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My 93-year-old grandmother who has all timers and dementia has spent the last seven years of her life in a nursing home. My mother and her sister take turns visiting my grandmother daily. Other family members visit my grandmother as well. I visit my grandmother every other Sunday with my mom. My grandma's health has been diminishing because of her loss of appetite. She's always been a little bit chubby but she has been losing weight drastically because of her loss of appetite. My mom generally feeds her fresh fruit Jell-O and thickening liquids that the nursing home provides. We've all discussed that my grandmother probably gets no other nutrition besides when someone comes to visit and spoonfeeds for lunch or dinner.

A few weeks ago a hospice representative approach my mother and told my mother that their services would provide comfort for the family and my grandma as my grandmother's health continues to deteriorate.

Last week when I went to visit my grandmother I noticed that she had a brand-new chair that seeded her a lot better and she seemed more comfortable.

today when I arrived I thought my grandma was dead. I've never seen her look so poor and not in control whatsoever of her body functions.

We proceeded to the nurses station and found out that hospice has been administering morphine since Friday at midnight every six hours but the nursing staff could administer more every two hours if they felt my grandma was in pain. I asked the head nurse how has this happened that the family has not consented to morphine yet my grandmother has been given morphine for the past 48 hours... The head nurse said that hospice is supposed to contact the family to let them know but in order to stop giving her morphine they would have to have a doctors order faxed to them immediately... Where they would have no choice but to give her the dosage. I am mediately called hospice and left a message on their Emergency number. My mother said by the time she got home hospice had already called she return your phone call and they agreed they would call the nursing home and tell them to stop. This evening around 630 we were called by the nursing home letting us know my grandma's blood pressure was 74 and they said she may not have much time left to get to the nursing home immediately. Grandma was itching her skin and hair... The majority of the time she seemed disoriented and confused and still highly medicated. Her mouth was wide open and it looked like she desperately needed water or something moist to quench her thirst. A hospice care worker was there as well and said she would be willing to meet with me in the hall to discuss my grandma's condition. I told her I was not interested in speaking to her about my grandmother's condition and they have already caused enough problems. Miscommunication could be detrimental to my grandma's condition... And no one in the family had consented to my grandmother given morphine.

My question is do you think my grandmother will survive after having morphine in her system for more than 48 hours? The nursing home also told us that hospice had change the doses of some of her medicines and in fact she was placed on another medicine for anxiety; one that is not recommended for Alzheimer's and dementia patients- we were told the drug makes patient very lethargic.

Seroquel 25 mg -- is the drug and dosage.

My grandmother hasn't had food or liquids for several days now. I'm actually ticked that hospice could be so negligence and not inform the family about the morphine and we had to find out through the nursing staff at the hospital.

The nursing staff knows my grandmother for seven years -- it's not like no one came to visit her-- family was constantly surrounding her-- now hospice has come in and in within one weekend has caused her to be incoherent, non-responsive in a coma like state.



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Just an FYI update ... my friend's husband today decided he won't be taking treatments anymore for his stage 4 cancer. He is at home, on hospice care.
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sdnbishop, I offer sincere condolences on your husband's passing. Even though you knew it was inevitable somehow it is always a shock.

Hospitals are traumatic places for most patients and especially the elderly. This is well-known and documented. But sometimes I think we don't acknowledge how stressful and traumatic they are for loved ones as well, particularly. My husband died on hospice care too. I am so glad it was in our calm and familiar bedroom!. My heart goes out to you.

You know what? I think that nurse who explained the reason for rushing your husband out didn't do you any favors. And why would we assume that she was accurate in her opinion? Was she in on policy-setting decisions for the hospital?

Actually, statistics about death rates in hospitals include deaths within 30 days of discharge, so sending someone off to die elsewhere doesn't really improve the rating.

Hospitals are not supposed to keep patients beyond the point they are able to help the patient. To do so gives the appearance of milking the insurance for all they can get. It is a fine line they walk.

After the hospital determined that there was nothing else they could do for my mother they were eager to discharge her to her nursing home and strongly suggested we consider hospice care. We were also extremely eager to get Mom out of the stressful, traumatic, confusing ambiance of the hospital.

Hospice is for people who are expected to die within six months. For a hospital to allow patients to remain there to die could really take up beds where no benefit was being delivered, for weeks. In your husband's case it was only a day, but this is very hard to predict. (In my mother's case, she did not die by the end of the week as the hospital expected, but in fact is still with us (and not of hospice) more than a year later.

I am sorry that not only were you in the stressful environment of the hospital but also that you were forced to make decisions about hospice without knowing anything about it. How uncomfortable.

My husband had a terminal disease and so I looked into hospice long before it reached the end stage. I was well aware of what we were signing up for. My best friend's husband has stage 4 cancer. She has explored hospice care. The most recent episode that had her husband in ER and then admitted for a few days, she asked his doctor if her husband was actively dying. He assured her that it wasn't time yet for hospice.

So, sdnbishop, poor dear, you not only lost your soul mate but experienced it in a stressful environment with little knowledge of what to expect. And someone you would naturally respect gave you a cockamammie explanation that did not value your husband's comfort. No wonder you have an uneasy feeling.

It is hard enough to deal with becoming a widow without all these extraneous bad feelings thrown in. Please accept that your dear husband died when it was his time. Medical facility policies may seem heartless but they are not generally based on a disregard for human comfort and safety. I hope you can discard these bad feelings, focus on your sadness over the death itself, and proceed with the slow healing process.
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LME your story is normal as hospitals and Medicare have the home hospice program for the final days.
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I have had this gut feeling something wasn't on the up and up the night the hospital transferred my terminably ill husband to hospice. It was a very rushed situation. They wanted me to meet with representatives from two different hospices to ask questions then make a decision. I knew nothing about hospice, therefore I didn't have a clue what questions to ask. I was in the dark and against the transfer and told the staff I did not want my husband moved to hospice. The hospital would not allow him to stay. He passed away the very next morning once he was at hospice. I asked the hospice nurse why didn't the hospital just allow my husband to remain there to die instead of moving him to an unfamiliar place. I was shocked at the nurse's answer. She said hospitals do not want patients dying there because it reflects negatively on the hospital's ratings! People don't question why a patient dies at hospice, because that's the purpose of hospice, but the CEOs question why a patient dies in their hospital. The number of patients who die in their hospital gives people a bad impression of the hospital facility and its staff. That upset me even more knowing the doctors deliberately wanted my husband out of there before he died, yet the less moving him around seems to have been the best option. Has anyone ever heard anything about this? Remember, this was a nurse on staff at hospice who confided in me something that I'm sure wasn't supposed to be discussed with patients and their families.
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LME: What do you mean by "she must have had a stroke or something?" They owe you a definite answer!
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Nobody is denying the use of morphine in the last 48 hours fortunately it is humanitarian to lull the patient into a doped sleep so that they die without pain and realization.
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Happy Hallowe'en, everyone 🎃 This is for blonde, et. al : Having been through a similar experience with a grandmother and an aunt, I'm sorry if what I'm about to say is negative, because it is. I'm afraid that unless your legal counsel is F. Lee Bailey, you can pretty much forget about winning that case; I really believe he may be leading you on. I think you'll find that what you have is pretty much a losing battle. But I have seen some pretty bad suffering - and absolute gobs of ignorance. By this stage, please realise that morphine is your - and their - friend.
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I HAVE SAID MANY TIMES THAT EVERY MOMENT WITHOUT PAIN IS PRECIOUS. WHEN THEY ARE GONE REALISM SETS IN AND FOR AN OLD MARRIED GUY LIKE ME I AM READY TO JOIN HER AS MY LIFE NOW IS WAITING FOR MY MOMENT. 72 years with one gal is more than a lifetime for others. I still cannot imagine that we had all this time and life is precious for me with family I am getting tired but will renew my passport if I can make that last trip to the UK.
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LME, what a sad story. They did not want you to lose hope, yet the poor woman was 97 years old! We need a little more truth telling about dying and our final months and days, instead the process is often shrouded in mystery, leaving loved ones in denial and with unfinished business.
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My aunt, age 97, died 5/31/15. She died from CHF. Around 5/1, she must have had a stroke or something because she slept up to 20 hrs/day. She was on no meds. Her head was bent forward. She said it was easier to breathe. She started losing her appetite. She said the only thing that tasted good was water. I asked if she was dying I was told no. I Googled Hospice and her symptoms were in the 1-3 mo prior to death range. She continued to decline. We called in Speech Therapy to eval her eating and swallowing. Her Living Will papers said no invasive measures so no feeding tube or IV. The doc ordered high calories Ensure. I knew her symptoms were shutting down. No one validated me til three days before. No one mentioned Hospice til 2 days before and that was one of her caregivers. I had negative feelings about them, but by the early morning of 5/31, she could no longer drink due to choking. She could still drink the say before. I told her nurse to call Hospice as she was thrashing around in bed (she was sideways across the bed) and she said she was in pain. It was Sunday and the doc was unavailable til early afternoon. Finally the nurse gave her a shot of Ativan at 1:30 to calm her. She fell asleep and died with me, her two caregivers, the one's 4 yr old and her former home care nurse holding her hands and knees. She breathed less and less til her last. Hospice showed up after she passed. I wish I had said to call Hospice sooner so she wouldn't have had to suffer. Now I advocate for people to call Hospice. My aunt was dying. Blood tests showed very bad CHF and her kidneys were failing. Hospice care would not have caused her to die.

The nurses said later they did not say anything about her being in the dying process because they did not want us or her to lose hope. We were still trying things 3 days begore.

Please do not be afraid of Hospice or morphine. If she is actively dying, it's best she be comfortablem
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Dr. Blonde keep on fighting I am 96 and carrying on with my advocacy and your zeal is welcome. My wife broke her hip years back in terrible pain and they OD on morphine she never recovered her faculties properly and drifted into AD, I have been preaching the elimination even to my professional family who think I am not competent to blame morphine for her early onset. Can we communicate privately I am in a WashDC Virginia suburb.
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There is NEVER a losing battle. I thought so too but have a fantastic attorney working with me to go after hospice for morphine and adivan overdoses. NEVER EVER throw in the towel. You have been dealing with the wrong people. They will NEVER admit to wrong doing. My lawyer is excellent and unfortunately went through almost the same nightmare with his 'x' mother in law with morphine overdose that also killed her. And a lot of his clients who have had family members die from the morphine given without permission. Please Do NOT give up so easily. I'm NOT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
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I have been fighting a losing battle on the morphine addiction by doctors who OD patients to hasten death, Thanks for supporting my many statements on this and other blogs but all think I am out of my mind on this subject. Experience is the best teacher.
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The way I perceive this is that hospice did the SAME to my dad. I AM in medicine and told them NO morphine at aqll as it will reduce his respiratory rate and 10 minutes after I left him they gave him morphine and within 20 minutes he passed. I do NOT give a hoot of what anyone says that they know they want to die. BULL!!!!!!!!!! I think hospice (some) decide it is the time and I went through the same thing. One day my dad was drinking soup and the next semi-comatose from the meds. And he NEVER came out of it and the hospice nurse told me oh he will be awake tomorrow and he never woke up!!!!!!!!! I HATE them!!!!!!
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Grieving - I do think it a conflict of interest that the Dr who sent your Mom to hospice had a financ ial interest in the same. However, my understanding is that hospice companies are paid a flat daily fee for their services, whether provided in a NH, at home or another location. There is FAR more $$$ to be made in providing useless medical services to elders, because there is no cure for old age. This is why the great majority of people spend the most on health care in the last 2 years of their lives. Here are 2 studies:

forbes.com/sites/michaelbell/2013/01/10/why-5-of-patients-create-50-of-health-care-costs/
which states, "According to one study (Banarto, McClellan, Kagy and Garber, 2004), 30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with 1/3 of that cost occurring in the last month of life."

AND from this link:
cbsnews.com

"Every medical study ever conducted has concluded that 100 percent of all Americans will eventually die. This comes as no great surprise, but the amount of money being spent at the very end of people's lives probably will.

Last year, Medicare paid $55 billion just for doctor and hospital bills during the last two months of patients' lives. That's more than the budget for the Department of Homeland Security, or the Department of Education. And it has been estimated that 20 to 30 percent of these medical expenses may have had no meaningful impact. Most of the bills are paid for by the federal government with few or no questions asked."

I sympathize with you for your loss, but you must come try to come to terms with the fact that your mother could not live forever and is now in a better place.
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We all know that pneumonia starts the downward trend and I agree that the timetable for morphine is approaching. What a sorry mess we are all in to watch our loved ones drive forward to the end of the road. Weeks before my wife asked me if she was dying and of course my response is not I on my watch I will not let you go. Then I left the room and months later I am still crying.
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It sounds to me like the hospital has offered two protocols of care for your Grandma #1 Hospice or #2 Palliative Care.
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I'm with you Garden Artist. I hate it when someone shoves a form in front of me and says sign here. Ah excuse me, I ain't signing anything until I've put my reading glasses on and read everything, especially the small print.
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Kellse, shush, please! Hopefully FG is still on the other hospice thread and hasn't discovered this one.
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Grieving, why weren't you able to read what you signed? I've never heard of anyone making a statement to this effect. I do know that officials pressure people to sign, but everyone has the right to demand the time to read something before signing it.

And no one needs to be told to read anything before signing. This is in fact one of the problems with online shrink wrap agreements; people don't read the terms and conditions of websites they use.

If you were pressured, all you had to do was tell them to take a seat and you'll sign only if and after you've read everything. You have no legal obligation to sign w/o reading, and in fact it is your legal obligation to read everything you do sign. It's called "informed consent.

I do it every time and make people wait until I've read everything, regardless of whether they like it or not. If they make a remark about the time required for me to read everything, I hand them the papers and tell them I won't sign without reading.

We each have rights but won't enforce them if we allow ourselves to be pressured into signing something without reading.
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It's interesting that you bring this up. My mom has dementia, but stills knows us and is lucid. A year ago, her heart started slowing down. Off to the hospital, and she had 3rd degree heart block. The upper and lower chambers were not communicating electrically. A pacemaker was the answer. We were told that this was no longer considered a heroic measure as it was years ago. We ended up asking mom if she wanted it, explaining the risks, and the discomfort it would cause short term. So unless your elder is totally out of it, it pays to recall (as I didn't in the midst of the crisis) that the medical POA is only operational if the person can't communicate, or is under anesthesia, or is so far gone in dementia that they are no longer in this reality.
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that should read - Death is not pretty and hard on all of us.
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waiting for flowgo now
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I'm very sorry for your problems,nurse 25 years& caregiver almost 15.I don't know who called hospice in.known fact they come in w certain meds designed to make patient comfortable.You can fire then idk your grandmother's quality of life I wish you well take care God bless
..
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dear confused, my mom died of Alz. in January of this year. Yes she was being given morphine to ease her pain, and she WAS in pain! My mom couldn't talk or do anything at all during the end-stage. It was up to us (my dad and I) to read the signs, to know she was in pain. Sometimes she would cry out when we had to move her to change her diapers and it was obvious that she was in pain....othertimes you could see it in her face and eyes. I'm glad she was on the morphine to ease her pain. It is NOT being given as a form of euthansia, it is used to relieve pain and suffering. As for the not eating or drinking....well that is normal for a dying person to refuse both as their systems are failing....she could not digest food any longer and if given water she either would leave her mouth open and let it run out or she would spit it out. Yes, it makes US feel better to feed and give them water, but for the dying it is not better. There are special 'lollipops' that you can use to refresh their mouths but nothing will stop them from dying. Those of you who have written in that are guilt-ridden over their loved ones not eating or drinking .....please forgive yourselves...you did nothing wrong. Death is Blessings, Lindaz.
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err... advance directives. I am always adding a d to it.
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This thread brought to mind a question that is important to me. Suppose someone has signed their advanced directives stating no heroic measures and no resuscitation. If their healthcare proxy believes that it may not be the person's wishes at the present time, can the proxy direct the hospital to ignore the DNR?

When my father died I knew that it was what he wanted. To resuscitate him would have been cruel. OTOH, my mother does not seem to be ready to let go of life. The trouble with advanced directives is that they are signed before the reality of the situation is at hand. People can sign them for a future time without giving it a thought. So there is the big question, if there are advanced directives that read no one should be able to contest them, should we try to go against them if we don't think it is what they want.

I guess we could just not tell the hospital that there are advanced directives unless we are sure.
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I agree Babalou. In my case hindsight is twenty twenty. At the time it was horrific
to me watching my Mom, knowing in her lucid moments which at the time were very few, that she was probably thirsty and so on. I would imagine her thinking why are they doing this to me. But in retrospect I don't believe she was thinking much of anything. However I was suffering big time watching someone I love wither away.

There is no easy way to let go of someone. She has been gone almost six mths. now and it still feels like it was just yesterday. I think they should have courses that teach people how to let go.
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I guess a lot of folks here are questioning if their loved ones are actually at the end of their lives. It CAN be ambiguous. My mom has been in granite health since her stroke/broken hip/ pleural effusion/chf two years ago. She's in a NH, gets pneumonia every few months. Over the summer, the pneumonia wasn't clearing up. We (at her behest)decidedly DON'T want her taken to the hospital and don't want heroic measures taken. The pneumonia gets treated in-house. But my sister in law, when things get dicey says "we don't want mom to feel like she's drowning" and "we should have her taken to the hospital so they can cure her". Somewhere, there is a disconnect in her understanding that mom is dying, and that the way to make in less painful FOR MOM is to get her on morphine BEFORE her lungs start filling with fluid. So, I get that there are lots of posters here know that their parents are dying, but who don't see that morphine might be a friend in the end.

They used to just show rosey pictures of childbirth, too. Life, death, birth; they are all messy and painful. I'm all for making things better through science.
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I don't think there is any easy way to die unless you are lucky enough to die in your sleep.

When my Mom was in the hospital during her last days I was amazed how a person could linger for so many days without food or water. As was explained to us if they gave her fluids she would be like a bag of water cause her kidneys were shutting down. She could not swallow and her living will had specified no feeding tubes or any artificial means to keep her alive.

So it seemed cruel and inhumane not giving her food or even water but what was the alternative. The morphine was probably the most humane thing they did give her at that point. At least she was not aware that she was starving.

I think it was harder on the people who loved her than it was on her. When deciding what to do for our loved ones maybe thats something to keep in mind.
What would you want if you were them, not what you want.
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