My mom is has end stage COPD, I have to put her in a home but what should I expect?

Mommysgirl asked...

My mom is only 56 years old. She has end stage copd and also chronic bronchitis and also emphysema. Since August 2010 she has just gotten worse and worse by the month. She has been in and out of the hospital, they put her on 02 in augsust non stop 02. She has to do breathing treaments every 4 hours and still smokes. She looks horrible. She signed her power of attorney over to me yesterday while laying in the hospital. This last sunday i went into her room and knew something wasnt right she was having so much troubles breathing which she has for almost a week not but this was bad she could barely talk to me and didnt know what was going on at all so i called 911. She is in the icu on a bpap machine and they told me she is in her final stage of copd and that the only thing they can do for her is make her comfortable. They wont give her but some hydrocodone for the pain which she keeps saying isnt working. I am so scared and dont know what to expect i know i am gonna have to have her put in a home because i cant take care of her i have 3 young daughters at home and when they get sick it makes her sick and they doc said one of these times it could really kill her.

Expert Answer

Audrey Wuerl, RN, BSN, PHN, is education coordinator for Hospice of San Joaquin in California. She is also a geriatric trainer for the End-of-Life Nursing Education Consortium (ELNEC), which promotes education in geriatric nursing and end-of-life care.

COPD, chronic obstructive pulmonary disease, develops over time and includes several diseases such as chronic bronchitis and emphysema. As the disease progresses, the patient has difficulty getting air into (and out of) their lungs. Sadly, smoking only makes the situation worse. You have seen this first hand.

This disease pattern, from a hospice perspective, is especially difficult because the patient has periods of stress (we call that exacerbations) where they end up in the hospital, and periods of "remission" where they appear to improve. There are a lot of ups and downs. It is especially hard for a physician to determine a six month prognosis, which is needed to refer to hospice services, because the patient keeps getting "worse" and then, "better."

You state your mother is now in ICU on a BiPap, or Bi-level Positive Airway Pressure, machine. The BiPap is helping her get more air into her lungs, as she is unable to do so herself. The mask is usually not comfortable for the patient and generally, the oxygen liter flow is quite high. This means she needs to be where she can get the amount of oxygen her body requires, and not every facility (except the hospital) can provide that. Add to that the exhaustion and fatigue and frustration she must feels, we get a sad picture for end of life.

You might speak to your mother's doctor, or nurse, regarding providing morphine for her pain and to help her breathing. This would be part of comfort care. This would also be an appropriate drug at this point. Keeping her comfortable and safe may be the best course for her now.