Hospice

[mia]

My Father has been in hospice since Thursday. It was prescribed for him 2 and a half years ago and we said no. He has been living happily with my mother until now. Last night they started giving him morphine. Does anyone have experience with this?

[pipoman]

1. My mother and my sister...

Sorry....

[Person 2713]

2. It was the best place for my mother and offered a lot of support

[PoliticAverse]

3. Depends on the individual situation/prognosis. See if you can get answers from those in charge

of his care. Best wishes to you and him.

[NRaleighLiberal]

4. My dad, my wife's dad both benefited incredibly from hospice.

Can't recommend it enough for leaving this life with grace. I think the experience does vary state to state, however.

[msongs]

5. my dad chose hospice near the end of his life. it was...a good experience, if anything about that

can be called good.

cyber hugs for you and your dad

[Thinkingabout]

6. Hospice provides assistance with the patient and also supports the family.

Morphine helps to curb the pain and relaxes the death struggles. Personal experience has given the last days with dignity and stops the last struggles making it easier on the patient and surely the family. Hospice can advise the family of what is occurring and usually there will be a change in breathing pattern in the last 24 hours. It can also be a time to say your goodbyes, the best advice I received from my mothers doctor. I wish you the best at this time.

[Iris]

14. ^this. exactly this^

The hospice workers were a godsend when my mother-in-law died.

[Thinkingabout]

15. Very special and lots of compassion

[840high]

22. To my Dad, too.

[DesertFlower]

7. my husband passed peacefully in hospice.

some of his co-workers were upset because they didn't wake him to feed him or give him water. i tried to explain how hospice works. they're not going to keep you alive. their goal is to keep you comfortable. my husband was given morphine.

[WinkyDink]

39. Same with my husband, last year. But I've had second thoughts often since.

[DesertFlower]

47. second thoughts about what?

[Nite Owl]

8. My mom had hospice

but at home. She wanted to die inher own bed. Hospice nurses visited her
several times a week or more often if she wanted it. They gave her meds including morphine.
It worked out well for all of us.
I wish you and all your family much peace. The hospice nurses are kind and loving people, your Dad will be in good hands.

[Quayblue]

9. my Mother

This is a journey you all should have in love and togetherness.

She ended on the fentanyl patch and I won't say much else about it.

Peace and Love to you and yours.

[GP6971]

10. Yes

My wife entered in home Hospice for the last 6 weeks of her life. They were incredible in providing support for her and me.....no stone left unturned.

The morphine eases the pain as the organs begin to shut down.......sorry to be blunt, but that's what happens. The morphine let her go into a gentle and comfortable coma and she passed peacefully.

She had a living will and medical POA which in many ways made the decision process much easier for the survivor. I highly recommend everyone having one.

I'm sincerely sorry you are going through this. To say the least, it's not easy.

[HappyPlace]

11. My mom. Love to you and yours, mia.

I hope you will all be as at peace as our family was.

[BigDemVoter]

12. Yes.

Morphine will provide good relief from pain and also will help with anxiety. If he has breathing problems, it an ease breathing or at least make it seem easier. It's not a bad way to go at all. When it's my time, I hope I'm lucky enough to go that way.

[Gormy Cuss]

13. Hospice is the best way to go for the last few months of life.

It sounds like he may be at that stage now, where palliative care is all that matters. My mother had hospice care -- it was all about balancing pain management against quality of life. If the hospice is doing this it is absolutely the best thing for a dying person.

[Juicy_Bellows]

16. Living it with you. My dad as well.

I knew clicking on the thread was going to mess me up and it did.... peace be with you and yours.

[GP6971]

17. Hang in there

All of us survivors do.....just takes time.

[Juicy_Bellows]

33. Thank you. Doing my our best. nt.

[Kali]

18. yes

let them help, it can make his passing an event that is peaceful and loving

[GP6971]

19. True words

Thank you.

[GP6971]

20. Can All the responders kick this thread?

End of life issues are very hard and there is a lot of great information here that will help people.

Thanks

[MADem]

28. +1. nt

[GP6971]

50. Thank you !!

[MADem]

57. Here's another kick; input on this kind of thing is always helpful, I think.

There are a lot of thoughtful posts in this thread. Hope they help.

[mia]

63. Thank you.

The posts in this thread have been so helpful for me.

[MADem]

65. My cousin lost his partner after a long battle with brain cancer.

The poor guy had the same thing that took Teddy K. Fought a mighty battle, too.

Hospice was invaluable at the end. My cuz can't say enough about how much they helped.

[Agschmid]

40. Kick.

[GP6971]

51. Thanks for the kick!!

[greatlaurel]

21. We went through this with my mother. She was able to stay in her home with hospice help.

My sister-in-law was an even greater help. She knew how to give the pain tablets rectally from her experience with her mother. Both dear ladies died of cancers and had a great deal of trouble holding anything down due to the nausea.

Anyway, my mother found some of the hospice workers to be unpleasant and even a little ghoulish. She could not rest while they were in the house. She could not speak any more but kept kicking her leg until my sister caught on(such a smart woman). We told them to leave and not come back. My mother was much happier after that. There was an aid who she felt comfortable with so we had help without having to keep the unpleasant ladies around. My suggestion is to keep an eye out to see if your dad finds any of the hospice people difficult and keep them away from him. Be sure to check the nonverbal signs to make sure he is resting comfortably and is not troubled by the presence of any of the staff.

The hospice brought her oxygen toward the end just so she did not have to struggle to breathe, which is really unpleasant. They were able to provide that as a palliative not as a life extending effort, I think. It has been nearly 20 years, so the details are starting to blur a little.

It is such a difficult thing to loose a loved one. Please accept my sympathy for this difficult passage. Be sure to take of yourself and be gentle with yourself, too. It is taxing physically and mentally.

Take care.

[Hekate]

23. Kicked

Peace be with you and your family.

[MiniMe]

24. My mother

She did fine at home with Hospice visiting, but toward the end, we couldn't control her pain, even with the morphine. They admitted her to the hospice facility. I would have brought her home if they could have controlled her pain, or if they had a way for me to control it at home. At the end, her pain was quite obvious to me. The Hospice was wonderful, the nurses were great and very helpful.

I don't want to ask you personal questions, but why was he prescribed hospice 2 1/2 years ago? Usually they don't put somebody in hospice unless they think they will be passing away in less than 6 months.

I'm sorry you are going through this. The last time my mom was in the hospital, I asked about hospice care when she was in full control of her mind. She agreed. Mom didn't seem to be in much pain until close to the end, she knew the cancer was going to get her, she just wanted to be kept comfortable.

[Maru Kitteh]

25. I am a hospice nurse

You are welcome to PM me any time if you like.

[Sissyk]

34. Bless you! n/t

[avaistheone1]

58. The kindness of DU members like you is truly inspiring.

[Binkie The Clown]

26. My father, then my aunt, then my wife.

It's a time to make peace with the inevitable. Remember that in hospice there are no emergencies. We all must leave this life, and hospice is a good way to take that leave.

[onecaliberal]

27. FIL was on home hospice.

He was given morphine. After a few days he slipped peacefully into a coma and passed gently. The hospice nurses were fantastic. We also had a family friend who is a CNA that was able to administer the med.

[Blus4u]

29. Kicked for the merciful angels

Peace for your father.

[mia]

30. Thank you to all of the angels here who have shared their experiences.

I feel more peace as this new day begins. I will be seeing my father again this morning.

[Siwsan]

31. My father was in hospice, my sister and mother had at home hospice

I have nothing but high praise for everyone we encountered. We spent every minute with my father, while he was in a hospice facility. They fed us and kept us completely informed of everything that was happening. The at home hospice experience was equally caring. I don't know how we would have gotten through these incredibly emotionally draining times, without them.

My thoughts will be with you.

[a kennedy]

32. My brother was the first hospice patient when it was first talked about in 1980......

our family had a whole wing of a hospital for this purpose. My brother died of melanoma on December 23rd 1980., and the hospice experience made it possible. Prayers and thoughts go out to you and your family.

[hatrack]

35. My Dad, 18 months ago

1. Is home hospice care an option? W/O knowledge of his household and medical circumstances, it's hard to say. That said, the in-home service we got was just first-rate, and Dad didn't end up in some hospital room for the last two weeks of his life. He his had family, and his cat, and his books, and I think that really made things easier for him.

2. Get to know your hospice nurses - as was posted above, there may be some that you (or more importantly, your Dad) don't really get along with. If he does have staff preferences, be sure to let the hospice agency know.

3. Know the drug side effects - Morphine may induce strange and vivid dreams, or visual/auditory hallucinations with some patients. Be aware that if his behavior seems to be getting really weird, there's a good chance it's the drug talking.

4. Make sure that paperwork and medical/legal issues are settled to match your father's wishes. If there's a DNR (assuming he doesn't want extraordinary means taken), make sure it's signed and that hospice staff know about it. This wasn't an issue for us, luckily, but my brother's seen plenty of knock-down drag-outs between family members when patient preferences were not clear during the end stages, and where there was no DNR/Advance Directive.

I really hope you get through this OK. It was really hard, and I still miss him every day, but the fact that I was able to be there, and able to help out when he really needed it the most meant a great deal to me.

[onethatcares]

36. my heart to yours

I wish you strength. I have no more words

[gvstn]

37. I have experience with in-home hospice which is different than in hospital.

With in home you may like some nurses/aides and not be so fond of others. In hospital you probably don't see everything of the interactions between your loved one and the aides/nurses.

Once you fully accept that hospice care is only palliative it gets easier. We all want to "save" our loved one up to the last minute but hospice is about saving them from pain or suffering.

Morphine is usually used to make breathing more comfortable. If your father is struggling to breath the morphine eases that fear response but will not cause him to stop breathing it actually helps make it easier to breathe.

I wish you and your family strength and peace. My mother died this Spring and I am not handling it well even 6 months later. I cared for my mother for several years full time and now that she is gone it is difficult to redefine myself. Be patient with yourself and your emotions.

[WinkyDink]

38. Yes. All I'm going to say is...please read these articles on how hospitals are PUSHING hospice care

on Medicare patients.

Last year, my husband died within two weeks, with "nil by mouth."

THIS year, I REFUSED IT for my 91-year-old mother.

http://www.washingtonpost.com/business/economy/medicare-rules-create-a-booming-business-in-hospice-care-for-people-who-arent-dying/2013/12/26/4ff75bbe-68c9-11e3-ae56-22de072140a2_story.html
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"Another stumbling block is the Medicare requirement that patients “give up” curative care when they enter hospice if Medicare is paying the bill. Considering that Medicare pays for 84% of hospice care, this is a significant issue. Micromanaging care based on payment takes precedence over common sense of what is right for the patient. ".....

"Hospice is paid a flat fee per day for the care they provide. The incentive is totally opposite fee for service – the less they do, the higher their profit. This is the reason some hospice organizations will not provide certain services."

"And finally… who can really tell if you have less than six months to live?

Verification that you are going to die in less than six months is a requirement to enter hospice. Physicians are thankfully moving away from the “God” complex and it is unfortunate they are still asked to play that role in making predictions on life expectancy. This requirement delays care that could help people live longer and more comfortably."
Forbes: http://www.forbes.com/sites/carolynmcclanahan/2013/01/19/time-for-a-shakeup-in-hospice-care/
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Lastly, this article from the JAMA:
http://healthleadersmedia.com/content/QUA-292985/Hospitals-Fear-of-30Day-Penalties-May-Speed-Hospice-Admissions

An" exception to federal 30-day mortality measures may incent hospitals to prematurely push patients into hospice care, says one critic, who calls it an unintended consequence of healthcare reform.

To avoid 30-day mortality penalties, hospital clinicians are aggressively steering newly admitted patients into hospice rather than usual inpatient services if they are at high risk of dying soon."
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

BTW: I have nothing but praise for the hospice nurses who helped my husband in his final days.

[pnwmom]

41. Just to clarify -- patients don't have to give up all curative care to qualify for hospice.

Just curative care for their terminal illness.

My mother in law was in hospice for the last six months of her life. She stopped receiving treatment for her breast cancer, and had palliative care instead. But when she developed a UTI they treated that and cured it. The point of hospice is to relieve pain, not worsen it.

[WinkyDink]

45. I think that depends on the facility. I know a return to the hospital proper was out of the question

for my husband.

But hey---they were literally starving him, so why bother treating a UTI then, had he acquired one?

[pnwmom]

46. Every situation is different.

In the case of my MIL, hospice allowed her to live a fairly active last 6 months. She had the pain medication she needed, and she did pretty well till the last three weeks, when she was bedridden and slept most of the time because of the high doses of narcotics she needed then.

She had the UTI in the first month or so, and UTI's can be extremely painful. Also, her UTI could have led to a kidney infection and killed her quickly, if untreated. The point of hospice isn't to kill as fast as possible, but to allow someone with a terminal illness to spend their last months or days with as much comfort and dignity as possible.

Legally, the issue of "curative care" doesn't depend on the facility. The Medicare law is the same everywhere. But the best decision for any individual patient depends on his or her individual situation. In a cancer patient, for example, a decision could be made not to treat an aneurysm -- but that doesn't mean they wouldn't treat a UTI.

[mia]

60. Thank you for these articles.

They explained a lot of questions and suspicions that I've had difficulty speaking about. I've passed the articles on to friends and family members.

[hunter]

42. My hundred year old plus great aunt lived in her home until she died, with powerful pain meds.

Her family enabled that.

Her bones and organs were disintegrating.

She was telling her stories until she was gone.

[Stellar]

43. I've been through that with my dad.

Morphine helps with the pain. My HEART, to you and your family.

[MerryBlooms]

44. Almost 14 years ago, I lost my first husband to cancer

He was diagnosed with ocular melanoma that September and his left eye was removed... the cancer had metastasized to his spine, liver and spleen by November, and we were told to make sure our affairs were in order. He died January 14th. I took leave from my job to care for him in our home with hospice a three-time-a-week hospice nurse. I kept a meticulous diary... when I say meticulous, Not just medication, but I mean down to every bite of food, description of bowel movements... together, she and I kept my husband's pain level at a point where he was comfortable, and still recognized me and our teen sons.

It was an honor and a blessing to be in the position to stay home and care for him. Hospice nurses... if one believes in angels...

[Skittles]

53. you sound like an angel yourself, MerryBlooms

yes indeed

[MerryBlooms]

61. .

[vankuria]

48. My dad 12 years ago

he was in the hospital and wanted to die at home so we brought him home and enlisted Hospice. He went pretty quickly once we brought him home, but even for just the week he was home, Hospice was a godsend. They managed his pain and other symptoms he was having and were with us when he passed. My mom and I were so distraught they called the funeral home for us, stayed with us to give us comfort and even washed up my dad and changed his pajama's since he had gotten so sweaty. They even changed the bedding and disposed of his pj's at our request. They stayed with us until my husband and brother came and could not have been more loving and kind.

Your dad is in good hands and I wish him a peaceful passage...my thoughts and prayers are with you.

[smirkymonkey]

49. My 95 year old Grandmother had hospice care in my parents home.

We had all moved out and far away after college, so only came to visit when we were able. However, she seemed very comfortable, well taken care of and pain free. She was dying of a brain tumor and once diagnosed went within 6 months. She wasn't afraid, which I think helped. She was a tough, independent old Welsh woman who had been a lifelong nurse and was very matter-of-fact. She knew what she was facing, which I think helped her endure it.

My mother was a Dean at a medical school so she was able to help as well. My dad was useless, but a good sport. She finally went peacefully after 4 months and my brother was in the room with her when she went. She lived a long, full life and I am glad she went that way instead of in a nursing home. She would have hated that. She was independent as long as she could have been - playing golf, skiing, taking care of others, gardening right up until she was incapacitated. I think hospice helped her feel like she had some dignity until the end. All in all, I think it was a blessing for her and I hope it is for you as well. It helps the dying patient and it also helps the grieving family as well.

Peace be with you and best wishes!

[SheilaT]

52. My in-laws both had

in home hospice, and as others here have all stated from personal experience, it's wonderful.

I'm not sure posting some links to some unethical providers is at all helpful. Although if your father was "prescribed" hospice two and a half years ago and has been doing quite fine until just recently, that original "prescription" sounds off.

The most important thing is that in hospice heroic measures aren't taken, and often people do live longer than they do where everything possible is done, causing pain and distress. Hospice treats people with dignity, eases pain, and usually alleviates a lot of the concerns family members have.

[shenmue]

54. {{{Hugs}}}

[Skittles]

55. my mum died of cancer in hospice

she nixed the home option because she feared my severely autistic brother would not understand

the hospice workers were outstanding

I think she was already in a coma when they started the morphine

[sorefeet]

56. They tried to put my brother

Pinkie in hospice. Brand new facility, he would have been their first customer. Instead I got him to my sister who got him treatment. He bought a little house and raised few pigeons. He lasted for 19 months and hospice came to his house one week before he died. They were absolutely wonderful. Hospice nurses really are your last gift on this planet.

[avaistheone1]

59. Yes.

Bless those nurses, and your brother.

My brother passed a year ago. Unfortunately he never made it to hospice.

[marble falls]

62. My mother just this April. This means that it is thought he is in his last few days....

My experience hospice also includes my grandfather's passing, and I was in a relationship with a wonderful hospice nurse. Hospice is a blessing for you and your father and you needn't be concerned with your father's care.

[dembotoz]

64. Good experience but keep both eyes open

Different types of hospice have different payment so different implications for the estate
Ask ahead of time
In walkers Wisconsin the state is much more interested in cost recovery.
In shows up quite early in the estate paperwork

Mom died last Sept and it was a fascinating process in a Gothic horror novel kind of way
By asking questions Medicare paid for it and the estate process (I am executor) stayed simple

[ladyVet]

66. Peace and strength to you and all his family and friends.

Two of my sisters' MIL, a couple of cousins (so far ) and a work friend have gone through hospice. The work friend was in their facility at the end. I never heard a bad word about any of these experiences, only how wonderful people were.

Our hospice has a lovely facility, on a small piece of wooded land. They serve our county, and I believe the county next to us, since it is very rural. They run a thrift store (used to have a flea market every August, which was super hard for me to attend, due to the heat {nearly had heatstroke the last one I went to, stupid me for not leaving earlier}), which is very nice and all the volunteers are super.