Mom's nursing home has no hospice.
Mom is declining, down to 82 pounds and not eating. Being on morphine and tranquilizer she sleeps most of the time, is confused. Its hard to tell if she is slowly dying, or if the drugs are making it look that way. She is looking worse and worse over the past 3 months, so it appears she is slowly going downhill (not surprising at her age and condition).
No drugs mean she would be so agitated she will try to get out of bed and fall again even with the fractured pelvis. Without the tranquilizer she is like a trapped animal, thrashing around, confused, upset, pulling her splint off, etc.
I asked if it is time for hospice and they told me they don't do hospice, but comfort care. I had to choose from a list of care items what to have them do or not. I chose pain alleviation and comfort and to treat only a UTI if necessary, no life extending care, tubes, etc.
It appears to me she is receiving excellent care, turning her to prevent bed sores, washing her and putting lotion on, keeping her comfortable, feeding and liquid if she wants it, even to using a hoist and putting her in a geri chair so she can sit by the nurses station if she wants. Yesterday, she did not want to be moved, so they let her sleep. They check on her a lot.
This sounds a lot like hospice care but without the extra people. Since this NH is so far out in the country, I'm guessing that hospice won't come out that far and they have no staff nearby.
What you are saying about comfort care, sounds similar to what Hospice would be doing. Sounds like the nursing home doctor is prescribing drugs the same type of meds that a Hospice doctor would prescribe... comfort is the #1 issue.
My Mom also spent a lot of time in her geri-recliner by the nurses station except for those days when she wanted to sleep, which became more and more often. Hospice is pretty good about letting you know when time is near, I remember they told me it will be within 24-48 hours, so I stayed overnight and sure enough the second night was Mom's last. Yes, she passed in her sleep.
Wish I could be there to help you through this, as our Mom's were taking very similar paths.
It does sound like Mom is dying doesn't it? I pray it will be soon and she just goes to sleep. She has no dignity left, confused, in pain and helpless. If she were in her right mind, she would not want this.
My mom is also on Comfort Care. We specified no transport to the hospital unless they get explicit permission from us. She's got morphine "as needed" on her med list should she start having breathing difficulties from a recurring pleural effusion.