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My 93-year-old grandmother who has all timers and dementia has spent the last seven years of her life in a nursing home. My mother and her sister take turns visiting my grandmother daily. Other family members visit my grandmother as well. I visit my grandmother every other Sunday with my mom. My grandma's health has been diminishing because of her loss of appetite. She's always been a little bit chubby but she has been losing weight drastically because of her loss of appetite. My mom generally feeds her fresh fruit Jell-O and thickening liquids that the nursing home provides. We've all discussed that my grandmother probably gets no other nutrition besides when someone comes to visit and spoonfeeds for lunch or dinner.

A few weeks ago a hospice representative approach my mother and told my mother that their services would provide comfort for the family and my grandma as my grandmother's health continues to deteriorate.

Last week when I went to visit my grandmother I noticed that she had a brand-new chair that seeded her a lot better and she seemed more comfortable.

today when I arrived I thought my grandma was dead. I've never seen her look so poor and not in control whatsoever of her body functions.

We proceeded to the nurses station and found out that hospice has been administering morphine since Friday at midnight every six hours but the nursing staff could administer more every two hours if they felt my grandma was in pain. I asked the head nurse how has this happened that the family has not consented to morphine yet my grandmother has been given morphine for the past 48 hours... The head nurse said that hospice is supposed to contact the family to let them know but in order to stop giving her morphine they would have to have a doctors order faxed to them immediately... Where they would have no choice but to give her the dosage. I am mediately called hospice and left a message on their Emergency number. My mother said by the time she got home hospice had already called she return your phone call and they agreed they would call the nursing home and tell them to stop. This evening around 630 we were called by the nursing home letting us know my grandma's blood pressure was 74 and they said she may not have much time left to get to the nursing home immediately. Grandma was itching her skin and hair... The majority of the time she seemed disoriented and confused and still highly medicated. Her mouth was wide open and it looked like she desperately needed water or something moist to quench her thirst. A hospice care worker was there as well and said she would be willing to meet with me in the hall to discuss my grandma's condition. I told her I was not interested in speaking to her about my grandmother's condition and they have already caused enough problems. Miscommunication could be detrimental to my grandma's condition... And no one in the family had consented to my grandmother given morphine.

My question is do you think my grandmother will survive after having morphine in her system for more than 48 hours? The nursing home also told us that hospice had change the doses of some of her medicines and in fact she was placed on another medicine for anxiety; one that is not recommended for Alzheimer's and dementia patients- we were told the drug makes patient very lethargic.

Seroquel 25 mg -- is the drug and dosage.

My grandmother hasn't had food or liquids for several days now. I'm actually ticked that hospice could be so negligence and not inform the family about the morphine and we had to find out through the nursing staff at the hospital.

The nursing staff knows my grandmother for seven years -- it's not like no one came to visit her-- family was constantly surrounding her-- now hospice has come in and in within one weekend has caused her to be incoherent, non-responsive in a coma like state.



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Why did you put your grandmother on hospice? If you are unhappy with them, have her medical proxy change her care. I am a bit perplexed. Your gma hasn't been eating and has been in the NH for 7 years, suffering from Alzheimer's. She has her liquids thickened and has been losing weight. It sounds like it is time for you to give her permission to let go if she wants to. You may visit her once a week, but she has to live with her condition each day. Is she in pain? Is that why she was receiving morphine? Please let us know a bit more.
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Check the admission papers signed when she was admitted to hospice. There generally are broad consents allowing the admission of medicine as needed, as determined by the staff, as well as other broad consents. My guess it that consent was provided in these broad provisions covered by the admission document.

Many people don't even bother to read the medical consents before signing.

As to your question of whether your grandmother will survive after morphine administration, that really can't be answered by anyone here who doesn't have access to your grandmother's specific chart to know what else was administered, what other conditions she might have, what the general state of her health was, etc.

I'm confused though...you wrote that you learned "through the nursing staff at the hospital" that hospice was administering the morphine. What role is the hospital playing, or is your GM in a hospice wing at a hospital?

It must be very frustrating for you to be dealing with this unresolved issue. I would sit down very quickly and have a discussion with hospice, even if you don't have confidence in them, to get the information you seek, especially the issue of what consents were granted when admission papers were signed.

I'm sorry to learn this has been so upsetting to you.
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It sounds to me like they are providing comfort care for your grandmother which is basically end of life care. Thats when they usually stop all foods and fluids and keep the person comfortable with morphine and sometimes anti anxiety medicine.

There must be a complete misunderstanding on your part. Hospice is usually reserved for end of life care so why did you call hospice? I know how hard it is to make decisions like this but perhaps as Jessie said maybe its time to let grandmother go peacefully and that sometimes involves administering morphine.
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My mom was approached by a hospice rep while she was visiting with my granny close to a month ago now. The rep said hospice could help get her a better chair that fit her better and would allow her to be more comfortable- which they did right away.

The rep also said they had volunteers that would come visit my grandma, my mom said she assumed they were visiting her... That's why my mom said she signed my granny up for hospice visits.

Yes granny has been in the nursing home for 7 years... Everyone there seems to like her because she's a character-- always happy go lucky and waiving and laughing holding on to her dolls which she calls her babies, etc.

She's been on the thickening liquids for more than a year for sure.

Food wise she would eat only if we feed her or if someone else did.
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Was the reason for involving hospice then to get a better chair? Wasn't the issue of hospice being for terminal situations discussed?
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What did you think that putting your loved one on hospice was going to mean? Did they say they would call a family member before each and every drug change or new dose? Or did they say the would take charge?

My husband died on hospice in our home. They gave me the drug kit, explained what each thing was for, and I was in charge of what to give when.

When my mother went on hospice in the nursing home, we understood that Hospice, rather than the NH, would be in charge of what drugs she would be given and when. That is kind of the point in bringing them in. Their goal is to keep the patient comfortable and pain-free. They did a great job. Mother graduated out of that program in a few months. That was a year ago. She is doing well. When her time comes, I would certainly have her back on hospice care.

It is always hard to say how much of what you are seeing, if any, is due to the drugs, and how much, if any, it might be worse without the drugs. Hospice has A LOT of experience with the dying. That's why they insist on that comfortable chair immediately, and demand and get different mattress pads or beds. And it is why they make the drug decisions they make. They are all about comfort care.

Remember, hospice is for persons expected to die within the next 6 months or so. People who are actively dying don't look and behave like they did before they were actively dying.

You say "My grandma's health has been diminishing because of her loss of appetite" but it is probably more true that her appetite has been diminishing because of increasing and accelerating loss of health. People who are on the last leg of their journey are often not interested in eating. And at the very end, eating when their body can no longer process food may make them suffer.

It is so very hard to see our loved ones' health decline before our very eyes. My heart goes out to all of you.

Not all hospices live up to their mission. Maybe you got a bad one. But I think it is very likely that you had/have a misunderstanding of what hospice was going to do. It can be extremely stressful to see a loved one in the final stages of life. I suspect that is really what is so upsetting to you. And it would be upsetting whether there was any morphine involved or not.

Who is in charge of medical decisions for your grandmother? That person can cancel the hospice program at any time. Personally, I think that would be a mistake, but it is perfectly possible to do it.
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My mom and my aunt are the POAs not me I'm the grandkid. Hospice is coming in tomorrow to meet with my mom and aunt.

I had a feeling the paperwork probably stated something to the fact about administering meds based on granny's conditions and changes etc.

I guess my main question was the one I asked already ... Will she survive after having 48 hours worth of morphine pumped in her?

But like on person said it's impossible to answer unless you look at her medical charts, etc.

Thank you for your time!
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Yes, your grandmother can survive even after having morphine. It is not morphine she is dying from. How long she can survive the conditions she has in another mystery.

The hospital that discharged her to hospice care thought my mother might not live out the week. That was 18 months ago. She's still enjoying bingo. Hospice thought my husband had at least several weeks left when he died. All anybody can do is give a best-guess.

I think you will find this article about morphine use by hospice very enlightening: http://www.hospicenet.org/html/pain_myths.html
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By the way, please come back and tell us about the meeting with hospice by your mom and aunt, and what they decide to do. We learn from each other.
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Confused, go with your mother and aunt tomorrow and ask your specific question about survival after morphine. And don't be bashful - make sure you get an answer or at least a project of survivability so you understand the situation.

I hope you feel better about this and get the answers you need tomorrow.
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Update: now the morphine is wearing off and granny will die with out fluids being administered intravenously. My Aunt, one of two POAs has hit the road for a day trip while we are left to question why would one leave Granny with no way to eat or fend for herself now that she is coming off of the drugs. Regardless living out your days on morphine or without is horrible. However no communication at a time when communication is needed the most is just plain ole belligerent. It is what it is and I can't change the path for my grandmother's demise. Thanks for your feedback and knowledge on Hospice and morphine.
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Confused, in "end of life" situations, as the body shuts down, nutrition is neither desired nor needed by the patient. It seems to me that you are questioning if granny is really at the "end of life" stage, although everything you've written about her condition would seem to indicate that's where she is.
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Was there a meeting with Hospice? Were you present? Did you get answers to your questions?

When you say "we are left to question", who is the "we"?

Granny is being left...isn't she in a nursing home? With hospice care? So, do you want someone to be with her 24/7?
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We that have been through it know that death is hard to accept and to deal with. We always hope there will be a turnaround and maybe one more day. ConfusedHoosier, your gma seems to be at the end of her journey. Perhaps you can spend some time with her and not worry so much about fighting for one more day or week. Maybe you can think about what your grandmother would have wanted if she knew this was going to be what happened.
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There was only a meeting if the POAs wanted one -- my mom is one of the two POAs -- there was not a meeting today - although my moms spoke to the head nurse and she didn't realize my grandma was put on morphine over the weekend.

When I say we are lefted with questions I mean me, my sister, my cousins, my granny's niece, etc.

My grandma would kick all of our a**es if she was able for putting her in a nursing home in the first place. When she was stronger she would resist as much as she could and say lets get the hell out of here - take me home- your grandfather would roll over in his grave if he knew your mother put me in here! :)

The family who were present at the nursing home today and tonight kept saying why isn't she in the hospital? Where's the fuilds? I feel exhausted-- because I don't have the answers nor am I the POA... But the staff filled me in well enough to understand if we take granny to the hospital or hook up fuilds for granny to be comfortable as possible and hydrated -- hospice will walk-- so if grandma does start going into shock and is in agonizing pain thanks to their shenanigans hospice will say ... oh we have a 6 month wait see you when we can get back to you.

I don't have the answers -- but I can tell you this much from what I've learned thus far Hospice seems pretty "snakey" to me ... Perhaps I will change my point of view at the end of this experience -- but for someone to not communicate with the family that morphine is being administered is unacceptable-- yeah we are all appreciative grandma got a chair 2 weeks ago that she fit in comfortably -- but to have her bedridden this week isn't worth it-- I'd rather take the crappy chair back at least it had my grandma in it awake and coherent.
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ConfusedHoosier, think of it this way, your Grandmother is deciding what she wants to do and that is to go into her final chapter of her life, she is doing that by not wanting to eat or not wanting a lot of liquids. Let her have control of this choice. And let her rest peacefully, and if morphine helps her rest peacefully then let her have that medicine.

My Mom [97] is on hospice care.... hospice usually calls the POA and not the rest of the family members as they just want one person to make the decisions. I was told about the morphine and agreed it would help if my Mom had any discomfort. If hospice called everyone in the family, half would say yes, half would say no, and hospice would be at a standstill until everyone in the family comes to an agreement... and that is not fair to the Grandmother.

ConfusedHoosier, you are visiting your Grandmother once every two weeks, thus you are not seeing the ups and downs of what your Grandmother is going through. With my own Mom one day she would be alert, sitting in her Geri Recliner, and being chatty... the next day she would be in bed totally zoned out... next day back to being alert, same the following day, then the day after back to being zoned out and again the following day. My Mom also had her mouth wide opened and that was because she was breathing through her mouth, that does happen. Then there is delirium which is frightening to watch unless given a certain medicine to zone the patient out. Then the picking at one's clothing, the bedding, one's skin, etc. Whenever I see this in my Mom, I want her to close her final chapter sooner than later. The quality of life is gone.
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Confused, since you are not the POA I want to suggest that you trust your mom and aunt. It is their job to carry out Grandma's wishes. I am sure that the three of them discussed this and your mom and aunt have the very difficult job of carrying out grandma's instructions and wishes. Please do not make it harder on them. I will tell you my mom is 89 in later stages of Alzheimer's Disease and her instructions are no heroics, that means surgeries, tubes, whatever to keep her alive and suffer just one more day. She completed her documents 15 years ago when she was perfectly capable of making these decisions.

My suggestion for you is to call your siblings and whoever to tell them you all need to support your mom and aunt through this. Trust in them that they are doing as grandma wanted. Do not make this harder for mom and aunt than it already is. Then all of you call your moms and ask what you can do to help and let them know you love them.
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My mom was put on hospice, and it was what the hospital and doctors pumped her up full of medicines, steroids, she was out of it. Then they sent her home with nothing but hospice. We ended up firing the hospice people, and we took over. that was February, and they told us my mom was going to die. We were in denial. We knew what happened was from the hospital, she walked in there. Now that God, she is living with my brother. I want to call the hospise people up to come and see the woman they said had no hope. Don't ever give up hope!
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I'm sorry for your distress,it is not illegal however hospice usually bring the meds for pain,anxiety,nausea and such.In majority of cases I've seen the family usually administer these dr
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I give up,this iis messing up too much
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My mother is 100. The first time she was in hospice care, I thought they were wonderful. She had pnuemonia and could have lived or died and we managed to get her well enough to be released from hospice and continue "living". This time, I have a completely different view.
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See above under mymomsmom. She is under hospice care again. I will never allow them to give her morphine. They persuaded me to forego food and water and once I realized what I was doing to her, it was too late to bring her back. This starvation and lack of water is barbaric, inhumane and, quite frankly murder. I will NEVER be able to forgive myself for doing this to her. She is lingering and wasting away and it's a terrible death. I wouldn't put my dog thru this and yet, I've allowed myself to kill my own mother. I'm a Christian and I can't even pray anymore b/c I am so guilt ridden.
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You know u can change hospice companies,right.
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Morphine is your/ her friend, and I don't understand the ignorance of it. I was on morphine for seven months following a car accident, and my Mum has been taking it for six years. And we manage to "survive" it. And yes, it does make you thirsty. If it were me, I'd get my grandmama a glass of water if I had to walk *over* staff.
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WHY do you want to keep your poor grandmother alive? For what? She has advanced Alzheimers and is losing weight - it's apparent she's had enough!

Hint: there is NO CURE for old age!

We have been caring for my 93 yo MIL in our home for the past year. Here's what we have learned: neither one of us will EVER go through what she is going through: sleeping 18-19 hours/day, bored - but unwilling to go to a senior day care (and my husband is too guilty/foolish to force her to - unfortunately for her and us - since we are now trapped in our home 24/7), a burden to others with NO quality of life, no hobbies, failing eyesight so she can't read much (not that she ever did, she dropped out of school as a teen), slowly declining physical health, increasing dementia making it harder for her to function and even have a conversation....

No no - we've discussed it, and we'll both be taking a pill before we get to this point: a living death, a "life", days and weeks just waiting to die....recently added to my bucket list: if I make it to 90 I intend to try all the drugs I didn't try earlier in life - and maybe some of those too. Haha!

So again, WHY do you want to keep your Grandmother alive?
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Anita, I was thinking the same thing. I don't know what people expect when people are dying slowly. My father died naturally after a 10-year descent to the grave. The last few days were not pretty. They were not the touching scenes that are common for movies and TV. If I had to pick a word to describe it, I would say withering. We watched as his organ systems failed and his circulation stopped working. He had a lot of pain in his legs. He didn't really want food and water, though he would eat a bit. The only relief from the withering state was when he rallied about an hour before his death. He ate a turkey sandwich and drank some Ensure. He still had turkey on his lips and teeth when he began his final descent into death as his lungs filled with fluid.

He didn't know who I was. He thought I was a nurse or other employee. In the last hour he couldn't find words. It was merciful when death finally came. I had called hospice in that morning and they arrived quickly, but he had just died. I wish I had brought them in earlier, but there was denial and resistance from my mother. I know if they had been there his last few days would have been better. They would have relieved the pain that he had in his legs. It was excrutiating to him, I know.

So... while some people are sorry for calling in hospice, others of us are sorry that we did not. Hospitals are reluctant to give morphine -- probably because of what we are reading here and being questioned about the use. I don't know. I just know it would have been a great gift to my father in easing his pain during the final days.

My father was still walking slowly a week before his death. When the final days came, they moved in swiftly.
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Hospice put my mother on an opiod without my consent. I was the POA. She was not in pain. I questioned them about this and was told they were in charge of her care and not the nursing home. She was 83 and had been bedridden for 2 months after falling and breaking her hip. She died after 12 hours on the opiod. I believe hospice hastened her death. Is hospice legally liable?
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In the case you describe morphine is used when the patient is near death to keep them comfortable. This is generally the doctors decision as the end is close.
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When it seemed clear that my Mom wasn't going to recover from her fall/head injury the geriatric/dementia doctor at the hospital recommended hospice. Hospice gathered the family in for a meeting where hospice described what kind of care they do and what to expect in the future. I was glad there were many ears at this meeting because it can be difficult to digest as this is one's final chapter in their life. I am sure most people don't hear everything that is said, I know my Dad didn't. I am sure a lot of people didn't read word for word what they are signing.

Hospice had called me [POA] to talk about the meds that my Mom had been taking from her primary and specialist doctors, to which all was stopped, and that if Mom was in pain would it be ok to use morphine... I had suggested another med to try, but if that med didn't work then yes to morphine... I wanted my Mom to be comfortable.

I know occasionally Mom my will say "I've had enough" to which we believe is in reference to being bedridden for the past two months and having her mind befuddled.
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Ultimately the patient or healthcare proxy is in charge. If patient or their proxy say no, then something is not done. If it is against hospice policy, then hospice can pull out.
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