic drugs) you know the staff including security. Occasionally you may get a nurse who will actually sympathize with you.
Written by-
Ron Panzer (President of Hospice Patient Alliance)
“Because of the savings hospice care can net the federal government through Medicare, Panzer believes the government doesn't want to hear any bad news about the industry—even news of murder. It would tarnish the image, turn people away who would otherwise use the industry for their relatives—maybe even make some stock prices tumble. It's also easy to falsify patient records—to make it look as though every effort was made to manage their pain for as long as they needed to die naturally, as the government requires hospices to do under the per-diem payment basis (for every day a patient is enrolled, not for each service rendered)—even if those efforts weren't made”.
Hospice is an old war and I knew NOTHING about it. Yet many still do not know of this silent killer. Most of us learn, by happenstance, which is far too late.
We are left ignorant on purpose, in areas that have caused great impairment to us all. Why are we are not informed on medical healthcare decisions such as the Medicare-Hospice agenda toward the elderly? We have blurred the boundary lines pertaining to our laws and have stumbled over into homicide.
However, when we find an abused animal, we report it, and you will hear of it all over the media and on the talk shows. Everyday these rouge organizations administer an acute level of morphine intoxication to a vulnerable human being that leads to the cause of their death. The coroners know this, I dug-up reports online. But it is rare to hear of these findings on the News or the Talk Shows. In stead you hear about inhuman dog fights and groups of animals let by their owners to starve to death.
Well that’s what’s happening in these rogue Hospice Organizations. Their relatives (owners) have left them or has been convinced by hospice and their Doctor’s to withhold water (dehydrate) and starve them to death too, with a shot of morphine on the side finish the job. The first thing they tell you is to not give them water. How can anyone sit for hours next to their love one (who is able to swallow and absorb and not give them water) because the nurse and the Doctor’s advice you not too. Is it because the staff do not expect anyone to stay for hours or even days, so it’s easy to deteriorate a person through DEHYDRATION.
Perhaps, we desire to advocate for animals because they can not speak for themselves? A severely dehydrated, medicated human being can not communicate verbally either! So, where is the sympathy? Or is it because we’ve discovered we need to be loved too, and an animal is the least expensive and least troublesome of the two choices. Perhaps it is because we can put an animal down, as the animal, (just like a vulnerable human being) is unable to communicate verbally- neither has no say so in the matter.
Have we become delusional? You cannot substitute an animal for a human being. A delusion comes to distract us from the truth and if repeated enough times others will believe the delusion also, and repeat it. A reprobate mind.
Why is there not a voice that will dissect, uncover and unveil what is happened REALLY happening, right here in America. Everyday and every night bodies are FORCED into eternity, right under our noise thorough dehydration and acute morphine intoxication, and starved to death intentionally in other words, calculated homicide, a medical kill, homicide. You will find several articles on the Topic INCLUDING "The Side Effects of Morphine." Please look it up!!
The Institution of Hospice has grown away from its original purpose, taking on a dark agenda, devouring the terminally ill and feeding off the vulnerable, the sick and the elderly by any means necessary. Including seductive kick-backs for hospice referrals. Even the nursing homes receive kick-backs and bonuses for Hospice referrals.
I am reminded of the old Charleston Heston movie, entitled Solent Green- where the elderly were carted off in secrecy, never to return again targeted to be used as a food substitute in the famine. However, no one knew the true ingredients or the source of their daily food rations (they were literally feeding off the elderly).
At least now we are cognizant of dishonorable Doctors who’ve greased their palms while lining the pockets of Pharmaceutical Companies for years. For years they have over medicating us with extensive (lifetime) prescriptions, addictive substances, kick-backs and incorporating excessive branding as a part-time side job in their practice.
It use to be hard to embrace the thought that your Physician would write a prescription with the intent of padding his or her own pocket. A shocking thought to digest in the pass but now there is wanton corruption of all sorts of body trafficking that is still not front page news but should be.
ClarionFilms at 11:11 PM
And yes, we put animals down when they are suffering. We allow human beings to linger, in pain, in psychic agony and worse. I am NOT a proponent of euthenasia. But on my own, I would NOT have agreed to a pacemaker for my then 92 year old mom, suffering with dementia. It would have been a much less painful death than the next two years that she endured. But doctors at the hospital INSISTED that a pacemaker was by no means an extraordinary measure. Paid for by that nasty, cost cutting Medicare you keep ranting on about.
I don't know where you live, Mark, but in NY, where I live, and in Connecticut where my mom lived, they seemed hellbent on keeping her alive at Medicare's expense.
If anyone is against hospice THEN DON'T USE IT! You're free to do whatever you want with your loved one. Let them die screaming in pain or writhing in anxiety. Fine with me.
But, for the rest of the folks who CARE about their loved ones in pain or anxiety, hospice is a free service provided by Medicare.
Mark, do you really think the federal government would sanction and fund such a practice as hospice nurses purposely murdering their patients?
This thread will NEVER die. Why? Because there will always be believers and non-believers. Honestly, I wish I could give this subject a lethal dose of whatever would kill it!
And FYI, I'm not a paid shill. And darn it, don't tell me that I don't care about the people who have lost their loved ones. I truely mean I am sorry for your loss. I lost my dad and it was very painful. I'm sympathetic to anyone whose LO has passed on.
I am a part time hospice nurse. ALL the patients I have had WELCOMED my assistance. Do you think ALL of them wanted to "bump off" their loved ones? Heck no. They wanted them comfortable while they passed to the next realm. They told me they were grateful for my help.
I'm no killer and I resent you implying that I am. UNLESS you have worked for a hospice company and did the caregiving, then your word ain't worth a s---.
Can't we put this subject to rest? Let's agree to disagree. Those that don't believe, keep your loved ones at home and you can give them meds-or not. Or, if the health insurance will allow, keep them in the hospital where the nurses are going to give the SAME meds to your LO as the hospice nurses do. I don't see the difference.
To the administrator; How do you unsubscribe to a thread? I've had it. Yeah, I know, just don't read it.
And THANK YOU, to Veronica too! Hugs to you both.
Some people feel so guilty because they provided little help for their loved one while they were alive. If they had it to do over, they think they would have done much different. This is one time in our lives that there are no do overs.
Here's the link:
https://www.agingcare.com/contactus.aspx
If Mark is still going on tomorrow, I'll contact the Admins as well.
Not your fault.
The man is on a roll!
I need to not respond to this thread, as it brings out the "Hulk" in me. hee hee ;)
If you rather have your grown children [if any] and/or young grand-children [if any] remember how you were on your final days, well that is YOUR choice.
Forever engraved in their minds will be the vision of their father/grand-father wincing in terrible pain as whatever illness is sliding through your body and eventually shutting down your organs. Again, that is YOUR choice. Sadly, not THEIR choice.
My grandfather was my world and he was a stubborn man who would never complain about anything. My mother had moved him in with her because the stairs were becoming too much as he had COPD. It started with him having a "little ache" in his shoulders and hips and within a month progressed to him not even being able to support his own weight. I told him that day he was going to the hospital if he wanted to or not and I called for an ambulance. The X-rays had shown that these "little aches" he was having were actually his bones splintering and breaking due to the tumors within them. I get teary just thinking of how much pain that must have been and all he did was ask for some Icy Hot rub on his back? The doctor could not believe that he didn't express any signs of being in massive unimaginable pain and a nurse at one point, in so little words accused us of being neglectful. He still went to doctors, drove his own car, went to visit his lady friend, how were we to know?
His 2nd day being admitted he was still himself, he was a very smart man and we talked about random things as we usually did and he was fully with it when he thanked me for not letting him stay at home any longer, the pain medication was working at the time and he expressed his relief to me and said he never ever wanted to feel that pain again, even if it meant his passing. The next few days he was still alert but you could tell he was really feeling the pain killers and was speaking of things that didn't make sense, one moment I would be his grand daughter the next I would be his sister or his 4th grade teacher but he was in ZERO pain and that was one of his last clear minded wishes. With heavy pain killers there is a threshold and a half life which over time lowers the effectiveness on the body and for his amount of pain that threshold was being hit very rapidly. As per his wishes I told the staff to do whatever is required so he isn't in pain and they did. He died peacefully with his family by his side in no pain 4 days later.
How anyone can see this as a bad thing is a mystery to me, had I requested they limited his medications the scenario would have been very different. He would have been restrained due to the writhing the pain caused and it would have been an absolute living hell to be tortured when it wasn't needed. He wasn't going to get better, there were no treatment options available and he rode it out as far as he could handle. He deserved peace.
The older generation can be so stoic about their painful health issues and not let it show. Refusing to go to the clinic for help with it. I’m glad that you’re Grandfather didn’t reach that threshold when painkillers are no longer working. I still remember a man in the hospital begging for hours for help. It was awful. When we no longer could take it, we asked the nurse about him. He had cancer and it’s not yet time for his next dosage of painkillers... I’m so glad that your grandfather didn’t go through this!!!
She was in hospice the last week of her life.
I’ve thought too that hospice rushed her dearth. No doubt she was close to her end regardless, but she was fully alert and herself until they started injecting her with morphine. Right before her first dose I took her outside to get some fresh air, shortly after we came back inside they gave her the first injection. Within minutes she went to sleep. I came back the next day and told her not to give her anymore while I was there. She was slowly starting to wake back up and respond again.
When I was leaving late that night I told the nurse to stop giving her morphine by needle and go back to the IV. The nurse working that night said she’d tell the nurse in the morning to follow my wishes.
Well the next day I went back and the nurse that morning gave her more morphine and she passed away that afternoon.
I’m happy that she passed in peace and likely in no pain. I just wish I had more time to talk to her.
As I’m writing that maybe it’s selfish for me to feel that way. At least she wasn’t suffering, but if I just had a couple more days it would have meant so much.
If only we had a crystal ball that would show the final day.... then we all could get our words in that we had missed over the years.
My Dad was on Hospice Care for less than one week, it was just his time. Even while in a coma, I told Dad it was ok for him to go and be with Mom [who had passed the prior year], that he had taught me well and that I would be fine if he left. A few hours later he passed. I feel he waited for me to give him that reinsurance that I would be ok.
Mark, nobody hates you. They disagree vehemently with you, and they are concerned that your views may needlessly further frighten and distress people who are already afraid and distressed. That is not the same.
Your definitions of the words prove, necessary, and factual may not necessarily tally with generally accepted ones.
And Liberal? Moi? How very dare you!
I agree about the name-calling habit. But this is hardly unique to Liberals.