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Tuesday, April 17. 2018
Hospice, aka Comfort Care
Barbara Bush in failing health, won’t seek additional treatment
That's the right thing to do. It is unwise and inhumane to continue to treat people medically when it is clearly their time to go.
Posted by Dr. Joy Bliss in Medical at 13:45 | Comments (10) | Trackbacks (0)
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When a 92-year-old woman's heart and lungs are failing, there's comes a time when medical intervention is needless torture. She'll have excellent palliative care. No need to keep rushing her to the emergency room for resuscitations and procedures that won't make much difference anyway. It's not as though they could cure end-stage congestive heart failure.
We have a family member who passed after a long battle with COPD, similar to Mrs. Bush. There is no cure nor treatment that restores the lungs, only palliatives (oxygen concentrators, inhalors, etc). The lungs progressively fail to collect oxygen, and this inexorably leads to congestive heart failure. The recoveries are temporary and always at a fraction of previous condition - a case of becoming progressively weaker and less able to recover. There comes a point where keeping the patient comfortable and at ease is the primary goal. I wish the Bush family all the best in this sad time and trust she will have the best of care.
IMHO hospice is torture. Probably not the hospice Ms Bush will receive but the send you home to die and we will check on you once a week to see if you are dead yet hospice that everyone else gets is not "humane". Sadly I don't have a better answer except maybe .357.
The only people I've known who were receiving home care from Hospice made the choice themselves. They wanted to die and home and got their wishes. Hospice came weekly until more care was needed and finally came every day. Hospice is wonderful in the original meaning of the word.
Essentially you are right. But understand that if you are on Medicare you MUST go home. You cannot stay in the hospital even if the doctor would prefer that you do. AND IF YOU CHOSE hospice you cannot go back to the hospital even if you have a serious medical issue while at home. You are not supposed to call 911 or have the EMTs come help, because... you chose to go home and die.
Sadly I don't have a better answer except maybe assisted suicide.
Sadly, I concur with you. When my mother fell and hit her head two years ago at home alone, it was the beginning of the end. Hospice was called after we were informed her brain was irreparably damaged. Thinking they would "be there" to assist me, I was mortified to learn that they would show up twice a week to see if I "needed" anything. For three grievously sad & exhausting weeks, I maintained a bedside vigil for my precious mom at her home. I have zero nursing skills but did the best I could for her.
It's horrible the way that elderly patients get treated at the end of their lives. And it all happens because neither Doctors nor the medical industry want to be held responsible for anything.
Right now, they actually starve old people to death. Really.
Here's what should happen: When the end is near, a hospice nurse should administer 30cc of insulin. A fast and painless death will ensue.
I feel compelled to say something good about hospice because there is something good to say.
They did provide the bed and medical equipment to help the caregiver and the patient. They did have a nurse show up and I think it was twice a week and she did spend 45 minutes to an hour with the patient and the caregiver (my wife). They provided a volunteer to bath the patient and stuff. They had some serious pain medicine, a patch, delivered as needed.
But it was a long process with no hope and no training or backup. We were on our own.
One family member who was in hospice passed away and I'm guessing it was simply that the pain medication made her so groggy that she didn't drink enough fluids and her caretaker wasn't aware enough so she died from dehydration. That's my guess. I would never say that to the person taking care of her. Again no training no real help so mistakes are made.
I'm horrified to read these stories. I've had two experiences experiences with home hospice care now for two relatives. Both got good palliative care and constant attention when it became necessary towards the end. There must be huge differences among the providers. Keep looking and find a good one. In both cases the dying patient was treated far more kindly and appropriately than would have been possible in a hospital. The doctors stopped doing invasive and unpleasant procedures that no one really believed would help any more, and concentrated on making the patient as pain-free as possible. Were the patients being "sent home to die"? Well, yes, they clearly were dying, so it was a question of being kept in the hospital to die or being sent home to die. The answer was obvious.
Let me give some examples: My mother in law was placed in hospice and may well have lived weeks, months longer. But she didn't. She died within a week. Most probably from dehydration because her pain patch made her incapable of choosing to drink water and the total and complete lack of training and preparedness of the care giver allowed her to think "mom" was resting and all was well if she wasn't complaining. There was no doctor after the decision to use hospice and there wouldn't be any doctor no matter what happened. That is the hospice agreement, i.e. you are sent home to die and we will not send help if things go bad. There was no nurse, it all happened quick enough that no nurse was scheduled for weekly visits yet.
If you are on medicare in a hospital for any of those illnesses that likely results in death they WILL send you home without regard to whether or not it shortens your life or that there isn't adequate care at home. The law requires the hospital to discharge the patient; it is a cost saving feature of Medicare. If you are sent home on hospice you are advised to not call 911 if things suddenly go bad because the patient is expected to die and it probably won't be pretty.
This is the reality of hospice. The visiting nurse is nice but her primary duty is to make sure the patient is adequately drugged so that they feel no pain. The patient could be bleeding from every orifice and the nurse would and could do nothing. The patient is there to die, period.
One other important little known factor. If you are on Medicare and are hospitalized the hospital is on notice that the clock is ticking and they need to decide what to do and discharge you as soon as possible. AND if your are discharged you cannot be readmitted for the same problem/illness within the next 6 months. Most people do not understand this; that when you agree to this hasty discharge you also agree that if it all goes bad at home that's just too bad.