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I am living a nightmare. From one week ago, the hospitalists have been relentlessly pursuing my mother to go on palliative care. I wouldn't mind if they said, "We are here if you need us," but they are RELENTLESS. They have my mother on a do not give food by mouth, and they refuse to feed her, even though she asked for a cookie. They WILL ONLY FEED her if I agree to put her on palliative care and take her out of hospital care. They said she will never leave the hospital alive, but will she leave HOSPICE alive. I thought Hospice was an OPTION. I didn't realize it was mandatory. She is on IV fluids, and they are pressuring to pull the fluids. I just have a gut feeling they are trying to rush her demise because she has dementia. She is not in any pain, but they mentioned Morphine, and I said NO! Can the hospital continue to starve my mother unless I put her into hospice??

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We are missing a lot of info here. Surely your mom is having difficultly swallowing. If that is the case, swallowing brings the danger of aspiration of food directly into the lung, and then death. So they will not feed her by mouth unless you say you are fine with that death as a result. Hospice gives extra time and extra care and most of all COMFORT to Mom. The hospital can place a feeding tube into your mom. This would mean restraints so she doesn't pull it out. Is that what you would want for her. If she is ill and debilitated then the tube feeding will give her diarrhea, bed sores, infection, and an awful death.
Hon, I think what they are trying to tell you is that your Mom is dying. The quality of her life is diminished, and she cannot be brought back from this place. What she is going through is, in the opinion of this nurse, somewhat a torture when kept going beyond when we can swallow normally.
You know your Mom better than me. I don't know her age, her diagnosis or anything else because you have told me nothing but that you are not ready to see her go and leave you. I don't know what she felt about these things. Was there a time when she said to you "Don't you EVER let me go; you fight for every second I have left in life because I want every second no matter what".
Most doctors no longer believe in heroic measures (and feeding by tube is honestly that) any more.
Hospice is an option. If you are health care POA then you can refuse it. But it is meant to comfort and help. If Mom has no pain you can refuse pain medication. If she has no breathing difficulties. Because Morphine helps breathing problems, as well.
If the doctors are this adamant then I believe your Mom must be suffering to no good end. Because it is unusual for them to be this brutally honest. I am so sorry. This is a terrible loss, the worse when you are not ready for it. I know you just want her to have that cookie, but with it, she may choke and die.
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Dear Have Faith, is this the first time you have been part of the dying process? It does sound as though some of the medical comments from here are probably new to you. Emotionally, perhaps you find it hard to accept that death is coming, whether in hospital or in hospice. Are the people who are talking to you, assuming that you have more experience than you do? Or are you finding it hard to listen? It might be helpful to have a ‘back to basics’ chat with the hospital social worker, or a chaplain, or even the hospice staff member who does the first discussions. This is a very very difficult time in everyone’s life experience. Best wishes for coping.
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If mother is on hospice, is given solid food, aspirates and dies, that is within the parameters of hospice – give her what she wants because death is coming anyway. If she is in hospital and the same thing happens, it’s a failure of medical treatment for which they are (justifiably) liable. It really does make sense. However it is more than possible that hospice won't want to give solid food, just because it is so dangerous.
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Not only aspiration pneumonia, if her body is shutting down eating anything could cause a tremendous amount of pain. People do graduate from hospice, get well enough that they no longer qualify.

Hospice can help mom by making her more comfortable and providing additional services, including free counseling for you. All paid for by Medicare.
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If a Hospital has recommended Hospice, then that is what Mom needs. They do not suggest it lightly. My daughter worked in rehab/nursing homes for 20 yrs. She does not recommend feeding tubes for people that are actively dying. It does more harm than good. Your Mom may have lost the ability to swallow. Her body maybe shutting down, so feeding her does more harm then good. Like said Morphine is used to ease breathing too.

On Hospice your Mom will be kept comfortable. Your decision will be where. If u take her home, u will receive an aide maybe 3x a week a nurse too. But you will be the one doing the most work. I would ask the Hospital if u agree to Hospice, will she remain at the Hospital. Or transferred to a NH. Be aware, Medicare may pay for the hospital but they won't pay for the facility. They only pay for the care and supplies. My GF was on Hospice at a Hospital, not sure how the hospital bills were covered. My Mom was on Medicaid in a NH so the facility was covered.
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FloridaDD Mar 2020
It bothers me that they will only feed the woman if she goes on hospice.  Either she can be fed food or not.
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I'm sorry. It seems as though your mother is stuck in that terrible place where eating will almost certainly result in aspiration. Hospitals can't fix everything and they are ethically correct to not allow something that will certainly do harm (food by mouth). Hospitals are for acute curative care and they aren't the best place for your mother now, it is time to decide where she goes now - will you take her home or can you afford a hospice facility? It may well be that her days on this earth are numbered, unfortunately studies have shown that even feeding tubes do not significantly change the timeline for those with advanced dementia.
https://www.choosingwisely.org/patient-resources/feeding-tubes-for-people-with-alzheimers/
Hospice should allow you to focus on the quality of her remaining life however long it may be - for example you may opt to allow her the option to eat what she chooses while recognizing the risks. You don't have to start any end of life medications until she actually IS end of life, but the Hospice will supply them so they are readily available when needed. You should be able to hash this all out with your Hospice provider so that you are all on the same page, remember YOU are the one in charge and although they may suggest they can not force anything you don't approve of. If you can't come to a meeting of the minds with this particular Hospice group perhaps a different one will suit you better.
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It sounds awful to me.   Ask them, how can they justify feeding her if she is in hospice, but not if in hospital.   Either she can be fed or not.   Of course they want to give her morphine, because once they stop feeding her, she will be in pain.  Can she be moved to another hospital?
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worriedinCali Mar 2020
She won’t be in pain once they stop feeding her.
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