How long does a doctor or other health professional usually wait to give morphine if the patient is not eating or drinking?
How long does a doctor or other health professional usually wait to give morphine if the patient is not eating or drinking?
When someone is not eating or drinking, this is usually a sign that their body is shutting down. If the potential is there that someone is nearing death, I will make sure that they have pain medications ordered so that they will be comfortable. If a person is able to swallow safely, oral medications like Vicodin can be given. However, as time progresses, morphine is one of the best medications for a terminal discomfort. Not only can it help pain, but it can ease breathing, help lessen anxiety, and promote comfort. Not only that, but it comes in many formulations so that we can tailor it to individual patients needs.
The key is not to start it too late, as then the pain can get hard to control. At my facility, we start it as soon as pain or shortness of breath becomes an issue. We initially use very small doses, usually only a couple of milligrams at a time. This usually works quickly, without causing too many side effects.
I have many years of experience with taking care of dying patients. Unless you give someone an overdose, morphine does not hasten death as many people believe. I have seen people on morphine for years who are able to live comfortably. Please discuss any concerns you have about morphine use with the healthcare professionals that are taking care of your loved one. I am sure they will address your concerns.
It depends on the illness and the manner in which the doctor is treating it. My mother was was put on morphine when I signed her up under Hospice. She was in the end stages, and I think that is when it is truly considered. Most patient's pain is managed by Vicodin, but eventually this does not do the job well.
One thing to remember is that morphine will hasten the process of the illness and death.
This issue is something the doctor would go over with you in detail. There are pros and cons to it, but ultimately when they get to this stage, it is heartbreakting to watch them suffer.
My Father's estate was embezzled by a paid home health provider, one that I hired. Dad lived in CA at the time and I was in AZ. This paid care giver became engaged to marry dad, brought in her own attorney, had Dad revoke his POA, his medical care directive, and sign his personal property over to her and her adult children, who were on unemployment at the time. I learned that legal documents prepared on behalf of the Senior are not worth the paper they are written on. They can be revoked with the stroke of a pen, unless you have been deemed incompetent BY THE STATE. Dad had a family trust that was established 10 years prior and it was revoked with one stroke of the pen. The care giver told Dad that I wouldn't allow him to write checks, and that he was signing for a new checking account.
That incident cost Dad over one million dollars and me over $250,000 in legal fees, in addition to 3 years of my business income. It has left Dad penniless, me financially bankrupt, and both emotionally and physically drained. Someone needs to wake up. What is the value of a revocable trust if an elder can sign it away with the persuasion of a home care provider? This is been a costly lesson for me and for Dad. One from which we can not recover.
By the way, this home care provider administered morphine, without consulting me, and at the direction of Hospice, since she was "in the home". I was told by hospice that i was interfering with Dad's care, even though I was his trustee, and his POA and medical care director at the time. I was the one who HIRED Hospice. Dad was poisoned by morphine, and when he began to projectile vomit blood, he was given 24-48 hours to live. This care giver then emailed her new POA to Dad's attorney who in turn called me and APS. I was ordered by the state to file for a guardianship.
Hospice social workers and nurses need to have more PRACTICAL experience before deciding to administer a drug that can kill a senior without the family or POA's approval. Dad is still alive and doing well, but I do not trust Hospice providers.
This care giver was not bondable, but cost me 3 years in court, objecting to my guardianship, stating that I had hired her to murder Dad, but to make him suffer before dying.. Where is the justice in the legal system, and where is the protection for our Seniors? I am disappointed in an elder care system that promotes fraud, disregards trusts, and in a Hospice service that promotes marriage between a Senior that is obviously unable to protect himself and a paid care giver 30 years his junior. I have lost all faith in the elder care system. I think it's time for these young social workers to get some experience before instigating corruption to the very people they were hired to assist.
Hospice helped my mother through her final days. They managed her pain medication with grace and care.
I was with my mother most every day and sometimes in the wee hours of the morning. When I wasn't with her, my sister or brother was. We were beside our mother's bed. We talked to the doctor often. We talked to staff. (DAILY). We talked to nurses. (DAILY). We talked to our mother. (DAILY). Communication was on-going. We worked as a team on our mother's behalf. Bottom line. We wanted the best for our mother. We didn't want her to be alone. We didn't want her to suffer any more.
It was not until Hospice came in.... that my mother was FINALLY without pain. Other patients would say, "I wonder when that baby is going to stop crying."
The administering of morphine brought her comfort. It did not kill her, but eased her into her next passage, i.e., death.
Vigilance and being 'on top' of all that goes on is extremely important.
Elder care is available for guidance, but the big job is the full responsibility of the family member (s).
I'm sorry you had such difficulty. It's unfortunate you had distance between the two of you and too bad you could not have been physically present to the extent you could have fired the caregiver and hired somebody else.
Obviously, very complicated. I hope you let things go and heal. Go forward with your own life as it's all you've got. Good luck.
When my mother-in-law became bedridden, that was the day she stopped eating. Two days later, she could no longer swallow teaspoons of liquid and her toleration for the pain she was in also ended the same day. The hospice nurse (who was in my house every day)and doctor, along with the primary care doctor and myself, decided it was time to put her on morphine. Before then, she had been on methadone for many months and for the most part, was relatively pain free, as far as we could tell. However, once she became bedridden and completely stopped eating, it was clear that the end was very close. Her ability to mask her pain was no longer there and it was obvious that the methadone was not going to be of any use any longer. She immediately responded to the morphine and for the next 6 days, mostly in a deep sleep, she was as comfortable as we could possibly make her. I think it was more the amount of pain and the degree of discomfort that she was in than the fact that she had stopped eating that was the catalyst for putting her on the morphine. I hope this answers your question. Prayers and thoughts are with you.
I just need to get off these meds
I acted as caregiver for my mom who had been entered into hospice care when I took over her care,and for a sister in law a few years later. Both were under the care of hospice and both were given morphine. A dear friend of mine was also under the care of hospice and provided morphine for pain. All are now deceased. What I learned from my experiences with hospice is that they are an organization who's focus is on providing comfort to those who are terminally ill, So that when a patient is assigned to them for services,if they do not protest any of the nurses, doctors or aids recommendations, then everything will go smoothly along the lines that hospice plots for the patient, and that is ultimately the administration of morphine,and/or other drugs and the death of the patient. You will not have problems with hospice unless you run awry of their reommended services, that is go against giving drugs and you will get an argument, and more than that if you push it.
If the patient has family and other individuals that are clearly commited to the care of their loved one, hospice does not take such a strong stance against family if they disagree with any recommended hospice practices. If the patient is of the mind that they aren't ready to meet their maker, and don't want to take drugs, they may be met with some resistance, but no one is forced to accept their services, and if their protestations are strong enough they will be heard and released from Hospice services. I was told that one can go in and out of hospice care as often as neccessary, Beiing signed up for hospice care is not a death sentence, everyone that goes in for care does not die. And if you think you'd like to try some other type of treatment you are certainly free to do so.
I met a lady who had throat cancer and gone through chemo and all of the rest of the tortures that cancer patients must endure, to go into remission and then contract cancer elsewhere in her body. She was eventually sent to hospice care and given the morphine, which she said only had her sleep all day for days at a time, and that she had to get off of the drugs becuae they were killing her. So she did, that was three years ago, and she is still with us. I believe that how you feel about your ailment has a lot to do with its effect on you. So make up your mind to get off the meds if thats what you want to do. Acupuncture works real well for pain.
Mt brother had been sick for about 3 weeks and in the hospital. They said he would most likely not live thru the night but he did, the dr encouraged me to call in hospice. We had them for a day ro two in hte hospital, but he wanted to return to the nursing home where he lived, so hospice signed him off their service. He got sicker the second day back at the nursing home and hospice was called back in. They immediately gave him morphine and some pain med that started with an L. They were giving it pretty quick, seemed like maybe each 2 hours. I left as it got later in the evening (oh how I wish I had stayed longer) andhe was dead before 7 AM. I do believe he was given too much morphine along with the L pain med. I had no idea he was gonna go that quick or I would not have agreed and I would have stayed with him longer, not allow him to die alone with no family there. I had great thoughts of Hospice before, now I am not so sure I would want them for another family member.
Until I saw first hand how Hospice works with Morphine I never would have believed it was legal.
I don't think Hospice programs differentiate who their patient's are. When they came in for my father with Dementia/Alzheimer's they arrived with a "comfort package". Haldol, morphine, ativan.. and they wanted us to give it all to him to "keep him comfortable". He wasn't ever in pain and I don't get it. I wouldn't let them give this stuff out like candy. One time they have him haldol and he had an EPS reaction. Great. 85 year old with Alzheimer's dying and they want to medicate him to death. I have heard families say they gave the morphine more than they needed to make sure the person was comfortable. Isn't that a mercy killing? What happened to dealing with the death process with dignity and respect. K
They did the same thing to my mom. When I was asked about my mom going into Hospice, I was told only that they would be an extra set of eyes and ears for her care. Instead, the first act they did was to remove her IV's, including a basic saline drip to keep her hydrated. When I protested, the Hopsice "nurse" told me that "there can be problems with too much hydration." When I said there can also be problems with NO hydration, she begrudgingly started the IV. But when I couldn't awaken my mom the next morning to feed her breakfast, I checked her meds and found to my disbelief the so-called nurse had given her haldol and morphine. She had pnemonia and dementia. I tried to fight the efforts to euthanize her but lost the battle with a family member who had the POA. I will regret to my last day on this earth that I let them get the POA. I am convinced if I had it, my beloved mom would be alive.
What i will never understand is how Hopsice gets away with putting human beings to sleep like some vets do with sick pets? How is this legal in the US.
I stayed with my mom as much as possible, usually 16 hours a day to try to protect her from being juiced on the morphine. When i was able to keep her off of it, I could wake her and feed her. The day before she died, I went home at midnite. When I arrived back the next morning at 7 am, I could not awaken her, I checked with the nurse who said the hospice nurse gave her morphine at 4 AM. She died the next day. I feel so guilty that I didnt fight harder to challenge the POA and Hospice.
All the recent talk of the so-called "death panels" allegedly associated with the new Health Care Program completely ignored the activities of Hospice. How is what they do legal?
When my father died four years ago in a hospital ICU, he lay gulping for air as his lungs seized up from advanced emphysema. The staff refused to give him enough morphine to help calm him and allow him to rest because they feared the drug "might impede his breathing." That seemed unbelievably cruel. My mother died two weeks ago here in our home. She had Alzheimer's and non-healing spinal fractures, and in the last two weeks could no longer swallow. The hospice staff kept insisting we not artificially hydrate or nourish her but allow the natural process to advance. My sister and I received more morphine than we could ever use in order to keep her comfortable. Now I'm not sure we did the right thing by not insisting on at least IV hydration. Of course there's nothing I can do about it now, but it's crossed my mind that if she'd been hospitalized she would have received this basic intervention immediately. We wanted her to be home. . . perhaps both povs are correct, no IVS as well as basic IV intervention. I very often felt way out of my depth in regard to her care, that docs and RNs were throwing serious narcotics at us without much guidance as to their correct and appropriate usage. God bless you all for you love and care.
My mother is currently enduring stage 4 esophageal cancer. Hospice has been nothing but open, compassionate, well trained nurses. The goal of hospice is not for curative treatments or to prolong the terminal illness the patients are dying from; it is their goal to create a qualitative, painless stages of dying process.
I am truly sorry those of you have experienced such negative and regretful hospice care.
It is also of note my mom has worked in hospice, and for the very people who are helping us care for her, for over 20 years. She has shared many insights to me about hospice and what kind of special people it takes to guide and listen to families through the end life process.
WOW...this is all quite disturbing. I thought I was alone in this! We brought my Dad to a Hospice facility and told them NO medication. He was sitting in a chair and eating food when we dropped him off. 36 hours later he was dead. They told us "When you drop him off to Hospice you have given him permission to die". What??????? He wanted to live!!
within an hour of us leaving the first day they gave him 4 different medications (without our approval....we found out once we got the medication report). Even though we said NO meds.....he was NEVER in pain!!!!! Yes, we believe the Morphine killed him.....he got 4 doses in less than 24 hours. Even though he never had pain!! (He had COPD.....that was all).
Yes, perhaps there are caring/compassionate people that work for Hospice. But based on our experience they put people into a sedation that the person never comes out of.
Yes, I call this mercy killing, even though my Dad never wanted what they gave him. Hospice is marketed as "Comfort care".
Hi, I'm so sorry for all your losses. My friend is in hospice now and we encountered the same issues. I just want to address to everyone that I found out that if they give morphine and ativan and take of the IV or not feed you or give you nothing to drink. They dehydrate your loved one on purpose to speed up the dying process and with all the morphine and ativan it will go fast. They would not even listed to us when we asked them to give my friend some water. She is still talketive and she was thirsty, how cruel is this. This needs to stop, I don't know how they can get away with this>>>With all the respect we don't want anyone to suffer from pain, but let people die faster thru completely dehydration should not be alloud.
my dad was having a hard time trying to take care of my mom by himself. I tried to get him to move close to me but instead he called hospice. She is 96 was just having a hard time getting around and had incontinence. They right away started her on a catheter which caused a lot of infection when she complained they gave her morphine. She couldn't even talk or eat any more. I told them to take her off the morphine and check her for a bladder infection. the nurse dipped the strip in her urine said she didn't have one. I insisted they test again by a different nurse she had an infection. She right away after taking the antibiotic got a little better but they kept giving her morphine. When I asked what it was for they said because of her pain. I asked what pain. They said her arthritis, I said she doesn't have arthritis, the nurse ignored me. Then I asked a different nurse she said because of her disease I asked what disease? she didn't answer. I told them to take the morphine patch off then they put it under her tongue. they then decided she needed a nursing home and my dad has to sign 1/2 of all their assets over. Does anyone out there know if hospice gets a kick back from the assets when they get someone to go into a nursing home. To this day my mother can't do anything but lay there and sleep most of the time. She goes to the bathroom in her underwear because of all the morphine. I am so upset. the nursing home said that hospice has control over all her medication.
Hi anonymous caregiver. I understand you being so upset during this situation, it can be very troubling. (You can see my submission above). A person in hospice does NOT necessarily have to be in "pain" for them to give a person medications/morphine. They "evaluate" the person and make a judgment call...if they fidget, blink their eyes, etc. You obviously didn't get a satisfactory answer so you should really question what they are doing.
My dad was in a hospice facility and only lasted 36 hours there. (They diagnosed him with "senile dementia" even though his memory was better than ours!) You need to ask what the hospice diagnosis is for your Mom. My Dad was put on 5 different "pain" medications and he went into a palliative sedation and never did come out of it. We did not know he was on anything (they hid it from us). We only found out when we asked for the medical records. You need to ask to see her medical records...she may be on more than morphine.
Also, to my knowledge hospice does NOT get a person's assets. They would need to know about insurance, etc.....hospice is usually paid for by Medicare (or Medicaid) and insurance. Hospice gets a per diem each day ($165+ I believe) whether they are with your Mom or not. The nursing home is correct. Once a person is under the hospice "community" the nursing home would not oversee the medications. That is why nursing homes, assisted living facilities, etc. like it when people are on hospice..less work for them. That is how it works.
Ask a lot of questions!
My gma just passed away yesterday. She was 92 and was in considerable pain from a 6 yr old auto injury that had broken her leg. She went into a nursing home on Aug 12 and on Sept 12 went into hospice because the nursing home couldn't manage her pain anymore. She was given liquid morphine from the time she went in until she passed which was at 12:55 am on Sept. 14. I feel like she was overdosed on purpose due to her age and condition. My grand father has POA and he thought it was okay that they gave her so much morphine because it was helping her when nothing else had. He was told that she would be let out of hospice on Monday the 16th but at 12:55 am he was calling me saying she had died "in her sleep". I believe that morphine overdosing is a much more common practice then we think to euthanize the elderly.
Hospice very clearly induces death by dehydration. Once admitted to an inpatient hospice, morphine and ativan are administered and hydration is removed. Any effort to give a patient a simple drink of water is highly discouraged by hospice. They will give you a little sponge to wipe the mouth but nothing more.
In some respects, this may be better than the alternative of a painful death from the terminal illness. However, the idea that it is peaceful is wrong. My wife suffered. She eagerly took what little water I was able to give her. She was thirsty despite what they say. There is fever and the patient is soaked with sweat in the last few days.
The worst part for me was that they initiated the process only a few hours after my wife and I were told that she was terminal. It was a shock since the doctors had thought the cancer under control only a week before. In their words, they were stunned. So were we.
But, the circumstances didn't seem to matter to hospice. They immediately started their chemical formula and put her into a virtual coma within hours. No time to talk. No time to say goodbye. She tried to fight it but they simply gave her more ativan to knock her out. It was a cruel and insensitive experience.
I have read all the above and I am currently taking care of my grandmother although I do work in medical and fortunately, I am the main care provider for her so, I am the one with knowledge that is making the observations and the calls as to what I do and do not accept for medications or treatments. On one hand, as the granddaughter, I understand where a lot of these comments come from about Hospice. On a medical stand point, from some one who has worked hospital, O.R., and long/short term facilities, I see where they come from because we know what comes after a certain point and how it looks and the patients expression when you aren't there, because they don't know how to tell you to let them go or because they can't tell you. These are sometimes things you don't see and never will because they know you love them so much and that YOU are not ready for them to leave, not them! Don't get me wrong cause I do see what you are saying about the pushed morphine now that I have experienced it my self, but what I say to you, is look at your family member and see what THEY really want and not your self...the decision is usually very clear if you choose to see it and allow them to show it to you. Young patients passing before their time I have very minimal experience with but the elder is where I have a lot of experience and I have never worked for hospice, nor will I! It is to depressing! I'm used to curing, not ending and like it that way! But if it eases the pain and it is the time then except the comfort measures. If you know that he/she isn't ready and they just need pain management then hold off or find something that works before you have to see them suffering from it! My grandmother is 84 and has Alzheimer's. She has had the disease for over 16 years and is finally in the last stage where she is now bedridden. She knows no one, not even her husband of 66 years, she will give a smile in the mornings but is in pain with foot drop, contractions, arthritis and none moving bowels. She no longer remembers how to converse and has so many mini strokes that she can't move her left leg and has a droopy eye...quality over quantity is all I can say because she is just now IN THE process of forgetting how to swallow and looks like a very lost little girl in her eyes everyday I go there and it is very heart wrenching to see. She will eat and drink if you give it to her, but not much, only enough to continue the suffering. She is a wife of retired Navy from WWII and has 13 children, not at all the same person that I grew up knowing. Quality or quantity...is how I see it, let her feel the last of suffering or let her sleep it away and leave it to her the last of her dreams and memories. The decision is yours as POA but think of them first is all I ask, not your self...that's all I am saying about it, just put your self in their shoes and what you should choose is very clear. Bless all that have dealt, are dealing, or going to deal with this process cause it isn't easy no matter what quality or quantity is, it's just hard.
When my son was in the nursing home from an automobile accident and left him a quadriplegic, he was doing well except needed pain meds and later a feeding tube (for backup); usually ate very well. His mind was very much intact, got around in his electric wheelchair fine, very social, etc. Hospice wanted to be POA. At first my son thought their spiel sounded good--new bed, etc and signed the contract. But. . . when I met with Hospice and found out their rules, we had a run-in. I was told his doctor didn't know anything about treating him; he was to be taken off the feeding tube and anything except their pain meds. I talked with his/my doctor (who was on the Hospice board), and when he found out what was going on, he called Hospice himself to break the contract. My son lived long after that. I would never, ever sign a contract to make Hospice a POA alone. My experience is bitter.
i have been a caretaker for family and in law members for 14 years. My mom died suddenly at the age of 100+ in the hospital due to unknown complications. She had health issues with her heart and stomach. She was pretty lucid all the way to the end, but suffered from lack of mobility due to joint injuries that she never took care of and as a result cause a lot of problems at the end, and general mistrust and paranoia. I had to put her in a nursing home because she was not able to manage by herself and refused help. At the time i was also overseeing care of my mother -in- law who was 95 with Alzheimer since she was about 83. When her husband died my wife volunteered to take care of her, and we bought a house for her and hired a full time live in care taker. We lived 5 miles from her and made frequent trips to check on her. At about the same time my wife was diagnosed with early stages of Alzheimer, she was 63 years old. I tried to have my mom taken care of with my mother-in- law and had her move in with my mother-in- law. Things went pretty smooth for about 6 months until one day my mom decided that people were trying to kill her and i was after her condo. That was more than i could handle and I found a nursing home that would accept her. Like anything else, there are good facilities and bad facilities, and you really don,t know until they have been there for a while. In my case the nursing home was the best thing i had done, and overall my mom was pretty satisfied with the place. About 3 years ago my mother-i-laws care taker was diagnosed with cancer and left her job. I decided to move my in -law in with me since i already was taking care of my wife who at this point was in mid stages of Alzheimer. i had her for about 4 years. My mother- in- law died Christmas day 2013, complication from late stage Alzheimer, inability to swallow, she lasted for about a week with no nourishment , she was 101 years old. My wife is 71 now and is in the final stages of her life due to the same thing, inability to swallow. I think she had a stroke and that lead to this condition, because it just came on suddenly. I had dealings with the local hospice group for both, and can only say good things about their service. They are not an organization the is forced on you, and you have the right to refuse their service. From my experience with Alzheimer and end stage care, the best thing you can do is to make their passing as comfortable as possible, which normally requires the use of Strong sedatives and pain killers. There is no cure, and the end is inevitable, and you need to be strong and make this decision. My doctor told me about 7 years ago that my wife has Alzheimer, and i should be prepared to deal with it for an average of 10 years . That fact does not sink in till the end stages when you realize that the end of life is approaching and you need to accept that fact.
My husband Robert, who is probably in late middle stage Alzheimer's, recently went on Hospice and has developed a very painful, red, swollen, hot-to-the-touch foot starting at his big toe and spreading downward. His Hospice nurse is unsure what is wrong but wants him on (surprise) morphine and ativan. I'm contacting his nurse practitioner for another opinion. It resembles gout, which he has had before, but Hospice nurse says it's not. I don't want to just mask the pain without dealing with the cause. Ibuprofen may be a better try so Robert won't sleep around the clock like he started to do on these two drugs.
As a person who faces terrible chronic pain I pray for death daily. I find family members and friends who, in their emmense medical knowledge, begrudge dying loved ones the right to compassionate and pain reduced death utterly reprehensible!. It is your own selfishness that judges a dying loved ones requirements to pass sans agonizing pain...is it really so vital that you have one more day to go visit a few hours whilst your loved one lives in...no endures, another 1440 mins in agony because you have bought the lie about drugs? Do people live for you? Or do you live to ensure they are offered any and all relief available to allow them freedom from the terrible burdon that pain is. I endure torture daily. Is that fair? I am virtually bedridden and even have had ketamine treatments at the hospital to curb my pain which left me utterly sick and humiliatingly vomiting quietly in the corner of the waiting room whilst waiting for me to be wheeled me to another infusion for yet another of my illnesses...I quit. No more docs, no more meds, no more food...and now debating if I am brave enough to endure more pain by truly starving myself..stopping water...for what 2 weeks...three...God help me if it is four...all whilst no pain meds...alone. sounds pretty terrible to me. All I wish is that I can finally find relief from unending pain. Since we have zero compassion in this society I must now stop eatting and drinking and starve myself to death without anyone at my side because there is so little compassion. only a selfish person would require that a person in pain live on in pain for anothers selfish desires or own fear of death. How fair is this? Why do I have to face death in pain and alone? Why can't more people love their loved one enough with altruistic unselfishness so that people in pain and dying can access relief in compassion. God bless the people who are gifted hospice along with those who gift a peace transition from this life...my dad died on the floor retching out the bile from his stomach...because his doc wouldn't give him 6 months to live order so he could get help and pain relief...he died 6 hrs after being approved against his dr insistence he was med seeking. So, my Dad lying in a comfy bed with meds covering his pain...or lying in a pile on the floor with his face stuck in a pot of his green bile..it was absolutely the most distressing thing I've ever seen. how do you want to gift your loved ones death? Try to be a little less selfish and a lot more compassionate towards the people who so deserve your compassionate unselfish end of life choices. I am terrified I am destined to face the same terribke end as my father because I cannot find someone to help me thru my choice to no longer face my chronic debilitating pain. 1440 more minutes of pain is an eternity...oh I wish I could give my pain away in 5 minute increments so healthy people could have a clue what it feels like...along with the diagnosis I will never be better than right now...only a slow torturous agonising slide towards what I can only dream of...peace thru death which will finally be an end of my pain.
This began with a question about when to start morphine if a patient is not eating or drinking, and answers seemed to focus on relief of pain. Is a patient in pain because of not eating or drinking (if they were not in pain beforehand)?
My mother in-law was cared for by hospice services and never once was given morphing or anything out of the comfort care box. My father in-law is currently on hospice services and has never been given anything from the comfort care box. Page was on tier service for about 9 months before death. He has been 8.5 months.
My mom started going downhill this last weekend mentally; they should have thought UTI first thing, but they waited til she spiked a fever on Monday and was unresponsive (that morning - she WAS responsive in the afternoon) and dehydrated. Now they're having trouble getting her to drink and even if she's on her way out, dehydration cannot, I repeat cannot, be "not suffering" or "comfortable".
Sorry for all the losses, but when you don't consult hospice until the last few weeks instead of months before the regimens are different. They are not there to over medicate or "euthanize" your loved one. The helped my Mom with cancer for 6 months once she stopped putting that chemo poison in there for Stage IV which made her much more sick.
As for the very end of life (the last few days), ask any hospital worker and they will tell you when someone is suffering you dose high and morphine, cut 02 supplements if you can (like at home), and of course stop hydration. If they are snowed enough they peacefully go. From reading these comments I don't think they understand what hospice is all about, but the public is generally uneducated when it comes to End of Life decisions. You can thank our Dr. for that, among others.
Peace, I have read many sites and many opinions good and bad. I want to add my own experience in hopes that it will help someone. I took care of my dying sister in my home in the end stage of lung cancer. She was a smoker. She was 56. She came to my home on a Monday and Thursday she took a turn for the worse and could not get up. NO medication such as morphine or Ativan had been started. She asked for something to drink coffee is what we started with she said, this is not coffee gross. We went down a list of fluids NOTHING she then turned to me and said NO MORE LIQUIDS. Later that day she started to sleep more deeply still NO medications. By night she started to get restless and anxious. I started LOW does of morphine and it calmed her right down. She needed it more as the next few days progressed. Her fluid was building up. My sister left this world in peace. The following year I had my mom in my home she had end stage Alzheimers. She came to my home from a facility she would eat little and drink more. She came on Jan. 6th on the 19th of Jan. she passed. I did not start her medications until she stopped eating and drinking on her own and was sleeping with restlessness. She died peacefully. God called both my mom and sister home. They knew they were dying and we made them as comfortable as could be. I have this last thing to say. COMMON SENSE!! I let God guide me and HE did. May God Bless you in Jesus name.
Unless you're given an overdose, morphine doesn't hasten death. That's a myth. Please research legitimate scholarly/medical journals backed by research. Yes, strong opioids have side effects, but you have to weigh that against the suffering of the patient.
I had to fight another family member to give my mother morphine in her last few weeks. This family member was worried about my mom having potential liver damage, becoming addicted, being "out of it," etc. Uh, she was in the last month of her life, dying of cancer. Liver damage and addiction aren't really concerns anymore. And being "out of it" is better than suffering.
Hospices don't "euthanize" patients. I think many people don't really understand the role of hospice care. Some hospices, I'm sure, are better than others. Be sure to pick a non-profit organization, if you can. I've had three separate experiences with hospices and I have nothing but positive things to say about the services they provide.
My Mother just died in Hospice care... Yes, they did give her ativan and morphine. She had COPD and was panicked and in great pain not being able to breathe. I thought I had more time with her - she didn't eat much but ate some. She drank orange juice and coffee. She was 100% with it - and then she had a pain in her ankle... they gave her morphine - more of it. When I came back they said she had been sleeping all day... The next day the same - yes, I am sure they kept her drugged up and she died peacefully, but I was so sad they didn't explain to me what was happening... I never got to talk to her again. But my dad died of COPD also and he died crying Please help me breathe - that was sad too. I just now know that I want to talk to my Mom and wish I had been told that she wouldn't wake up from all this morphine and ativan that let her die peacefully.
My mom who was one month shy of her 98th birthday died last month. She had some dementia and forgetfulness. She was up walking with a walker 7 months previously. She gradually started to decline. She was having TIA's...(mini strokes) and each one left her a little more worse. I will say she had a GREAT appetite and ate anything on her plate. One day about 2 weeks before she died, she ate 100% of her dinner and the next night she only took bites. She also refused breakfast and really began taking only bites of food and drinking a little water. She had some very slight arthritis pain and by this time was pretty much bedbound. If we got her up in a wheelchair she was a total lift and then tilted to the side due to the strokes. She was alert. I have to say I have been an RN for over 30 years. I did have my mom on hospice but would NOT allow any morphine or Ativan to be given since my mom did NOT have major pain. She had a 24 hour caregiver at home and I as well was staying at her house. She needed to be turned in bed since she was unable to turn herself. She was incontinent in diapers and would always say, "why do people have to live this long". She was unhappy being like this. She just started to push away all her food and water. When we turned her over in bed she would complain of some leg pain but say it was not that bad. She went 5 days without eating anything and only had a few sips of water during those 5 days. I made the decision to start her on Vicodin.....she could still swallow a crushed up pill in pudding...I gave her this out of fear she might have a heart attack due to being so dehydrated and then would have pain...I knew by giving her this Vicodin that she was going to die soon...due to her old age, no food, sips of water only. Narcotics per say does not speed up death, but giving narcotics to a very old person does indeed speed up their death due to being sedated and sleeping and having their respirations decrease. On day 6 she could not swallow anymore. I will add that she also would get some severe agitation and confusion at times. I at this point made the decision to start Morphine AND Ativan, both liquids. I wanted my mom out at this point. I wanted her to know NOTHING. I wanted her to die peacefully and have ZERO discomfort. She and I had said everything we could possibly say over the past year and even in the past few months. Every night I kissed her goodnight and told her I loved her. I apologized for anything I might have done in my life to her. I told her what a wonderful mom she had been. I gave her permission to die. At first she did not want to die. After all the days of not eating and before the Morphine I asked her if she knew what was going on. She said, "I am dying, and its ok". I also told her I was sorry she could not swallow water any longer due to choking and said I knew she must be very thirsty. She actually said, "it really is not that bad". She knew I was starting the Morphine to help her transition to death. When I told her I was starting Morphine to help her she said, "I know" and "it's OK". She was on Morphine for 4 more days...for a total of almost 11 days with no food or fluids. I help her hand as she died. For me, it was horrible to watch. We think that having no food or water is a horrible thing and that is must be so awful....that was my hardest part in watching this. Just knowing she was going so long. She was just sleeping. For her it was peaceful. Totally asleep and zero discomfort. That was more important to me than being able to talk with her. I think so many people do NOT understand what Hospice is. It is for end of life care. NOT to cure, NOT to keep alive, but to let them die peacefully with pain meds onboard. If you are not ready for your family member to die, please do not put them on Hospice...but then I say...if you love your family member, please put them on Hospice and let the medications take them away peacefully. It is not suicide, it is not a mercy killing. It is the natural dying process for our elderly and our cancer patients. Let them go free of discomfort. So many on this thread are so upset that Hospice gave their loved one's Morphine and/or Ativan. WHY? Because you no longer could talk to them due to them being totally asleep? If that is the only reason...please feel blessed that your family member went in peace...Trust me, I know first hand and am so very thankful my mom went that way. Stop feeling guilty and know you did the very best for your loved one's. If they could, they would THANK YOU for allowing them to go in this most compassionate way.
I must answer a poster who says if you go along with Hospice you won't have issues and problems. My mother was on Hospice for a year after her strokes...She was NEVER given pain medications since she was not in pain and was up eating by herself and reading her newspaper. She was in a wheelchair and could not longer walk. Hospice actually took her OFF service for living.....Two years later I had to put her BACK on Hospice due to her just getting weaker and she was sleeping all day. She was almost 98 years old. Out of the blue she just stopped eating and drinking. 8 days of this...I started her on Morphine and some Ativan and 4 days later she was gone. most peaceful death. She knew what was going on before the Morphine and said she knew she was dying...We talked, be laughed, we hugged before that Morphine was started. Her last words to me..."I love you". Perfect ending for her...I miss my mom and it was the hardest thing I ever did for her...To watch her die for 11 days total.....it was NOT hard for her...since the Morphine made her so very comfortable.
My mother is on hospice and the nurse is pushing morphine to help her sleep longer. She is not in pain. She has terminal breast cancer, copd and newly diagnosed congestive heart failure. The nurse already had her on a high dose fentynal patch which she was overdosing from and the nurse kept saying she wasn't but when she ended up in the hospital with outrageous hallucinations and psychotic and the treating ER Doctor said it was an overdosage the hospice nurse finally agreed but still wanted to then put her on Halodal. I feel strongly that the nurse is deliberately trying to kill my mom before her time- she isn't in pain and she is doing all activities of daily living- so why hasten her death? But my mom listens to her since she's the nurse. I am convinced that hospice makes out somehow to complete the process as quick as possible. This should not be legal!
As a person who works in end of life care, I'd like to talk about morphine and other drugs used in Hospice and take a shot at answering these questions. First, I want to say to the family members that I empathize with you all. It is a heartbreaking and terrifying experience to let go. It is also very scary to hand over care to a medical team especially for those who have no prior medical experience. At the point that Hospice gets involved, the idea is to allow your family member pass on with the least amount of suffering possible. As mentioned above, a nurse or team comes in to assess your needs and those of your loved one and make the best decisions to help him or her pass peacefully. Often, that includes the "care package" of drugs such as Ativan, Morphine, Haldol and other drugs for nausea etc. Furthermore, life saving measures are halted which is also terrifying and seem like they would be worse for your loved one. However, you need to understand that actions such as hydrating a patient are only measures that prolong suffering. The organs will still shut down but at a much slower and more painful rate. Morphine and other drugs in the package are not used to euthanize your family member or even to knock them out to somehow make our job easier. Morphine itself will have a range of doses listed for the nurse or caregiver to administer based on the patients level of discomfort and shortness of breath. For the patient, shortness of breath is the scariest part of the dying process. It cannot be cured but instead a dose of morphine will take away that feeling and simply ease their efforts to fight what is inevitable. Haldol and Ativan are specifically used to ease your family members anxiety. Your family member has a lot to be anxious about. Common concerns are what comes after, giving up, unfinished business, letting go of the loved ones in their life, and whether or not their loved ones will suffer in their passing. The last one is often the biggest fear and the reason they will hold on through tremendous pain and suffering. Some will wait to be able to say goodbye to someone specifically or in hopes of setting right a perceived conflict with a loved one even through large doses of morphine and other like drugs. The biggest reason that family members fear them is that in large doses the patient no longer interacts as before. However, personally I think that if I were the person going through the active dying process I would like the idea of being able to go peacefully in my sleep, rather than suffering through a long labored process. Your family member can still hear you and feel your presence and in that can find comfort in knowing that you are with them to help them through the process. A word of caution is that even if you disagree with the process or have questions about the "signs" that death is near, please remember that your family member is sensitive to such things and should not hear questions about signs or conflict between you and medical staff. It's ok to ask these questions and feel the emotions that you are experiencing, but it's not ok to make your dying loved one more anxious and fearful. Lastly, I want to apologize to those of you who have had bad experiences with the Hospice process or staff. Not every person is meant to be an end of life caregiver in that capacity. Some forget that all people don't have the training or understanding of what is going on. A good hospice nurse or end of life caregiver should patiently explain it all to you rather than going on autopilot and expecting you to trust them automatically. Nevertheless humans are all flawed and you must remember that for them death and suffering are difficult even though it's not their family member going through it. Also, your pain is difficult for us to witness and some nurses aren't sure what to say or do in such an emotional and very sad situation. Though we mask emotions well, we still feel them and go over everything that we did in your family members care in our minds at the end of the day wondering if we could have done anything differently. We just cry in private on our way home when your family member passes because of the loss of another human life and because we know how difficult it is and will be for you. With all of that said, I hope that my post was helpful in answering the OPs question and in helping others understand the hospice process.
One thought, for those who fear that the goal of Hospice is to end the life more quickly. Hospice is generally paid by time. Therefore if the patient passes quickly the agency makes less money. These companies are usually started by someone who sees the patients needs, but could not continue without patients in their care. If you fear overdose, organ damage or addiction, you may need to consider that hospice care is for patients who are expected to die within days to months. There isdamage that occurs from prolonged use, but that doesn't apply in hospice cases. Also, addressing the poster above who mentioned that their family member with emphysema was not given enough morphine. Death from emphysema is much different than that of other conditions. Morphine use in these patients has been both recommended and considered contradictory depending on which experts are consulted. It seems as if your family members provider was concerned about the safety of giving the drug. Nevertheless, emphysema is one of the hardest deaths to endure for the patient, family and providers. And I'm so sorry that you had to witness it with someone you loved.
Thank goodness for the new right-to-die laws. Makes it a whole lot easier for the person suffering---forget this dragged out nonsense. Rest peacefully.
Morphine not only relieves pain, but helps with the gasping for air that people go through while actively dying. It seems that many people are being a bit selfish in wanting to keep their loved ones alive a few extra days or weeks, and not as concerned with them being comfortable. For me, my Mom died comfortably, under hospice, without gasping for air in her last day, and hopefully pain free. The end result is the same. My Mom was terminal. Trying to keep her alive for an extra day or two would have been selfish and cruel. I doubt she would have lived longer, as without the morphine she was panicked, struggling for air, in pain. I can only pray that someone would have compassion for me in that scenario, rather than buying into the "anti-drug" propaganda that seems so prevalent these days. Using morphine in normal life is risky as it can lead to addiction. Yes. But in the last week of life, please.......
My father was in hospice for the last 9 months of his life. He had end stage renal failure and had suffered several strokes which landed him in a nursing home. When we made the decision, based on his failing health to discontinue dialysis we were able to bring him home for his last few days. Hospice came to the house to assist with his care. The very first thing they noticed was that the hospital had sent him home on morphine which was contraindicated for someone with his health issues and immediately ordered a safer pain reliever for him. They did this with the knowledge that without dialysis he would not last long.
When hospice accepted my father into their program his level of care at the nursing home increased greatly. The nursing home knew there would be someone checking on him besides just family (someone from our family was there at least once a day to make certain he was eating and to visit with him). Hospice also bathed him in addition to the twice a week bath the nursing home would sometimes give him, and brought music therapists and visitors to him to sign with him and visit with him. He absolutely loved all of the hospice volunteers and nurses that worked with him. They were an absolute blessing to our family.
I cannot speak for each case mentioned here but my father would never complain of pain, but he would be restless or crabby, his nurses ( both nursing home and hospice caregivers learned top recognize this). He had not been eating or drinking much for over a week, maybe just a bite or a sip. We administered his pain liquid reliever with a dropper. Dad's last days were spent in comfort and he slipped out of this world like a whisper without struggle and without distress. Hospice helped make his passing easier for both him and our family.