Are terminal patients given IV hydration in hospice. or are...
Answers
People may or may not get IV fluids during hospice carefor cancer. Although it's important to keep a person reasonably hydrated during this last period of their lives, often terminally ill people find IV's uncomfortable and bothersome. For this reason, many hospice providers prefer to try to hydrate the person orally; even swabbing the mouth with a damp sponge can help keep a dying person comfortable.
Research studies on IV hydration at the end of life have shown mixed results. In some studies, no benefit was found. In others, IV hydration did help reduce delirium and other discomfort.
In the end, the best care plan recognizes that every decision has benefits and burdens. Hospice care plans should be individualized, based on the dying person's preferences and medical situation. Often a little trial and error is also needed, to figure out what keeps the person with cancer most comfortable.
My son had terminal cancer and died at the Hospice House. Right before he died he drank 5 cups of water. That was the only thing that he was able to keep down in over a week. Did not help any but it made him happy and that was all that we cared about at the moment.
One reason we did not force fluids on hospice patients was because as their system was shutting down the need for fluids decreased dramatically. Our policy was to give fluids as desired and to swab mouth frequently for comfort. It is difficult for family members to not feed or hydrate their loved ones and we worked very hard to help them through the process and keep the patient as comfortable as possible.
Human life requires water,if the patient makes the choice not to have an IV,then and only then should fluids be given by mouth.It should never be a policy to administer fluids one way.Every end life patient has his or hers differences in what they want if they are able to communicate,this is one reason why health directives are so important to have before we may become unable to communicate on our own.
sometimes it seems wrong not to give the person a iv. It is a very hard process to watch someone you loved die, my mother was in hospice for 3 long weeks before she died, miss her dearly but mostly hope she forgives.
My mom was on hospice care. They advised me to stop swabbing her mouth during the last 48 hours as this would be harming her. Thus the agony of being unable to do more left it's mark on me. I will carry this until the day I face my own end life.
As a Hospice nurse for 12 years, I am not surprised by the previous answers. Our policy is to do what the patient and/or family want. We do provide education that at the very end of life, as the rest of the body begins to shut down, so do the kidneys. Any fluid intake may increase nausea, vomiting, and diarrhea. It may cause fluid in the tissues which make people more prone to bedsores. It may cause fluid in the lungs which may cause difficulty breathing. It may cause saliva which a dying person cannot swallow so their respirations sound like blowing air through a straw into a glass of water. That is pretty disconcerting to family members. Nature's process of a 'dry' death is usually more comfortable. Dehydration causes endorphins to be released in the brain which produces a natural pain relief and euphoria. IV fluids prevent that natural comforting process. IV fluids do not relieve the experience of a dry mouth as well as gentle moist swabbing does. The dry mouth is what causes most people to feel uncomfortable. It is easily relieved with a sensitive loving touch with a moist swab-unless the patient has a sore mouth or some other reason to not want the swab. Because of our medical culture, however, people think the natural 'dry' death is uncomfortable and we sometimes cannot educate people away from that. In that case, we provide the IV fluids rather than have the loved ones suffer. In EVERY case so far, however, the loved ones see the discomfort that the IVs cause and have us stop them. I am sorry for the expressed dissatisfaction with Hospice. Our team does everything we possibly can for the patient and family to have the best experience possible during such a time as this. We are truly grieved when we have patients/families unhappy with our services. We do our very best to honor the wishes of the patient and loved one whether we agree with those wishes or not. That is what death with dignity is about--having your wishes honored.
My sister recently died in Hospice. It caused me to raise many questions. She was diagnosed with cancer. She refused blood, so her doctor "suggested" Hospice. Her religion (power of attorney) "handled" everything with the doctors. They removed ALL her other medications, even her C-PAP. (Said she wasn't a candidate for treatments.) With the new "Healthcare" Reform to Socialized Medicine "push" (Note the Caduseus "Serpent" Symbol?) - I find Hospice "law" (or lack of) very dangerous, as "legalized Genocide". Why was Jack Kevorkian imprisoned but religious and medical Organizations/Government (Legalized "Drug(gery)" Cartel ) not questioned, and allowed ...?
I don't see how a patient is "comfortable" without fluid or oxygen!
Who devised the Hospice idea and rules? I certainly don't think GOD had any part in it!
I was deeply grateful for Hospice care of my husband in his last days. He had suffered so horribly in the hospital for weeks and at the Hospice Center, I could talk to the doctor and the caring nurses and make sure he did not suffer any more. Only one who has watched a loved one suffer with cancer, hear his cries and moans, can understand how much it means to have help from knowledgeable people in those last days. I asked for the strongest pain medicine possible for my beloved husband of 45 years. I knew he would be unresponsive but I knew he depended on me to do the best for him. That was my final gift to him - a pain free passing with caring people there to help us. Thank God for Hospice and the people who help us through the end of life.
My dad was under the care of Hospice for the last 6 months of his life, he had lung cancer. We were fortunate in being able to have him in our home for the final 3 months, with Hospice staff making regular visits, increasingly so as the end was approaching. My dad kept his oxygen on until moments before his death, though at that point it was doing more for us visually- he was well past the point of it helping him at all. The last week of his life, dad wasn't taking any food, though we did offer him a popsicle, and did good mouthcare, swabbing it, keeping his mouth moist. The gurgling the last few days or so, he was unable to cough and the secretions were laying in the back of his throat, was bad. I questioned the need for suctioning, and was told once we started we'd have to keep doing it, and more frequently so. My family was so impressed with the Hospice team- we already had my mom in the nursing home with dementia, so it was good we had the option of not sending him there as well.
My 94 y.o. mother was in hospice for the last 2 1/2 weeks of her life. She had been refusing to eat or drink most of what she was offered at the hospital after surgery. The 'social worker' was under pressure to discharge her, so began contacting nursing homes -- which was NOT what Mom wanted, and what we knew would only prolong the end -- feeding line, little mobility, repeated bouts of pneumonia, etc. could be expected for the next 6 months. Her doctor agreed that hospice would be the most merciful choice, as she hated being pressured to take meds, eat, drink -- anything by mouth. We found a hospice in Connecticut, not far from where we grew up, and they were wonderful. While they said she might even recover in that atmosphere, they never gave us false hope. The answer from the Anonymous hospice nurse above was even more comprehensive than what we were told, but overall they provided excellent care & support -- for Mom and for us. If I had to die & couldn't be at home, I'd head there.
I lost my sister from stomach cancer in hospice. If her caregivers had been communicative, I would have understood why they stopped hydrating her, but no one ever explained what was happening. Because of this horrible experience, I dislike hospice care. It seemed cruel and uncaring, like they were trying to hurry up her death.
took care of my father at home...stomach and liver cancer...dads doctor ordered LIPIDS via an IV and since I was a nurse, I did his care. Whether it helped or not, ? but he was comfortable when he passed away....and I found it was also comforting for my mother to see this IV as dad completely stopped his intake of fluids.
My mother was under Hospice, and I am so thankful for the care and compassion that they gave my mother and myself, which I was her caregiver. They were there for me whenever I needed anything, My mother had pancreatic cancer and was 85 yrs. old, she never suffered one day under their care, she was at home , I cannot say enough about the care that she received during the last hours of her life. Now we found out in July that my only sister is in stage 4 lung cancer, and we will be under Hospice again.
I'm a Dietitian that has worked in Hospice for the past 9 years who works with patients and their families who are have difficulty with abilitly to eat and drink or with ability to tolerate tube feedings and hydration. There are no clear rules we use in the program and we listen to the patient and family wishes. However, our experience and a growing body of research does show that during extended disease and at the end of life that the body's need for for food and water declines and in most cases it's ability to use or even tolerate nutrition and hydration declines also. It is true that in some cases IV hydration may improve some symptoms such as confusion, but in the majority of cases it contributes to other symptoms such as edema, congestion, nausea, secretions that are aspirated, more frequent urination and bowel movements that require care. All of these can contribute to the patient's discomfort or what is referred to as the "burden" of continued oral intake, tube feedings, or IV hydration. Rarely does our medical team dictate what the patients and their families must do. Instead, we educate and work with them helping them through a difficult time and in making tough choices. IV's can be stopped to see if there is less congestion, tube feeding rates can be reduced, oral feeding and drinking can be limited to when the patient asks, and mouth care can be provided. I continue to be amazed how simple changes can provide such comfort and so quickly. I also understand how difficcult it is to accept that someone is approaching the end of life and try to help them understand that food and water at some point does not help and can hurt. It is the disease process that causes death, not lack of food or water.
When my Mom passed 27 years ago, we did not know about Hospise.We watched her suffer for 36 days. It was horrible to not be able to help or comfort her. My Dad passed 2 1/2 years ago. He had hospise. They were amazing,caring people. We got thru those final days with someone there that walked us thru what to expect and how to make Dad comfortable. As said above,watching a loved one die is not an easy task. Having someone there to stand beside you is a true blessing...
My dad is dieing of lung cancer at home right now. He is on an IV but we really had to fight for it. Without the IV he vomits and can not keep liquids down. He has no edema, fluid on the lungs, or other side effects from the I.V. None the less we get constant pressure from hospice workers to remove the IV because we are told that a dry death is better. I really appreciate everything that hospice is providing but I just can not help and wonder why so much pressure to get rid of the IV when it seems to be helping his quality of life and so far there are no negative side effects. The cynical part of me can not help but wonder if Medicare does not want to pay for a registered nurse to come check on the IV every day which is what needs to happen when you have an IV at home. Without the IV a registered nurse would only come twice a week instead of every day.
I took care of both my father and my mother with the help of hospice. I'm a complete chicken when it comes to anything medical, and would never have made it without hospice.
When the hospice nurse explained how the body starts shutting down towards the end of a terminal illness, I had to put my head down on my knees to keep from fainting.
My mother, however, chose to decline food and water. I had an extremely hard time with her decision. It just seemed wrong to me at every level. However, she asked me to support her, and let her die peacefully at home. So I agreed.
She stopped eating anything at all, and her nausea went away, and her stomach quit hurting. She didn't drink water, although I got a little spray bottle at the drug store and sprayed her mouth and lips frequently. During this time, she did get drops by mouth of a pain killer, so she felt fine. She even went out and planted bulbs for spring, and gardened.
It took 16 days before she died, peacefully in the evening. It was not awful at all, in fact, those last days were very pleasant.
I do think each patient and family should make their own choices, and certainly feel free to change them at anytime should the patient become uncomfortable.
Good luck and hugs to anyone here going through this experience.
Thank you to all who contributed to this discussion. It is so good to know we are not alone, and you have given such helpful insights.
Our elder relative is in the hospital right now in what we have been told is a terminal condition after suffering a major stroke. When we came to visit, we wondered why no I.V. was hooked up. He is obviously thirsty because he touches his mouth with his one working hand. He can not communicate verbally, but did smile and did squeeze our hands.
His quality of life has been declining in recent months, and he may have felt like a burden to his family. Once he and I were talking about anti-aging health supplements like biocritical priora, and he said he wasn't really interested because he was "ready to go". On the other hand, he was playing table tennis just a few days ago!
The family has been preparing, at least mentally, for his imminent passing over the last few years. They threw parties and special ceremonies to make him feel appreciated and much loved. It is difficult to accept the idea that it is now best for him to die as quickly as possible, as in a matter of days.
If I were his primary caregiver, I would give him water, and food and whatever comforts I could provide, and try to make him feel that it is a welcome burden, even a privilege. Still I am not in their shoes, and don't feel I have the right to judge, or tell his immediate family members what to do. God bless them in this difficult time.
My mother was on hospice and we fired them. She had scabies almost the whole time they were involved with her care at the nuresing home ,over half a year. Comfort care ??????
I'm undecided about IV hydration for a hospice patient. My mother just passed away on Nov. 19, 2012 in hospice care. We we told that their policy was not to give IV hydration, as that prolonged the process and added to the patient's discomfort. With this approach we were told that patients typically passed within 3-5 days. Hmmm.... We were also told that if the patient requested food or water that they would not be denied. We bought in to the approach - what did we know? Trouble is, with significant amounts of pain meds the patient is so drugged-up and sleepy, they have no desire or ability to eat, drink, or communicate. Mom entered hospice urgently via the ER, as her condition deteriorated rapidly and sooner than expected. My father was very distressed that she did not have hydration - thinking it inhumane. I'm not sure he was wrong. Mom was not comfortable in any sense of that word. Yes, we swabbed her mouth and applied moisturizing ointment. Though she didn't have edema, her breathing was horrendous, labored to the extreme, and eventually hampered further by secretions too deep in her throat to suction effectively. She also had a very high fever which caused her considerable discomfort - unrelieved by Tylenol & aspirin. Would hydration have offered some relief? It seems reasonable to think so, but the hospice doctor was no where to be found for a full three days! The nursing staff was supposed to be hospice trained, but only 1 nurse actually was a hospice nurse in this small town hospital with 4 hospice beds. The real hospice nurse was an angel - just knowing how to position my mother in bed provided instant and noticeable relief of her labored breathing - she was clearly more comfortable. That is, until the regular nursing staff changed shifts - they made a mess of things, and only entered the hospice room when a family member reminded them that it was time for meds, or requested their attention for some other matter - the fever, my mother's drenched clothing and sheets which made her shiver uncontrollably, or her increased nausea or pain. After witnessing her decline over 4 days, she passed within the estimated time frame. We were assured that the fever/chills, and the awful gurgling noises from the secretions in my mother's throat sounded worse than they felt. Really? I don't know about you, but when I've had the flu/respiratory infection the fever makes my whole body ache, the chills make my whole body tremble, impossilbe to get warm, and the excess phlegm in my throat makes me choke and makes it difficult to breathe. All very uncomfortable. Where do they get this stuff? How do they know these symptoms are not uncomfortable? Have the doc's and nurses experienced the dying process and come back to make a report? That said, my mother could not have remained at home as she wanted - her condition could not be managed properly or safely at home. It's not always easy or peaceful to die at home - for the patient or the caregivers. I have to wonder if some administrator sitting at a desk crunching numbers thinks it's best to have the no hydration policy because it's more expedient, requires less nursing care, and therefore, more cost effective for the facility. I've heard of positive hospice stories, but I would caution that not all hospice's are created equal. Mom suffered greatly at home. It seems that she suffered less in hospice, but she was definitely NOT comfortable. If there's time, do your homework, ask questions, visit the facility, and make sure that ALL of the nurses are hospice trained, and that there is a doctor available to make necessary changes in meds. God bless my poor little broken mommy, and God bless your loved ones, too.
I'm sorry for the loss of your mom. It sounds like it was very hard for you and your father to witness. Sometimes I think it is more difficult for the family than the patient.
As I mentioned above, I took care of my mother at home, with the aid of hospice, and my mother did not look comfortable at all. But luckily she was conscious the whole 16 days that she refused food or hydration, and I asked her constantly, and she always stated that she felt fine, up to the last hour she was alive. Then she slipped into sleep and stopped breathing. Of course, she was on a prescribed medication, some kind of morphine that I gave her by drips in her mouth. So that may have been what kept her feeling comfortable, even though by outward appearance it seemed to me that she wasn't.
You did the best that you knew for your mom. That's all most of us can do. I hope you will have peace about it.
Hospice care has done wonders for our family, they are here for the dying patient and the family. They are here for comfort and pain controll, and support. they follow all the wishes of patient and family. I am typing this now as my mother in law lays dying in her bed under hospice care, she has stage for lung cancer, Hospice has helped us so much but if a dying patient has wishes hospice respects them and that is the most important thing. I feel for everyone who has had a bad experience but wishes must be respected. jack kavorkin injected dying people with a drug to stop their hearts at the patients request ( that should have respected), try watching a person who cant tell you were they hurt, they cant talk, they dont eat or drink, moans everytime they are moved or breath- its horriable. you are so helpless, you just want the pain they are in to go away, thats what hospice does- the control the pain and comfort. I wish they could do what jack kavorkin did so loved ones didnt have to go thru this. As long as its their wish I see nothing wrong with it- do you think your loved one wants you to see them like this? do you think they want to feel that ? nobody would want someone to go thru this. thank you hospice of west michigan you guys have been great and we cannot thank you enough for what you have done. god bless you all
Dear jonaL,
I'm not sure when you wrote your comment about who comes up with the hospice rules. Hospice has undergone lots of changes (and also some marketing techniques) during the past years. There are some hospices who remain true to the original mission, but you have to be careful.
You could check out the federal government pfd file - gpo.gov - dated June 5, 2008 - conditions and rules that hospices must meet in order to get the Medicare and Medicaid federal dollars. They oversee the hospice industry (which is where hospices get a big chunk of their $$ - along with private donations.)
To give you an idea of the true mission of hospice please check out hospicepatients.org -- they have a wonderful website.
"The Constitution of our nation is firmly based upon respect for the sanctity of life, the liberty to live in freedom until a natural death occurs in its own timing." -- quote from Ron Panzer, Founder, Hospice Patients Alliance
My mother had lung cancer and was on hospice care living at home. She was admitted into the hospital part of hospice when she had uncontrollable bowel movements due to too much morphine at home .( Still a lose dose though). Doctors controlled her bowel movements which went back to normal one day later in the hospital. They then started adminstering much more powerful doses of morphine that she didnt need. Because she was not awake much of the time because of the morphine she stopped eating and drinking. I couldnt understand why they had given her a higher dose at hospital when she was fine with lower dose at home. She died 6 days later at hospital because she was not conscious enough to take in any nutrients. When she was briefly awake the nurse said dont feed her because you are feeding the cancer. She also was able to drink water and had no fluid on lungs . Her husband didnt want to give her water either. Between the negligence from hospice and her husband Im not sure whos worse.
My father had stage 4 pancreatic cancer and then he had a stroke. The stroke left him where he could not eat or drink. He was on a IV drip in the hospital and then they kicked him out after about 3 days. My mother sent him to hospice. They took out his IV and he was left to starve and die not from the cancer but from starvation. Yes, it is just another name for assisted suicide. I hope this helps others see hospice for what it is! Cheep and it kills fast. It has nothing to do with dying pain free... come on it is all about money and getting them to die quickly, so that the bed can get another body in it! So sad, that America is so screwed up that people actually fall for this
People died for thousands of years without artificial nutrition/hydration. Just in the last 60-70 years have we felt the need to put in IVs and tubes into the stomach to prolong what can be an agonizing process. The natural process can be so much more peaceful and comfortable. Each hospice, each physician, nurse, aide, chaplain, social worker is different. Hard to generalize effectively. One thing certain is death, no matter how hard we fight it, no matter how many tests, xrays, surgeries, drugs, we are still going to die. We can be tested, drugged, cut upon, etc. to the bitter end--to the point we can no longer even make our own decisions; or we can choose to die with dignity when we still can, before others are put in the position of feeling it necessary to prolong our agony at all costs. We can win awards for "fighting the good fight", but, really, is it worth it? Really seems kind of crazy.
