Did Hospice rush your loved ones death?

Mark,
I don't hate you. I don't know you other than what you write in your posts. I'm not trying to ban you. I would like to see this thread close because I think we have exhausted the issue. It's time to stop chasing our tail.

Some believe in hospice, others don't. No one is forced to sign up. It's a voluntary thing. The family member that's signing up should read all the material and fine print before signing a contract with hospice. They should inform ALL of the other family members, so everyone will understand the plan and be on the same page. If they don't find it to their liking-cancel it! If, after you've cancelled, you find it did a lot of good, sign up again. It's that easy.

People are expected to die from their disease. Hospice is to make a person comfortable at the end of life.

The US government is not in the business of hiring "hit men" to "finish off" these terminal patients. Actually, there would be an incentive for the hospice company to keep the patients alive, as they are paid for every day they assist the patient.

I have worked as a hospice nurse. You haven't. Even though you may have had a family member in hospice, there is a big difference being on that side. I was on that side too. My Dad was in hospice the week before he died. I was the daughter, in that case, not the nurse. Hospice explained things much more clearly than the jerk of a doctor that was assigned to my dad. I felt both of us (Dad and I) were well served by hospice. I don't feel that they ended his life. He was DYING from 2 massive strokes. His G-tube feedings wouldn't digest. They had to stop feeding him. We have to keep in mind that death can happen at any time. Because they are given meds that make them sleepy, does not mean that they are dying from them. I'm glad for any relief my father received.

We all have our own opinions about many subjects. I respect your right to your own opinion. But please don't tell me that I don't really care when I say I'm sorry that a loved one of a person on this board died. I DO care. I got into nursing BECAUSE I care. I'm a sensitive person and probably spend way too much time with my patients to my own detriment (clocking out late, backed up charting, etc.) Because I am pro-hospice doesn't make me a non caring person.
The same if I was, for example, pro abortion, pro assisted suicide or any other "hot" topic. Don't put me into a "box" because of my beliefs. My hair could be green and I could have 10 lip piercings but just because I wouldn't be conforming to YOUR way of thinking, then I'm bad? That's pretty narrow minded. (By the way, my hair is not green, and I do not have any lip piercings-it's just an analogy. I will keep my position on abortion and assisted suicide private.)

I think we've all said about as much as can be said. Let the thread die a peaceful death.
RIP

Mark; for the record, I don't hate you. I haven't asked that you be banned. I disagree with your vehemently, because I was glad to have the hospice option at the end of my mother's life when none of her pain meds were working on the pain she was having, when she couldn't, due to aphasia and dementia, what hurt. We just knew from her facial grimaces that she was in agony.

I promised my mother one and only one thing in life, that she wouldn't die in pain. Hospice gave me the option to relieve her pain. Not to end her life.

Time for a boycott. Our answers just encourage Mark to spew more rhetoric.

I have unfollowed this thread repeatedly. It’s just that I follow so many of you regular posters that whenever you answer here, this thread pops up in my newsfeed. I don’t like reading this thread. It would be great if we just stop responding here.

Let’s just allow this thread to be a venting place for those who believe hospice kills. A venting place that doesn’t require us to respond.....

This has become sort of like the "poop" thread awhile back.. it just goes on and on... I agree.. let it go

I stand by my word and I'll post links again on evil Hospice and how it's full of big corporate profiteers. Even the Huffing ton post had an article on that.

How Dying Became A Multibillion-Dollar Industry

By Ben Hallman
Development and data reporting by Shane Shifflett.
Additional reporting by Chris Kirkham.
Design by Hilary Fung.
JUNE 19, 2014
Evelyn Maples’ last day as a hospice patient wasn’t anything like her family imagined when the nurse from Vitas Healthcare first pitched the service two months before.

On the morning of Dec. 31, 2011, Maples’ daughter, Kathleen Spry, found her mom unconscious and gasping for breath, with her eyes rolled back in her head. Maples was at a Vitas inpatient facility on Merritt Island, 30 miles from the home the two women shared on Florida’s east coast. No one from Vitas had called to warn the family that the woman everyone called “granny” was in sharp decline, Spry said. No one from Vitas had sought treatment for the blood infection that had made her severely ill, despite the family’s standing request that she receive life-saving care in the event of a crisis.

KEY FINDINGS
The U.S. hospice industry has quadrupled in size since 2000. Nearly half of all Medicare patients who die now do so as a hospice patient — twice as many as in 2000, government data shows.

Since 2006, the U.S. government has accused nearly every major for-profit hospice company of billing fraud.

Hospices bill by the day, and stays at for-profits are substantially longer than at nonprofits (105 days versus 69 days).

In 2009, for-profit hospices charged Medicare 29 percent more per patient than nonprofits, according to the inspector general for the health service.

The average hospice stay has increased dramatically since 2000, regardless of diagnosis, a HuffPost analysis of Medicare data found. This has led to a surge in expenditures: $15 billion in federal dollars in 2013.

Despite widespread allegations of fraud and abuse, regulators have consistently rated hospice as a lower priority for inspection than traditional health facilities like hospitals.

The average U.S. hospice has not undergone a full certification inspection in more than 3.5 years, a HuffPost analysis of Medicare data found. HuffPost found 759 hospices that haven’t been inspected in more than 6 years. Nursing home inspections, by contrast, are required by federal law at least every 15 months.

Over a recent three-year span, 55 percent of all U.S. hospices were cited for a violation, many care-related, HuffPost found. HuffPost found 20 providers that were cited for more than 70 violations each during that time.

Those are from real people. Facts are stubborn things.

Here is another write up on greedy corporate hospices--bing.com/fd/ls/GLinkPing.asp

Give it your all, Mark. Obviously the FACTS that our posters' loved ones, who were dying and BENEFITED from hospice, means nothing to you.

No one is reading but keep giving this thread CPR. I've stopped the "code blue". Let it die.
No more for me.
Bye 👋🏼

KEY FINDINGS
#1 The U.S. hospice industry has quadrupled in size since 2000. Nearly half of all Medicare patients who die now do so as a hospice patient — twice as many as in 2000, government data shows.

Yes, that's more or less what you'd expect. a) The number of people reaching end of life has also increased dramatically by virtue of demographics; and b) fewer people are dying in hospital - which most people when questioned say they do not want to happen - because there is now a better-known and more widely available alternative.

#2 Since 2006, the U.S. government has accused nearly every major for-profit hospice company of billing fraud.

Fraud or error? Billing practices will be the subject of regulation; correction of poor practice is one aim; corporate malpractice needs to be brought to light in any industry. The system appears to be working, then.

#3 Hospices bill by the day, and stays at for-profits are substantially longer than at nonprofits (105 days versus 69 days).

I thought you were outraged at hospices bumping people off to save money. Or are you outraged at their forcing dying patients to linger, suffering, for the sake of profit? It is possible to be outraged at both, of course, I grant you - a sort of moral Morton's Fork with which to prod your target.

#4 In 2009, for-profit hospices charged Medicare 29 percent more per patient than nonprofits, according to the inspector general for the health service.

Yes. What would you expect? Non-profits reinvest surplus cash in their business. Profit-making organisations have dividends to pay, which they achieve by charging their customers more to create a fatter surplus. That's how capitalism works.

#5 The average hospice stay has increased dramatically since 2000, regardless of diagnosis, a HuffPost analysis of Medicare data found. This has led to a surge in expenditures: $15 billion in federal dollars in 2013.

So they ARE cruelly keeping their patients alive? Or they're wickedly (not to mention illegally) hurrying them off? Surge in expenditure: yes. Surge in number of patients, earlier referrals to palliative care, advances in end-of-life treatments. Living costs money. Living when you're dying costs a lot of money.

#6 Despite widespread allegations of fraud and abuse, regulators have consistently rated hospice as a lower priority for inspection than traditional health facilities like hospitals.

I too would like to see more effective and more frequent and more constructive, improvement-oriented inspection of all health and care facilities. But it's expensive, and implementing the recommendations would be expensive again. Where would you get the money? Or, rather, what other services would you take the money from?

#7 The average U.S. hospice has not undergone a full certification inspection in more than 3.5 years, a HuffPost analysis of Medicare data found. HuffPost found 759 hospices that haven’t been inspected in more than 6 years. Nursing home inspections, by contrast, are required by federal law at least every 15 months.

Same.

#8 Over a recent three-year span, 55 percent of all U.S. hospices were cited for a violation, many care-related, HuffPost found. HuffPost found 20 providers that were cited for more than 70 violations each during that time.

Violation of what? Some of the regulations are of interest only to civil servants and management accountants - what family member gives the proverbial if a hospice hasn't sent its diversity monitoring forms in on time? - so it matters. So does the word "many". If many meant enough for the reader to get excited about, any self-respecting journalist would have specified the number.


It's a wicked world. Sickening things take place in all corners of it, so why should hospice facilities be uniquely exempt? But that doesn't make bad practice the norm, and it doesn't make dying in hospital a better alternative, either. The answer is to be vigilant and to work for improvements, perseveringly and realistically. Has your research brought you into contact with the many dedicated, knowledgeable and compassionate people who are doing just that?

And, in any case, this forum is for people who are facing caregiving challenges right now. Their loved ones are dying now. And you're telling them not to accept the specialist help of experienced professionals for fear that their loved ones will be fleeced, abused and ultimately murdered. What is the better choice that you would offer them?

Facts are stubborn things Sue. Anyone can do a google search and see all the sites where people are angry with Hospice for big profits are raping the Medicare system or killing people off. There are so many sites I can't read them all. You'd have to be a darn fool to not notice the corruption of Hospice. We warned about this years ago. My Uncle who was a Doctor sure did. He was right. So was my Mom and I also stand firm.

Off all the things in the world to be pissed off about, HOSPICE!?

I agree with Sue. I’m sick of the nut bag crap this thread attracts. I’m gone. Never even gonna look at this thing.

I suggest everyone bail on this mess and let the crazies  have it.

Over and out.....

Hospice ended my father's life--cruelly and systematically. His is a cautionary tale. He was put on hospice on April 17th--approved for 6 months. Unfortunately, he was an outlier, and surviving was his downfall. Hospice wanted to take the money and run, and declared (out of nowhere) that my father was in "complete systemic failure" on the 6th of October. When I pressed for an explanation, the horrible, ESL nurse suggested that I read the "blue brochure". She then proceeded to forbid my mother from feeding or hydrating my father (who, days before, had been weak, but happy, hungry, and conversational). We watched my father die of hunger and starvation at the hands of these beasts, who wanted him to leave this world--and their care--by the end of this 6-month stay. He passed on October 15, 2017.

I will warn everyone NEVER to consider the organization known as Willow Tree Hospice, headquartered in Kennett Square, PA. May that beastly organization start its own "journey" into the afterlife.

As a PS: this organization, upon learning that we have questioned some of their methods, have now denied my mother the care and support she was supposed to receive for a year after my father's death. They prove their own guilt.

So yes, hospice absolutely hastened--and cruelly engineered--my father's death. I am sick over this.

Where to begin. I agree that not all hospices are created equal. Are we sure that Markmedsur1 isn't an "internet troll".? I have refrained from responding until I could read most of the posts. I think I will post on this thread just to keep anybody who is thinking about hospice or has a loved one on hospice from getting BAD information. My mother was just placed on hospice last Sat. She is alert, mobile, and pain FREE! at present. I ask LOTS of questions. I know the phone numbers of the nurse, social worker and MDS that write the pain prescriptions. I communicate daily with my mother,see her frequently at the AL where she is, I know and talk to the people that care for my mom and give her meds. I also had the BIG TALK with my mom years ago when things were calm about what she did and didn't want so I wouldn't have to guess when the time came when she wouldn't be able to verbalize.There will be no ventilator, dialysis, feeding tube. She will still be treated with antibiotics if needed, she has her cpap with oxygen at night, she gets 3 showers a week from a wonderful nursing assistant from the hospice. I also asked very hard questions about time frame and changes I might expect from the spreading of her cancer. No one but God him or herself can give an exact answer to time frame, we as humans can only give educated guesses. The time frame depends on so many factors, each person is different. Also, things can change literally in a heartbeat,if someone tells you 6 months, that is an estimate, it isn't written in stone. It could be days, weeks, months, or minutes, know one really knows. My mom's insurance pays 100% for hospice care thankfully. I know that the internal organs that are being effected by the cancer I can expect to possibly see seizure activity: again talking with the hospice nurse and keeping daily and frequent COMMUNICATION is imperative so that misunderstandings don't occur. There is already a plan in place for the meds that would be needed if seizures occur.You as family if you are going to be involved with this process have a responsibility to educate yourself on your loved one's illness and possible physical changes you may see in them. It is beyond hard to watch someone you love literally become physically unrecognizeable as their medical condition worsens.I have only had one complete experience with hospice 17yrs. ago with my dad and it was a positive one. Now I am at the beginning of my 2nd hospice experience with my mom. Her journey will be different as her medical problems are different than my father's were. If you have concerns about the care a hospice is giving your loved one,make them known, you can call their corporate office. However, unless you are the one with the medical care power of attorney you may not have any say so or you are trying to go against the loved one's advanced directive things may not go like you want.For those that are only children like myself, hang in there, having siblings doesn't necessarily make things easier. And for those with siblings,keep in mind that all families are dysfunctional,there is no Brady Bunch family. As your family dynamics will allow COMMUNICATE with each other,get your feelings out in the open before emotions get to high. Many of the negative posts about hospice,well we do have free speech but it doesn't necessarily mean that the speech is correct. Also please don't wait until your loved one is incoherent with disease and pain,so many people wait to long to involve hospice. I am glad I have engaged hospice at this point in my mother's care, my mother's recent MRI helped me with that decision and also the fact that she and I had talked about what she wanted before she got sick.She may even live longer that what the MDs have predicted simply because her pain is so much better controlled. In many cases you don't have to "knock" someone out to control their pain. And even if she doesn't live as long as predicted I do know that her wishes of not being in pain and anxious will make the time she has a much better quality of life.

timbuktu, thank you that was a very nice post . I am glad you took the time to read all the comments. That must have been a marathon.t . Like SueC and many others I am not wasting energy on this topic.

One thing I have noticed, vast majority those writers who come on as anti-hospice never once had written on these forums on Aging Care prior to their love one passing on. Never asking our recommendations for whatever they find on this journey of elder care.

And why did they seek out a website on elder care long after the fact? The reality of doing this doesn't make sense. Unless they still need to point a finger at someone or something.

Wish people would realize that the death time-table is the same for the love one whether they use Hospice or not. The question is, do we want our love one to pass over pain free or not. I know for myself, I prefer it be pain free.

I remind you folks who have said Hospice killed your loved one---they did my Father also. My Mother and I were furious and so upset. There are a few on here who get paid to promote Hospice--or enjoy death! It's almost sickening. I have heard that as it is a very big money maker today. If you hear someone constantly saying "Oh you poor soul" and making comments such as "yes we give moist lip gauzes and back rubs and turn q hour and we watch respiratory rates slow below 12, etc., that means they really dig their work of death. Hogwash! I've never seen them turn q hour constantly unless the family is there, then obviously they will put a show on for you! Run for your lives! Trust me it's a big corporate business. And those who love it so much usually try to make you feel guilty for speaking against Hospice. I feel no guilt man. I know what happened to my loved ones. I am also an RN and PA! Don't even attempt to belittle me. It won't work.

Now, that's ridiculous.

Perhaps we should insist that to be a hospice nurse you have to be terrified of the dying process and utterly unable to support families through it. Substitute hand-wringing and raging against the dying of the light for practical symptom relief and a reassuring presence. That should help.

Everyone has a right to voice their opinion. But, doctors have to write an order that reflects they think the person has 6 months or so to qualify for Hospice.
Hospice patients are terminally ill; the expectation is they will die soon. Every family should realize that fact.
Do patients rally & come off hospice? Yes, they do.
The person isn’t penalized for getting better.
I too am a RN. I had my mother enrolled in Hospice twice while she was in a NH.
The first time, she got better, substantially so, & was discharged from hospice.
One year later my mom had a stroke, & we called Hospice again. They came back in &  provided services to her.

I think she was on Hospice for one or two months prior to her death.

During her final hours the nurse came in to assess my mom and stated she was going to give her morphine but felt my mom was in no pain, this withheld the morphine.

Thus to believe hospice over medicates willingly is just not true.

I would think that being a Hospice nice is a hard job but in my conversations over the years with hospice nurses, all of them tell me that they loved their job - that they were honored and privileged in their role to provide support to the patient and their families during the end of a person’s life.

I asked if it was depressing having to take care of dying patients and actually not one of them said it was depressing- heart wrenching, sad, & hard work physically but not depressing. I am sure there are hospice staff that do get depressed from their job, but enlightening to me that many of them loved what they did.

We don’t know what expectations the anti-hospice posters were of the hospice team; were they unreasonable expectations? Maybe.

Hospice staff are not miracle workers, after all. They are human too.

To me while this thread asked if hospice rushed their loved one’s death, of course there will be those who have a negative view, but the majority of people that replied were very pleased with the hospice team’s performance in providing comfort to a dying person & if that meant giving more medication to that person, so be it.

No one can say they know how the body metabolizes narcotics and the person in hospice is usually quite ill meaning many organs are not capable of functioning as they should. I don’t believe any hospice nurse willingly over medicates the person to the point of respiratory depression and death. That provider uses their professional assessment skills to administer the appropriate dose the nurse feels will achieve the goal of comfort.

Families angry their loved one wasn’t turned every hour, lips moistened when they became dry all the time is an unrealistic expectation of hospice staff, and in this situation the family should be there to assure that person is turned and their lips moistened, as well as other comfort measures. 

That was MY job as I kept vigil with my mom in the last hours of her life.

Perhaps hiring 24/7 caregivers would have assured the hospice patient’s needs were being met because it is truly unrealistic to believe any health care provider will be available every minute of their shift to assure those needs were met.

An RN or PA with hospital experience surely is aware of this as well.

For those families reading the negative opinions on this forum, please don’t be frightened to where you will not choose Hospice to take care of your dying loved one.

My experience in the two times I utilized hospice were very satisfying, under the circumstances.

I will share one interaction with our hospice nurse Holly.

I lived 200 miles from my mom. I had spoken to the hospice nurse, Holly, every week prior to my mother’s passing. On our last conversation I discussed the distance & time I lived from my mother, & asked her to please notify me if she assessed that my mother’s death was imminent. Holly called my home @ 8:30am the morning of my mom’s passing and told me that today might be the day.
I thanked her & headed north on 95. I was able to get to my mom’s bedside by 3pm. My mother died 12 hours later at 3am. I was with her.

Moral of this story is that Holly, who was probably very busy, recognized the signs of approaching death and remembered what we had spoken about, as she called me & I was able to be with my mom when she passed.

Long post, I know! But please keep an open mind about using hospice. Hospice will assure the dying person’s comfort and needs are being met.

I’ve been a RN for 37 yrs & have never heard of any family complain that hospice didn’t do their job in past experiences. 

Don’t let the negativity of a few cloud your judgement. 

It's not unusual for a pt to just become unresponsive when the ammonia levels get that high. I've taken care of several patients with increasing ammonia levels and most of them did not even require any meds and they passed in the same manner as the ones that required meds for comfort. It's not unusual to see the periods of combativeness, then the very hyper alert mode prior to the pt going unresponsive. This happens with or without the meds. Hope this helps

Markmedsur1, since you are a RN, you would know that you can cancel Hospice at any time.  Why didn't you?

One of the most valuable things hospice gave me was stickers with their phone number to place on all my phones. I took advantage of that. It was a comfort to know I wasn't alone as I faced all the decisions I had to make. When I made the final call saying that my husband had just died it was also a comfort that that was the only call I had to make -- no coroner, not the funeral home, not the research center where he donated his brain -- hospice care of that, and I could focus on bringing my family together.

Whoever told me "Since I was an RN I should have cancelled Hospice right away DOES NOT KNOW WHAT WE WENT THROUGH YOU FOOL. THIS WAS OVER 20 years ago and my Mom and I did not know what Hospice did to people then so shove it. We learned after my Dad died 24 hours after being admitted to the Hospice unite. He was fine at home. He ate well , he was alert and oriented times three. His problem was the lung cancer and the adenoma carcinoma throughout his body and on his heart! So he needed up with assistance and he had to have oxygen. But he wanted to live !!! He wanted to live ---do you get that ???? Darn death trap. He was on morphine ER 15 mg per day and that was it. That helped his anxiety from trouble breathing to where he was calm and he could breathe easy . The doctor tried Ativan once and he just went Loopy and said "no more " and my Mother said "you will never get out of Ativan again". Well my Mom was exhausted and I was very tired at that time,  too. So she got him admitted for Friday night at the hospice unit at the hospital ! The doctor had sympathy on her because he knew if she could not take care of him he would die,  so the doctor pulled a string and said We will take him here over the weekend and you can bring him home Monday.  Btw the Doctor was a Cancer specialist and liked my Dad and did all he could for him and said he was a remarkably strong Man.  Mom was relieved because she was getting physically exhausted from taking care of him and I was busy working and finishing my nursing school.  Well he was fine when we put him in the hospice unit and alert oriented times three they put oxygen on him and he said "I'll all be ok here go home and rest". So we went home. The next day we got a call from this hospice doctor stating that he believed that my dad was dying. My mother and I were in shock because he was just fine the night before! By the time we got up there his respirations were 10.  And he had not responded to them all night or all day. Mom looked at his chart and I did as well and we seen that they were giving him almost double the dose of morphine a day and they were giving him a 1 mg Ativan IV push BID!!  We were furious but yet saddened and in shock and we thought "my god what are we to think here? ". I suggested Narcan. Mom said that would probably work . . Well then they all got upset and the nurse told me and my Mom that "oh that will make him so disoriented coming out of this and upset and he's liable to start screaming and it will just create a terrible situation and it would be best to just let him die ". We told them WE WILL decide on our own and we will be back ". So Mom and I went downstairs into a quiet room in the hospital Chapel to converse privately about this. We called several relatives and conversed among ourselves. We were probably in this room for an hour hour-- about an hour. We were told that he would probably die within a few hours so "go talk." Well low and behold they sent a health care tech down to our area and she told us you'd better get upstairs now . We did and what did we find? He was within 5 minutes of death and respiratiins were 6! They lied to us all the way through this experience too. And we were considering suing them with a huge lawsuit but due to my mothers Christian values she said I just can't do it.  So you people that think hospice is so great don't you ever tell me that and don't you ever put words in my mouth and assume! Disgusting comments. YOU WERE NOT THERE!! And 40 years ago there were no hospices but people died on hospital floors with out hospice and nobody complained ! Including my grandmother and several older great aunts and Uncles. .... at that time they all got food they all got turned , they all got IV fluids , they all got attention and the medications they needed , and they were able to die with dignity and not be doped up with lethal amounts of morphine and Ativan ! Dr Death awaits you in Hospice. As I have posted on here several times before hospice is a big corporate money maker !

And once again Why are Hospices located on private floors? All nurses are qualified to deal with dying patients! It's because they know Hospice kills them off faster!  I know many nurses who will not work at a Hospice. They won't do Euthanasia.

Markmedsur1 you are spot on. Hospice is BIG business and it will only get more profitable as the Baby Boomers age. Just look around at your local hospital. More and more of them are opening up hospice units. Our local hospital has been here for 100 years and its hospice wing is only two years old.

Here is how hospitals play the Medicare hospice game. They can "discharge" a patient from the hospital and, under Medicare, "admit" the patient to the hospice wing. (The patient never "leaves" the hospital.) Hospice wings are very profitable.

I know two families who had a family member in a hospital hospice wing. And each said their family member was given NO food. Not even ice!

Mark I am sorry about your father dying but in reading your last post it sounded like your mother was exhausted and at wit’s end from taking care of her spouse who was terminally ill with lung cancer that had metastasized all over his body. Your mom needed help, and it was given to her by your dad’s doctor, who knew your father’s end was near and was gently guiding your mother to accept that and she & he agreed to admit your father to the hospice floor.

My view as a RN am thinking his CO2 levels were high from not being able to breath well enough to get enough oxygen in due to his lung cancer. As you may know now being a PA/RN or whatever title you have acquired, there is something triggered when end stage COPD pts or lung cancer called the hypoxic response. Those patients are so used to functioning at a certain level of O2/CO2 that once that condition changes their respiration’s decrease and they stop breathing.
This coupled with fatigue & all the other adverse conditions from his cancer caused his demise, not the actions of the hospice staff.

I say this respectfully but you may benefit from therapy for you to work out all this guilt or projection that you have for not being able to save your father. In your role now as a healthcare provider, you must realize that your personal feelings about a modality of treatment - Hospice - can not prohibit you from offering that service to others. You have a duty to provide your patients the right to decide on their own but you need to be able to give them that information with no personal bias.

Your mother did the best she could have done under those circumstances 20 yrs ago.

I am curious, Mark, what do you feel should have happened? What treatment would have given you a different outcome? Your father had lung cancer with metastasis. What could you have changed about that?

I hope you work out whatever negative feelings you have stored back in your psyche and are able to see both sides of this discussion. I certainly hope those issues a will not prohibit you from supporting any patients you have the honor of caring for if they choose Hospice.

20 years is a long time to wrestle with the circumstances of your father’s death. I wish you peace.

I agree with you. For whatever reason, it does seem as though they go to unresponsive quickly and then to death quickly once they have been placed on hospice.