Hospice-Morphine-Elderly=Demise

[PeterRabbit2]

When his doctor ok'd hospice, we agreed, so that he could get the periodic pk checks for the coumadin, blood pressure medication, kidney checks, etc. Maybe we didn't have enough information when we made the decision. I have spent this day informing myself on meds that open blood vessels and I had found info on calcium channel blockers........I just spoke with my siste and he is on Norvasc already. When I was there 2 days ago his blood pressure was high, I believe the # I heard was 184 over 84. My sister was putting out a "dust up" so she couldn't talk for long. She told me that the hospice nurse that she spoke with today said that Dad was not coming out of this......We don't know who to believe, as in the short time that they have been in place we have found numerous errors. No one in our family has had to deal with hospice situation before and we just don't know what the right thing to do is.............

Go to (an) independent diagnostician(s) (cardiologist, internist, whatever) and get a second and then a third opinion.

Something is wrong with this picture. GET MORE OPINIONS (from doctors)!

[newyorkgal]

I have dealt with hospice during the last months of both of my parents life and my next door neighbor is a nurse in a hospice facility for children (God Bless her).... I am pretty sure that hospice care means a person has a diagnosis of six or less months to live. It doesn't always work that way, But that diagnosis is something the doctor must document . You also cannot be on meds that might prolong your life, such as chemo. Paintedlady.... I would get a second opinion fast or find out if there's something the doctor hasn't told you. When a person is in end stage of any disease, hospice is the kindest thing you can do for a loved one..

[doc.rose]

everyone gave you wonderful advice. I would definitely start to ask some questions. It seems that since your Dad is not terminal, he should be in a place like a rehab place, where he can get round the clock care. My grandma would stay in one periodically when needed, like after a surgery so she could recooperate and get medical care at the same time. I hope everything works out for you.

[newyorkgal]

Again, there could be things they haven't told the family about his condition. I find it hard to believe hospice would work with a person who isn't terminal, even for financial reasons. That's what rehabs and nursing homes are for. There are rules about who they accept. I would getk his records, take them to another doctor and find out what's really going on.

[doc.rose]

Again, there could be things they haven't told the family about his condition. I find it hard to believe hospice would work with a person who isn't terminal, even for financial reasons. That's what rehabs and nursing homes are for. There are rules about who they accept. I would getk his records, take them to another doctor and find out what's really going on.

NYGal, I was actually thinking the same thing as I posted my last response but decided to leave it out. I agree with NYGal, maybe the patient requested that the rest of the family not know the actual diagnosis. I would still look into it though. Good luck!

[cherry14]

NYGal, I was actually thinking the same thing as I posted my last response but decided to leave it out. I agree with NYGal, maybe the patient requested that the rest of the family not know the actual diagnosis. I would still look into it though. Good luck!

Agreed. Dad may know something you don't. I just have a hard time believing that he'd be medicated if he was not in pain (or is he not in pain because of the medication....?). I don't mean it badly, but you may not know everything about the situation, and neither the doctor nor the hospice staff can tell you without your dad's permission.

[marydelso]

Hi Sandra,
My Father also was a Cancer Patient. Our Family called Hospice because he was in pain, and Hospice killed my Father also. They had him on so many drugs it was insane. He could not walk, he could not talk, he could not move. He was like a zombie.
Evan while he slept, Hospice was giving him Morphine, Oxy Cotten, and many other strong narcotics. He laid there and starved to death. He was not given any food or water. You know if we do that to our animals, you go to jail, yet society lets Hospice do this to our elderly. We need to really think about this because one day we will all get there, will this happen to us also.
I live with the guilt that I did not stop this either. My Father could not talk, I feel I should of threw them out of my Fathers house. Yet I did not. I did not know what to do. Yet I watched someone I loved very deeply die a horrific death.
Please, do not call Hospice unless you want your family member dead. It is inhumane how they treat the elderly and get away with it.
I am sorry you went through that Sandra, yet I know exactly what you are going through because I am going through the same experience. I am sorry for your loss.
Sincerely,
Mary Delso

This right here, is where and when things went wrong. I too believed whatever the medical community suggested as "right" and didn't question beyond how it all worked and the difference between a hospital giving medical treatment and hospice treating the patient. My father also had so many other medical conditions that had recently been compromised and I was told by the hospice representative that he would receive additional care to what I was already providing for my father, privately. He was being discharged from the nursing facility and I was overwhelmed, knowing that instead of the 2 - 2 hour shifts I had daily for him, he would now need more care. I thought they were going to provide more care, not hasten his demise. When they added additional medication to what he was already receiving (and was working well for him all these years), I stupidly and regrettfully did not question anything. They told me these medications would control his pain and I thought, "great!" He wasn't given a terminal diagnosis except, as the doctor explained it, he was more debilitated now and transferring him from the bed to the wheelchair would be improbable because he wasn't now able to assist in transferring. (The doctor was the one who suggested hospice for him.) They kept him comfortable by "snowing" him, their term for over medicating. He had renal problems, slight heart failure and had been operated on for a hip fracture when a new aide dropped him in November. It took the hospital 6 days to prepare him (working up his platelets, clearing up a UTI, etc.) before he was safe for the surgery. And hospice comes into the picture and they ignore his medical charts and feed him drugs that immediately put him in respiratory distress which caused him to die.

I am living and suffering with an incredible amount of guilt and regret. I didn't protect my father and because I thought hospice would be a quick cure to my situation and help me in attending to my fathers care, my father died at their hands and I allowed them to cause this. He wanted to live. He lived with an extremely debilitating disease by his stroke 21 years ago and since then, had been severely disabled by the stroke but he managed to find pleasure in life and persevere. And that quickly, hospice comes into his life and robs him of what time he would have had, if they had not entered the picture.

Vcamo, you did the right thing by calling Paramedics. Paramedics did the wrong thing by their carelessness, not you! You would not have received a settlement if they were not responsible for what happened to your mother. All those "IF'S" that we look back on are definitely bad medicine, for certain.

Losing my father this way, is gonna eat me up. That's what it feels like now, 2 weeks after him being gone.

Thank you so much for your post. It shed a lot of light my way.[/b][/b]

[Catrina]

Hello.

This is a thread that is several years old and the original poster doesn't seem to post anymore. Maybe that's a good thing and she's been able to come to terms with her grief and heal. I hope that is so. However, the topic here remains pertinent as is evidenced by it still being resurrected by others dealing with elderly parents and/or loved ones.

Many years ago, my mother died of cancer. In those days heathcare was just then beginning to change and she wasn't able to stay in the hospital unless they were actively treating her to "become well". That simply wasn't the case so our choices were to have her admitted to a long-term care facility (nursing home) or to take her home and provide round-the-clock care. She was terrified of going to a nursing home and so she came home with me. Hospice was still a fairly new entity then and we did get some help from them. My Mom's cancer has spread into her bones and as a result she was in constant excruiating pain. Also in those days (not sure if it's still true) the only medication that could be given in a home setting was an oral form and so I had multiple bottles of pain meds that I was instructed to give her as needed and was told verbally that this really did mean as needed even if it meant every hour! That's what I did. I admit there were nights that I could hear her crying because of the pain and I would be sitting in the other room crying for her. I would be holding her med bottles in my hand and wishing I had to guts to give her just a little too much. There was no quality of life and clearly recovery was not in the cards. I never did find the courage to do that and she lingered for several months. To this day, I don't feel guilty about anything I did to take care of her except for not having the courage to help her to the other side.

Five years ago, we lost my mother-in-law after many years of severe heart problems. She had a quadtruple by-pass in the mid 80's after a massive heart attack. I believe to this day that oxygen deprivation caused early on-set dementia (she was in her early 60's then). We learned to live with her psychosis, but it was extremely difficult I don't mind telling you! She was in her early 80's when we were out having dinner for Mother's Day when she passed out in the restraunt and an ambulance was called to bring her to the nearest hospital that happened to be about 50 miles from home. She had suffered a major stroke in the brain stem. The doctors told us that whatever improvement she would have would be over 48 hours and then that would be the best we could expect. In retrospect, I guess he knew improvement just wasn't going to be. My mother-in-law was terrified of hospitals and whenever she was admitted we had to take turns staying with her so that a family member would be there at all times. Even though she clearly didn't know where she was this last time or who was there, we still took our turns and stayed with her. She wasn't being given any medication at all at first but when her condition didn't improve after the end of the second day, the doctor called us out into the hallway and told us that we needed to make a choice. That choice was to put her on life support and transfer her to a nursing home where she could linger for months or hang a morphine bag and just keep her comfortable. He also told us that if at any point we believed that she was uncomfortable that we only needed to let a nurse know it and they would increase the morphine drip. The words weren't said, but we got the message. For the next 3 days we stayed with her and never asked the nurse to up her dose of morphine.

On the forth night, it was my turn to take the overnight shift and my daughter, who is a nurse, stayed with us. We cryed alot that night but it was my daughter who finally took control and every hour on the hour went to the nurses station and calmly told the nurse that her grandmother appeared to be in pain and asked for the morphine drip to be turned up. By morning, just after all of her children arrived for the day, she peacefully passed.

I guess by now you have guessed my view of euthanasia. My mother-in-law was a proud woman who would have been devastated to know that so many people saw her in that hospital bed, her hair in disarray with her nightgown hiked up around her waist and medical equipment taking care of her bodily waste. We have no regrets for our decision. It was only making the decision that was difficult.

In the end, we all do what we believe to be the right thing when we are providing care to someone we love, whether they be elderly or not. We can only do the best that we can and leave the rest in God's hands.

Peace,

Cat

[Health Care Provider]

I am now a professional with an advanced degree in a health care field. Before beginning my professional training, I worked briefly for an organization where I helped to care for the elderly or disabled in their own homes. I was a care-taker, but did not have any certification. I was not even a CNA. I was asked to work with a patient who was being treated by Hospice in Dubuque, Iowa.

I was to stay overnight with a woman (Ms B) who was suffering from pain but whose diagnosis was not given (to me or to the patient). The woman told me she suspected that she had bone cancer but that it wasn't confirmed. She wanted as little morphine as possible, she said, because she wanted to maintain her consciousness and reasoning. She had been a school teacher. She told me several stories of her life as a teacher and also told me of a book she still wished to write if only she could find someone to help her. I had only worked with her a few times but was in the process of trying to find a way to help her to do this. She clearly suffered but insisted that she did not want more morphine than she was already receiving and she clearly still expressed that she had something to live for (writing this book).

One day, I was instructed by Hospice that I was to double her morphine dose, and that this was agreed upon by her sister and the hospice caregiver. I didn't even realize at the time but I was not supposed to be delivering any medications let alone morphine--a schedule II controlled substance! Obviously I learned this once I actually pursued my health care career! When it was time to crush up the morphine and put it into the patients nutrition drink, I reviewed the dosage instructions in her chart and asked her if it was correct that her morphine was to be doubled. She exclaimed "What! That would kill me! Of course not"! I told her I was reading the instruction. In disbelief she demanded to see the chart which I showed her. She said that was certainly a mistake. She was clearly very upset. The next day I was told that I would no longer be working with this patient and that the patient requested only those very close to her would now be working with her. I told the Hospice representative that she wanted to write a book and asked that someone please help her with doing so. I received no response on this matter. Three days later I found out that she was dead.

This could not have been coincidence. I know that she was given an overdose of morphine. I know that Hospice instructs unlicensed aides to deliver morphine (because they instructed me to do so). This is illegal. I know that some patients would wish to have this overdose and that if that amount of morphine was needed to reduce suffering, this would be understandable. But in the case of this patient who was an educator and who highly valued her own mental abilities and her ability to make sound choices, I know that the choice to double her morphine was made without her consent, even though she was rational and competent to make her own decision.

This has bothered me over the years. I know that it is a terrible accusation to make. I wish there was some chance that I was mistaken. If I do not remain anonymous in bringing this to light and choose to return to my hometown to pursue my profession, I am afraid of the consequences of having made this accusation, as true as I know it to be. As a short-term aid not even affiliated with Hospice, I would never have access to their records or that log book.

I also know, that if I had not questioned the dosage...had I been an average care-giver simply following instructions and not questioning my "superiors," I would have been the one unknowingly delivering the lethal dose!!!!! One wonders how often it happens that an aid working for an organization...not even working for Hospice--or a family member...is instructed to medicate a patient with a lethal dose of morphine...and doesn't even realize what she has done! I also didn't know at the time that even though I was instructed to crush up the tablets to deliver them: "MS CONTIN TABLETS ARE TO BE SWALLOWED WHOLE AND ARE NOT TO BE BROKEN, CHEWED, DISSOLVED, OR CRUSHED. TAKING BROKEN, CHEWED, DISSOLVED, OR CRUSHED MS CONTIN TABLETS LEADS TO RAPID RELEASE AND ABSORPTION OF A POTENTIALLY FATAL DOSE OF MORPHINE. "

I had been following my instructions. But I should not have been delivering medication at all! Perhaps instead as a professional of the community I now can at least be more involved with Hospice from an educational and ethical stand point. I have no doubt that the one who gave the overdose and/or the one who authorized it truly thought that they were doing what was in the patient's best interest. When you look up the subject of euthanasia, you will find many defending it without a basic education in the study of ethics. But ignorance, especially in the case of life of death, is no excuse.

Perhaps I could communicate and involve those from the Catholic church. I am not religious, but have now had ethics courses and understand the position of the Church as well as of the medical and health professions as they are all in line with Principals of Autonomy, Veracity, Justice, Beneficence and Non-maleficence which doctors and health care professionals should follow. What was done violated all of these principles. This patient (who had been the teacher of many who are now adults in my hometown) is now gone. There is no chance for her to go back and write her book.

Some victims of Hospice involuntary "euthanasia" have family members and loved ones who are making their stories known. Miss B had no family to defend her. (Part of her story was that as a school teacher from the 1920's...she was not allowed to marry even though she had met a sweetheart. She chose instead to be a teacher and to give up a traditional family life.) Only her sister was looking after her, and this also elderly sister herself was surely growing tired of her sister's complaints of pain and her sleepless nights. It was this sister who agreed (or so Hospice said) to the doubling up of the morphine. The sister herself did not tell me this.

Perhaps if the individual Hospice workers were more educated in the principles of medical ethics, and were made to pass ethics exams, and if these principles were reinforced regularly, these violations would not occur in this way. Also, adherence to the law must be maintained and reinforced. Hospice, patients, other caretakers and families need to be aware of abuses that can and do happen within Hospice and they need to study more the principles of ethics, not in a personal "this is what I personally think is right" way, but in the way that medical ethics as a structured, scholarly discipline is meant to be understood and applied.

Thank you.

[NITECOP983]

Both of my parents were snowed by hospice. I feel so guilty knowing that I actually helped kill my parents thinking I was helping them.
God, if I only knew then what I know now....Never again. Hospice better never get near me. I am putting that in my healthcare directive.
Bob Ruggeri
San Rafael, Ca

[newyorkgal]

Everyone has a different experience. I thank God for hospice. My dad passed in 1988 and I still donate to the hospice in Fla. that allowed him to die with a little more dignity. I think some people just don't want to accept that a parents' life is truly ending. The experience I had for both of my parents (different hospices) was that their rules stated they had to have a diagnosis of less than 6 months to live and no meds except for pain. My dad was only 65 but had lung cancer spread to liver and spleen. My mom was 73 with cancer that had spread also. They came to the house every day. They allowed us to get a few hours out. They administered pain meds. I believe at end of life there should be no limit to the amount of pain medication you can get. While I don't discount the negative reactions some have had, I really don't believe hospice is in the business of killing people or letting them die. We have to let go when the time comes and they made it easier, at least for my family.

[Benahli]

I brought my mom to come live with us when she began sleeping most of the day and night. She had Alzheimer's and my sister had been taking care of her and wasn't going to have any income once my mom passed. I brought my mom to live with us so my sister could start looking for work. I contacted Hospice and mom met criteria for Hospice based on various factors, not just an Alzheimer's diagnosis, which wouldn't have done it. Mom didn't know any of us by then, had needed to be fed for a while, etc. Unfortunately, mom went downhill very fast after arriving in our home and being put on Hospice, but Hospice wasn't giving her any pain medication at that time. At one point mom wasn't rousable, but the next day she was. She stopped being able to walk and things went very quickly. She started to refuse food. My mom was talking coherently for the most part when she got here. But, had better and worse days. During that time my mom told me, although she didn't know who I was, that she thought she was going to die soon.

Hospice provided pain medication that I had the option to use if my mom appeared to be in discomfort, at a certain point. When they said I could give her morphine to relieve her discomfort, I never interpreted that to mean they were saying I could euthenize her. They appeared to want to make sure she didn't suffer. I was full of guilt over my mom going downhill so fast and did everything I could, including trying to get her to eat past the time I should have done that (she ended up choking). I gave her as little pain medication as I could influenced by my sister's concerns, and my hopes she would make a comeback. I definitely didn't give her enough pain medication to kill her. I did give her a very small dose when she seemed to be in discomfort. Hospice told me I could give her a certain dose every so many hours, and explained it was a very small dose (which it was). I didn't give her as much as I could have. She still died.

My sister blamed me. My mom came here in December and died at the end of January. After being put on Hospice. But, they didn't give her any pain medication and I gave as little as possible. But, my sister still thinks I killed her. Really, when my sister told me my mom was sleeping as much as she was, I thought the end was near as that was what happened when my husband died of cancer. He died without Hospice, which I declined at the time. In hindsight, it probably would have been nice to have them involved and he could have died at home.

I would never have interpreted being told I could give my mom pain medication if she seemed to be in pain as a hint that I could put her out of her misery. Just try to make her comfortable. I'm sure there are different experiences. The Hospice we worked with did not appear to be sending the message we could take our mom out. They came and helped bath her, change her, etc. But, my sister still thinks I killed her and so I lost my mom and my sister. Very sad about that. Forums like this will only feed into my sister's belief that we killed my mom. I've been heartbroken about that. And, will never be able to change her perception. But, maybe something will happen that will help her feel differently. I've let it go, but do find it very sad. And, just imagine my sister reading all this.

[Benahli]

Addendum to above: My husband was one who was dying on the inside, not the outside. He went from being coherent and seeming fine to sleeping most of the day and then gone very, very quickly. He had asked if I'd wanted Hospice involved and I said no. If I had said yes to Hospice I suppose I could believe they killed him and they were the reason he all of a sudden was sleeping most of the day and dead shortly after having seemed fine before they got involved. But, people can seem fine when they are terminally ill and close to the end, and then it turns a corner and they are in their final days quickly. I imagine the woman with bone cancer discussed above died of bone cancer and people really didn't want her to suffer. People can take a certain amount of pain medication without it being a lethal dose. People can be sitting up and talking and still be in their final days, in my experience.

[JessicaHospiceRN]

I work as a hospice nurse, and one thing that appears to be missing in the fast demise of patients, is the concept that once the patient realizes that they are on hospice, or that the doctors have told them that they can't do anything more, or they have xx months to live, often times the patient "gives up". It has nothing to do with the pain or anxiety management, but the patient just shuts down. Often they become unresponsive, and to families, this is scary and something that they are not prepared for. The Morphine and Ativan are not the reason that the patient passes. They are given to be certain that the patient is in no distress and no discomfort. I understand these fears of the family, but knowledge is power.
I would encourage every person who has lost or is in the process of losing a loved one to watch this youtube video. It puts a lot of things into perspective.
http://www.youtube.com/watch?v=PPx-qpos57g
And know that most of us who do work in this field do so with nothing but the best of intentions, and our primary and ultimate goal is a dignified, comfortable, pain-free end of life, and not to "hasten" or "speed up" the process. We give medications in response to symptoms, and at no point have I ever been involved or with or given more than is ordered or appropriate. Being that a decline can happen very rapidly, it is difficult for a family to grasp, and easy to place blame. Please watch this video, and do stay involved in the care of your loved ones. Ask questions. Question the meds, get information, get answers, for knowledge is power. And if you have a complete understanding of the hospice process, and the end of life process, then the guilt and misconceptions of those left behind may be eradicated.

[bwinzagain]

I just personally witnessed hospice over medicate my Mother whom was holding perfect vitals for weeks until her breathing slowed so much I counted 30 seconds between breaths. her oxygen saturation plummitted to below 30 and she some how held on and pulled through it. Now I monitor the shots because I have power of attourney and she is now stat perfect!! Comfortable, and enjoying HER final days on her terms NOT HOSPICE!! They use morphine for patient sitters not pain managment. I am blown away from my experience. All i feel is great accept the lack of INTEGRITY ON ALL LEVELS OF HEALTHCARE.

When his doctor ok'd hospice, we agreed, so that he could get the periodic pk checks for the coumadin, blood pressure medication, kidney checks, etc. Maybe we didn't have enough information when we made the decision. I have spent this day informing myself on meds that open blood vessels and I had found info on calcium channel blockers........I just spoke with my siste and he is on Norvasc already. When I was there 2 days ago his blood pressure was high, I believe the # I heard was 184 over 84. My sister was putting out a "dust up" so she couldn't talk for long. She told me that the hospice nurse that she spoke with today said that Dad was not coming out of this......We don't know who to believe, as in the short time that they have been in place we have found numerous errors. No one in our family has had to deal with hospice situation before and we just don't know what the right thing to do is.............

[truthbtold]

You know what? You WON'T believe it until it actually happens to YOUR loved one. Do not be so quick as to discount these accounts. The scenarios sound like science fiction, but this IS DEFINITELY happening! Too much MORPHINE. My dad was not terminal BY ANY STRETCH OF THE IMAGINATION until hospice came on the scene. Who pushed us into hospice? His medical insurance plan, that's who! Over and over and over again. Made it sound all rosey and wonderful. Do you know that hospice gets paid by Medicare...a flat fee??? My dad was dead in six weeks...and that's only because his constitution NOT to die made him hang on that long. This was after the hospice doctor (hospice company -- or "palliative care" as they like to be called -- barf! -- owned by the doctor) -- debilitated him day after day with psychotrophic drugs (and btw, did you know that's illegal????) The last day of my dad's life, a "closer" "nurse" from hospice came in (not his normal nurse -- and with questionable credentials) and he was dead in an hour!! My sister and I were appalled and had a postmortem toxicology lab performed, and guess what, present were TOXIC levels of MORPHINE and OPIATES -- even though we had stressed written and verbal instructions, time and time again, for NO MORPHINE or OPIATES!! They did what they wanted to do without regard to anything other than their mission. If you will take the time to google HOSPICE KILLS...MORPHINE DEATH...ELDERLY EUTHANASIA...read the stories and be informed. Better yet, read Ron Panzer's book (you can download it for free) called Stealth Euthanasia: Health Care Tyranny in America. I am not promo'ing this book...it is just an extremely informative book. Believe me, I've seen more and more of these stories on the internet in the past two years, we lived it, and it IS TRUE!!

[grigorypogulsky]

Taking Care for people with dementia, mainly the elder people who stay alone at home is very importance for family members and carers. Keeping them in familiar surroundings, particularly during the early and middle stages of dementia when potential risks associated with living at home / living alone should be be managed and maintained safely.

Father of friend of mine is suffering from Dementia and he is using some Dementia Products and elderly care products, which supports them when they are alone. I just searched one the site where these products like memory aids, medication reminder, Fall dectection alarms, etc are available.

You can visit the site HomeCareTechnologies.ie You will also get some further information related to dementia.

[Jack99]

Wow where did you get your education. Do you not know what Morphine Sulfate does to the compromised person? Apparently you don't understand what euthansia is. Morphine decreases blood pressure, decreases the ability to breath causing a build up of carbon dioxide, causes shallow breathing therefore decreases the level of alertness and yes it kills people. Your ignorance is murder. I am a experienced critical care nurse. Death is not painful to the dying person. It is painful for the hospic nurse that treats her pain with morphine to end the life that is entrusted to her care. No angle of mercy, just killing. Morphine is conterindicated for the eldery, check your reference. Tylenol works wonders for most of the fragile patients entrused to hospic care. It appears there are few that need excessive pain relief, and hospic found that it ends life quickly. I just wonder how is hospic compensated, per case or by care delivered. Are they compensated at a higher rate if people die quicker. Are families educated that the Morphine will decrease alertness, breathing, and blood pressure, and hasten death? Trusting families want to trust their hospic nurse, it's a challenging time for the families, and yet they are frequently led to murder the very one they are trying to give the best possible end of life care. I look forward to reading about major rewards for families who sue for wrong information and murder of their loved ones.

[Rumrunner]

Forgive us, it's so hard to let go....