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My mother is 90 years old and is in a nursing home. She is suffering from some dementia and is having reoccurring UTIs. After her dr. appointment today her doctor pulled me aside and started talking about some end-of-life decisions. He informed me that most deaths in the nursing homes come from UTIs and pneumonia. He believes that the UTIs my mother is suffering from will be what ends her life and he said this would be the time to continue to treat the UTIs, which would not resolve them and could possibly end her up in the hospital again or to stop treatment and allow her to slip away peacefully. Is this a common practice?

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She has been on Cipro several times with no problems at all. Honestly, I don't need more anxiety right now!
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Xinabess,
Search bar above, enter CIPRO. There are pages on the dangers of Cipro in the elderly.
Maybe if your Mom is to be made comfortable, another UTI medication could be given.
Pamstegma wrote this:
"Find out what she is on. The FDA has posted warnings on quinolone antibiotics like Ciprofloxacin causing problems like this. Call the MD ASAP"
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So, more fun with UTIs. My mom's PCP took blood and urine from her about 10 days ago. Blood came back showing slightly elevated levels of this and that, which had her concerned that she has another UTI. I guess it's a chronic infection that gets tamed by antibiotics and then resurfaces periodically. PCP was being cautious and suggested we take her to the ER. My mom seemed fine, was ready to go out to dinner, but I was afraid it would get serious again.

So I call 911, we go there, wait for 5 hours. Doc there says her blood work is the same as it was upon discharge the last time she was there. He didn't want to admit her because vitals were fine and nothing alarming seemed to be going on. He suggested she take an oral antibiotic again since her UTI was responsive to it last time. He wanted to avoid catheterizing her/admitting her also because that can up the risk of a UTI. So we went home. This was Thursday.

She has been fine so far - eating, drinking. Tired and memory is getting worse, but that's just due to her age and unwellness, IMO.

Anyway, PCP talked to ER doc and she was pissed at him for not taking urine (tho she had just taken it a day or two earlier and we await results) and for discharging her, I guess.

I'm SO confused. Obviously, I don't want to admit her when she doesn't seem outwardly ill. I don't want to take her to the ER any old time. But since she had sepsis once and another UTI that she was admitted for, I'm in a constant state of worrying that I'm being neglectful. That said, the other two times, she had clear symptoms - not eating for a week, severe diarrhea or vomiting, chills.

Hopefully, the Cipro will work. I'm also upset because my mom's senior health center has a program where they provide IV fluids and antibiotics in the home - which would be a blessing, but her insurance doesn't cover it. That makes no sense to me, since it's a lot cheaper than covering ambulance and hospitalization. I'm considering finding out what it would cost out of pocket.

I've never been in a position where 2 docs disagree (in fact ER doc said he'd go with a different antibiotic than Cipro, but PCP wanted that) and where I have to be on constant alert.

I feel like *I* have to make a decision about when I think she needs to go to the ER - i.e., clear symptom of some sort (lack of appetite, fever, diarrhea, vomiting). We can't just pop to the hospital every week! But I'm worried I'll make the wrong call. UGH.

We are going to see a different urologist than the first one we saw about removing her large kidney stone, which is contributing to the UTIs. Procedure requires gen anesthesia and minor surgery, so urologist was concerned that was risky given her overall health/age.

Help!
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"Fantismajorical'.... you may not realize it, but you've simply reiritated much of what I've already said. 
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Tired1of 4 You wrote I mean I am genuinely bothered by this. Question; Would you let a tooth ache in your child or even in yourself manifest into a brain infection just because you know sometime in life they or you may pass from being old or for what ever other reason such as getting run over by an elephant while in Africa? ... A UTI is totally different the a toothache. And it is a natural cause of death ( I prefer the term AND, allow natural death, not DNR). Yes, it leads to sepsis, eventually. But recurrent hospital stays are traumatic to older people and as someone had mentioned antibiotics causes diarrhea for aging people. For my 90 y/o FIL the diarrhea lasted 6 weeks, with numerous episodes of incontinence of stool, which was frustrating him as well as humiliating. Also it weakened him greatly. He has said he will never go through that again, and therefore we will not treat this UTI. It is not that he or any of the family have disrespect for the elderly, as you were insinuating in the above statement. He did have an abscessed tooth 3 years ago, I insisted he treat that immediately, extremely painful. Also he has had a chronic UTI that his Urologist told him would not meet his wishes as he had discussed them with his doctor. He has no pain. After a year+ of cloudy urine, we are seeing color changes in the urine (red/brown). We are staring to see some mental changes, whether they are due to the UTI or other causes, we do not know. At 95, he is weak and tired, again we do not know why. We have caregivers to support his wife and him, as well as us being there almost daily, and helping with personal hygiene. We will get hospice again if we need it, we have a standing order. (Yes, he was on hospice 2 years ago with a 2 mo. expectancy.) Yes, I will admit that it has been a long 5 years and I am ready to move on with my life, and perhaps it makes me more compliant to not treating a UTI. On the other hand I see the burden that treatment has caused him in the past, and do not want to go there. Also you see, even in a weakened person, it does not lead to a super infection and death, immediately. I am fortunate that he was willing to discuss with me and his doctors, possible end of life scenarios, so that we can fulfill his wishes. As others have mentioned each situation and experience is different. So it is a thoughtful question by Pamz17.
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Veronica, i found one interesting subject you've raised within your comment saying not everyone who begins caregiving are trained, etc. perhaps Veronica that is exactly what irritates me ... no really, because what usually ends up happening is these people find themselves in charge of another adult life and many times they rely solely on a physician. Physicicians make so many mistakes many should be forced to prove competency, annually. I have witnessed physicians of several fields coming up with their own "plan of continual or not continual care ..several physicians with several different plans about one elder individual.. and the decisions each one makes can be detrimental to the person if perfect orchestration of both human respect and medicine is not performed.

.. all it takes it's one poor decision made by a physician to take one correctable scenario and turn it into a death sentence of the individual... and then I have watched these physicians sit there and talk their way out of the bad decisions by convincing family members "perhaps we just let nature take its course now" preparing the family of the pending death of the individual. So then, there's almost a relief and a giving up and the family seems eager to enter into that decision. Almost as if hoping the doctor tells them "let's just stop treating.

That Veronica, is what disturbs me. And to be quite frank, it's each humans decision at the end of life to decide for themselves how they go, problem is, we have as you've mentioned, untrained, tired famlies making decisions, decisions for another human and that includes the humans death.

To me, unless the elder is already suffering chronic illness/conditions and regardless treatment of even minor ailments the individual will pass, that is the time to discuss the do not treat ... Listen Folks, or me, "life of the elder should be respected as a right to life, and considered and treated as just as an important decision within these families and these physicians and these facilities, just as much as their death is.

It' seems to me, from what I watch, hear and read, more time and discussions are spent on the decision and planning of an elders death, rather than the decision of the elders life. (And no, I am not speaking of the terminally I'll.)

I believe in personal existence decisions when able to be made by each individual of sound mind and body ..I also believe in the quality of life rather than quantity of life...

... but when the individual can no longer make their own personal critical decisions, I find we as their keepers, should strongly seek the very real moral and the very real spiritual balance for this individual ....weigh both their life and their death equally and carefully for this person, and do not allow our (care givers and family's) own tiredness, our own impatience, and/or our own fed-upness with the elder position we are in, to ever, ever direct a decision of death, nor ever allow that same tiredness or fed-upness to allow a physician, or facility to ever behave the same ... but rather make deeply personal decisions for the individuals existence, or ... ending their existence. it's not supposed to be "they're old, just let them go. your elder regarding treatment? ... I guess everything you do or don't do for another human-being, solely depends on how much you love them or how much you genuinely believe they are valuable in some way. Because there comes a point where allot of control is gone, so making decisions that "fit your life about another's life... just seems very worthy of decisions that are being made are being made as humanly as possible.
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... I appreciate that "kendrabell
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Tired- I just went to your profile page and read what you have gone through- I understand a bit better where you are coming from. When I was a CNA, I saw so much abuse take place! And, yes, these were some of the "best" facilities. I left two skilled nursing facilities, because when I reported, I was threatened by other aides. The nursing home directors did nothing, so I finally got smart, and went directly to the ombudsmen. Because of what I've seen, I promised my dad he wouldn't get stuck in a nursing home. I can't say they are all bad- I only know my experience.
Anyway, I suppose all of us are making our decisions based on our very different experiences.
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Tired I happen to be old and not particularly healthy but have refused to sign a DNR several times.
I did go back and re read all the responses and I don't think anyone in this group is high fiveing each other because they see a high horse they can climb on.
As you know caring for an elderly loved one can and usually is very taxing both physically and emotionally.
When the caregiving starts most people are ignorant of the toll it will take on them, they are just anxious to do the right thing by their elder. This is usually based on what they have promised the elder or what they would hope for themselves.
Unless the caregiver is a trained healthcare professional most have no idea about proper care or disease progression and make their decisions based on emotions.
Pneumonia used to be called the old man's friend. This is no longer the case because of modern treatments but it still kills many when developed while someone is actively dying.
We do not know the history of the OP's loved or what stages of disease she may be in.
My understanding from her question is that she was shocked that the Dr should make such an unbelievable suggestion, maybe now she has read some of the responses she understands his reasoning.
There is no right or wrong decision to make in these cases because UTIs frequently become chronic with the bacteria hiding in the convoluted coils of the kidneys only to reappear a few weeks later. My advice would be not to treat anything where the treatment will cause the patient further distress from the treatment.
I was surprised that one writer said that Medicare would not cover IV antibiotics in the home. My supplementary insurance won't usually cover things that Medicare denies but they approved six weeks of IV antibiotics at home when my hip replacement became infected. They put in a permanent IV PICC line in the hospital and my husband gave the daily dose. Yes I did have a tube sticking out of my arm for six weeks and it was a nuisance but there was no pain and it was removed as soon as the course of antibiotics was finished. Most anti biotics have side effects usually related to the GI tract and these can be unpleasant such as continual diarrhea
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First of all theres no need to defend yourselves and stand-in a group high fiving each other regarding this subject, I don't want to read it, it's odd.  Second of all, if you read anything I wrote, which clearly you haven't, I was speaking of the posters situation not any of yours where your elders are "riddled with other issues so you can all stop the podium stance... quite full of ourselves now aren't we. ...  again, if you would have read thoroughly rather than reading what you wanted to tick you off and stopping there, what I said was clear that I was speaking a relatively physically healthy individual who just so happens to be old and has recurring UTIs and a physicians attitude to that (per posters comment ...  I Equally made it clear what I said regarding treating a UTI does not pertain to any "in-process of dying and any other underlying ailment individuals. Your elders are yours to do with what you want. So do it. But if you're gonna come back on here and stand up for your right to pull the plug of your elders at your descretion simply because you misread, might I suggest you read thoroughly next time.
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Kendrabell, I wholeheartedly agree, Every situation is different, and the Dr's who advise, understand best what is at stake. There are So Many Variables when it comes to the human body, especially in our elderly population, and especially when it comes to bacteria and our immune systems.

While I think it is good to reach out and ask questions, it is equally as important to have faith, and follow Dr's advice.

It almost impossible to get all of the information out in a simple post, so when asked in "generalities", you are going to get a lot of imotionally fueled responses, but nobody knows All of the answers, without knowing All of the pertinent patient history, and sometimes not even the caregivers to our LO's do not know All of the patient history and/or what is potentially best for them, that is why we put our trust in, and rely on our Dr's care, in good faith that they know best. There is Never just one true answer!
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Tired1of4- Every situation is different. My dad is full of infection in his bones. The IV antibiotic treatment given in hospital was a nightmare for him, and did not eradicate the infection. There was no way to cure that infection without surgery (which he could not tolerate). The UTI he currently has would only be suppressed temporarily by antibiotics at this point, and maybe not even that. He's on morphine for the bone pain, and so feels no discomfort from the UTI. You can certainly judge our decision not to treat. Dad is getting treatment to make him comfortable. Haldol and Ativan have reduced his delusions and agitation. He was quite cheerful today, and we even shared a glass of wine. I'm comfortable with his care, no matter what anyone else has to say about it.
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Xinabis.... In all due respect no where was I speaking of you or about you....you did not write the original post.
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Tired1,

I hear you, and I do NOT want my mom to die - of anything! The dilemma for us is that her urinary tract is colonized by bacteria and she will most definitely be getting UTI after UTI. Her large kidney stone is a big factor in these infections; it cannot be removed without surgery/general anesthesia, which is risky for someone in her condition.

If the UTIs could be treated easily at home, that would be wonderful, but, unfortunately it is hard to catch them early, plus giving her prophylactic antibiotics isn't good because there are different types of bacteria in UTIs, so not all antibiotics work, and taking them too often can make her resistant to them.

So in the past 4 months, we had to call 911, get her in an ambulance, sit in the ER, and admit her for a week stay in the hospital twice. All of that is so traumatic.

When push comes to shove, would I simply not get her to the hospital? Highly unlikely. So I guess that means accepting that she will probably go to the ER (can't get her there without an ambulance) repeatedly.

There is a service through her senior health clinic that can bring IV fluids and antibiotics into the home, after testing her for the specific bacteria, which would be ideal. Unfortunately, her insurance doesn't cover that. 

(Also, the kid with a toothache analogy is not the same. We are talking about very old and very ill people here.)
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.... treating a UTI will not stop an elder who is going to pass in the future from other causes or natural causes from passing... how-ever, not treating a UTI can most certainly cause a more serious condition, serious enough to lead to death ... do you understand the difference. ....do you.  

Treating or not treating a UTI is not a similar decision as the decision of removing life support or carrying out a DNR during a heart attack, etc.  Not treating a UTI is nothing I find reasonable under a DNR document or personal/family wish or respect, not when we are speaking of a still living being who is not passing in their death bed from other causes. 

But, if an individual with intelligent human beings around them are allowed to die because of a UTI ... big problem. 
And I will say it again, My god this subject and some of it's responding comments deeply disturbs me. 
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... I mean I am genuinely bothered by this. Question; Would you let a tooth ache in your child or even in yourself manifest into a brain infection just because you know sometime in life they or you may pass from being old or for what ever other reason such as getting run over by an elephant while in Africa? ... 
UTIs are infections due to several scenarios, and usually correctable scenarios, find what that scenario is for your elder and change the situation... and let them die, when it's their time of no causes or from more untreatable causes, or terminal causes that are out of your control ... a UTI is in your "control (one must read deeper into that, at least I hope.
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... to the ones making comments that prolonging life is not the thing to do etc... that is not what this discussion is about. What this discussion is about is a physician supposedly advising not to treat a person for a usually easily treatable condition, a condition mind you that is typically associated with pain. When typical ailments are not treated simply because a human is near the end of life (although I've yet to see god" appear to any as a physician, meaning they are not to play god) That's when, as I stated far earlier in this thread that willful neglect begins to show itself. Treating a UTI simply to relieve the pain associated with the pressure of an inflamed/infected urethra tract is what should be done no matter the individuals status of age or times of occurrences, unless they are already in the last stage of life, and that means this"if they are minutes away from death, then there are no tests going on for a UTI which means the individual is not minutes away from death .... Let me explain; Treat the UTI and place actual effort in finding cause and then take measures that work (meaning take the time or make their physician take the time to find the source of the continual infection so the individual does not suffer such from reoccurring.... period.)

An elder individual will die from cancers, Alzheimer's, heart or lungs or other serious conditions, and individuals will die from natural causes ... no where, let me repeat, no where is a UTI a natural cause nor a serious condition that stood the precedence to death due to reoccurring events.

If, and I repeat "IF" a physician ever expresses to any of you that your loved one has had too many UTIs to the point you should not treat it and just let them pass, you should dial 3 numbers .... those three numbers are 911 and press charges against that physician of willful neglect, malpractice and a whole host of other charges. This thinking among some of you, albeit I "get where your thoughts come from, I actually do, but just because you or whomever are tired of dealing with the elder is it actually moral to say "no we won't treat for a minor (which could turn major) ailment simply because we're sick of dealing with him or her?? I mean Jesus what the h*ll is that way of thinking, huh??? Anyway, those thoughts of let them die of even such a treatable ailment that I have read on this subject, is exactly how nursing homes, hospice and even assited living facilities are allowed to expedite death and get away with it. I hope I've made myself clear. And by the way I am a firm believer of quality not quantity of life, but equally a believer of human rights.
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My mom is not artificially hydrated... We offer her water frequently. We don't force feed her, we just offer it. These were easier decisions to make. Withholding antibiotics is a tougher decision. There is no right or wrong... We all do the best we can.
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I think that the comments here really point out how VITAL it is to put down in writing in advance what you want to happen regarding your health care treatment while you are competent and able. Be specific too and get it done with an attorney, to ensure it's done correctly. Your Advance Medical Directive should provide the details you want to designate things and also issues of artificial hydration. I shudder to think that my family members and HCPOA would keep me alive at all cost under any circumstances. It's really scary. I wonder if they have spent much time in nursing homes or Memory Care units.  
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Ugh. I've been through this. Mom has been through recurring UTIs and two serious bouts that put her through ICU/rehab/nursing home. The first time the nurse came over to me (first day in ICU mind you) and said sometimes it's better just to let them go. Mom was still conscious, could answer questions and was pretty lucid. I was shocked. How about we figure out where she is before turning everything off? I told her I can't kill her while she's able to hold a conversation. Both times she ended up having drug resistant infections. Both times she went septic. She was able to fight them off but her dementia really amped up. She never says she has pain from the UTIs. I can tell from her demeanor: sickly, confused, pale. This past time she was away from home for six months. The next time (I know there will be a next time) I don't know what we'll do. She ended up breaking a hip while in the nursing home this last time. But her dementia is also worse. It's all so difficult and doesn't feel like there is a good decision. I definitely don't want her to suffer but beyond that I don't know what the line might be. I hope you feel comfortable with what you decide. It's so hard.
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My mom is on Hospice. She is stage 7 Alzheimer's. She is bedridden, incontinent, has to be hand fed, verbally rambles most of the time, but does say a sentence here and there. She has had a number of UTIs. She lives with us and is extremely well cared for. She is changed every 2 hours and her Peri area washed, we use a barrier cream and expensive disposable briefs. She is kept hydrated and given probiotics. The UTIs are coming more frequently...it is not just because they are not changed often enough. Hospice does allow us to treat her UTIs in home. My mom is extremely allergic to penicillin so this adds to the issue as she cannot have anything derived from penicillin either. At this point, we have made the decision to no longer give my mom antibiotics. It is not that we are wanting to hurry along her death...we have done everything possible for the past 9 years to extend her life with the best quality we can. My mom is a fighter. She over came cancer, twice! I believe that at this point, the quality of her life is so compromised that she is ready for the next chapter...she is ready to go be at peace with her parents. We will do nothing to hasten her leaving this world, but we will also do nothing to force her spirit to stay. This was a long, tough decision for us to make. I think each family must consider all aspects of their loved ones life then make the best decision they can. No one else has a right to judge these decisions...it is so very difficult. I have to say I am so glad someone started this thread and for all of the comments...it has helped me to strengthen my resolve.
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My dad is not being treated for his UTI. It's been chronic, and he has a bone infection as well. For us, it's the right choice. He is bed bound, and suffering from rapid onset dementia. He's miserable, and has been in pain for years.At 90 years old, it's time to let him go. Hospice has been a godsend. The nurse and social worker assigned to my dad are amazing and caring women.
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I agree, Sassy. I am dismayed by those posters who believe in prolonging life at all costs. My mother still has some quality of life after her stroke, is not demented, and can speak and enjoy food and drink, but the only thing she can do for herself at this point is speed-dial her phone, assuming someone has remembered to charge it and put it near her unparalyzed hand. That's it. Only one of her friends is still alive, plus me and my daughters. She is not saying she's ready to go and she never will, and I am utterly terrified of losing her, but how many trips in an ambulance to a NYC ER, where you wait for 12 hours to be admitted, can anyone take for repeated UTIs? Every one of those has made her disoriented and unhappy - and me too.

When she was in rehab at a NH, there were so many people (99 percent women) who were cleaned, dressed, fed, and parked in their wheelchairs in the world's most depressing, flourescently-lit room day after day, staring blankly into space or yelling or pulling their pants down. Hopefully, they weren't suffering, but, boy, their loved ones sure were. Why do we do this to humans when we would never put our pets through this? What is the point?
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There comes a time to let go - or for we who love them to let them go. UTIs can be treated, but antibiotics are less and less effective and in high dosages, the cure can be as discomforting as the problem. My Mom definitely had a UTI when she died at 90 - but she had had a series of strokes, was bedridden, and unable to speak. At some point, if the patient is comfortable, it just doesn't seem important which of the age-related issues resulted in her life ending.
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You are not describing a person who is suffering terribly, and terminally ill. Why would a doctor not want to treat a UTI (which can be very painful or uncomfortable, and cause worse dementia symptoms)? If she has family visiting her, and a pleasant environment, you would want to treat normal illnesses like UTIs..How about the doctor making suggestions on what can be done to avoid UTIs?
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Learned something new about UTIs and hospice. I do know that constant use of catheters can cause UTIs especially someone who ends to get them frequently. Mom had a UTI last Oct and hasn't been had one since.  She has been on cranberry tablet and a probiotic.  When she was in the hospital they put in a catheter to get all the urine.  The problem with the elderly is they can't void completely.
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Hospice is there to ease pain and suffering and mental anguish for the patient and help and comfort for the caregivers.
To be admitted there must be a terminal diagnosis with the expectation that the patient will die within six months.

They will continue medications for the admission diagnosis as long as it is beneficial for the patient. Other conditions remain the responsibility of the patient and family. If the diagnosis is heart failure but the patient also is diabetic they do not supply those medications but will offer helpful advice and visit if there is a crisis.

Things like infections may or may not be treated depending on the patient's general condition and  the wishes of patient and POA. If family does not agree with hospice decisions they are free to have the patient discharged and seek more aggressive treatment. There is not a problem with readmission after treatment. Hospitalization and visits to the ER are strongly discouraged and can lead to the patient's discharge from hospice. Sometimes these are deemed necessary by the RN for many reasons in which case it has no impact on the patient's status with hospice.

Every few months there is a five day respite when the patient can go to a hospital or NH to give the caregiver a break. Hospice nurse continues to follow patient and has to approve changes in treatment.

These are always difficult decisions to make and there is no right or wrong choice and there should be no guilt. After all there is no way of knowing the outcome of a different decision. The wishes and welfare of the loved one are the primary goal.

They are preparing to die and that situation must be respected however much the caregiver wishes otherwise. You can only do your best.
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My mother, now 86, has suffered from chronic UTI's for years. It was not until we had her hospitalized from seizures resulting from these infections that she was able to find relief. Her kind hospital doctor said that he didn't think it was going against her living will to put in a catheter, get a clean catch (which they weren't able to do in the ALF), and take it out.
Getting a clean catch and having it cultured is the only way to know which antibiotic is the correct one. She had been taking the wrong ones for years, as the bacteria she had was a very rare one, according to the doctor. Many months have gone by without a new infection developing, and when one did, I had them use this method again. After all, how "comfortable" is a UTI, as painful as it is, especially when it leads to seizures.
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This is a horrible thing to ask of a daughter. To stop treating UTI'S? Fire that doctor immediately. You are allowed to have any doctor you want take care of your mother in a nursing home. it doesnt have to be the 'staff' doctor.
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My mother has been in hospice care at home for close to 1 year. She has a feeding tube (for meds or when needed for nutrition or hydration) she has a colostomy (which I am now proficient in caring for) and she has a foley (catheter). She was having persistent UTI's, which is not uncommon with having a foley, and is now on an antibiotic 3x's a week. I administer cranberry tablets crushed and dissolved into feeding tube on days she is not taking antibiotic. Hospice is very accommodating in keeping her comfortable. Thankfully my mother remains pain free. It is interesting that hospice will treat a UTI but they don't supply insulin. We get Mom's insulin through her private insurance plan. Mom is 92. I pray she goes peacefully but I would never not treat something easily treatable to allow her to pass on. My Mother is bed bound and I would not call this a great quality of life. She still knows my name and holds my hand when she needs to and cries at times with me joining in. She still waves and blows kisses to everyone. When she moves on is God's call. Till then I do the best I can for her. Bless you all and hope you all find good solutions for whatever you encounter on this caregiver journey. After all, we are all walking each other home.❤️
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