rosie123 Posted October 2013

Did Hospice rush your loved ones death?


I have posted on here many times and answered questions every now and then. Dad passed away Oct 7th 2013 from Liver Cancer . He was in a hospice facility for 11 days until he died. The day before he was admitted he was in the hospital and was talking,eating and very clear headed but his ammonia levels were high and he had been very combative, not eating and wouldn't take his meds for 4 days at his nursing home. ( He was in for a Psych Evaluation.) The hospice worker talked to me about admitting him instead of returning to the nursing home. I agreed to this and arrangements were made. He was transferred later that day and was alert and in good spirits. The next morning he was unresponsive and stayed that way until he passed. They gave him morphine and ativan around the clock. He never got any water but they did cleanse his mouth and moisten it with swabs. It seemed like he could hear me the first few days because I would shake his shoulder and say "dad". His eyes seemed to be moving under his eyelids and his mouth would move slightly. I did ask about them lowering his dosages so he could wake up a little. The nurse said he was getting a very small dosage already. I just wonder if the drugs made him unresponsive and if less was used he could have ate and drank and lived longer. I know it was time for him to go but I'm kinda puzzled about his going from complete alertness and straight into unresponsiveness so quick. The nurses did a Great job. I myself don't know how they do it. They treated dad like he was their baby. So gentle and compassionate. I was just wondering if anyone else had the feeling that death felt a little rushed once their loved one was placed in Hospice.



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JessieBelle Oct 2013
rosie123, I have a feeling that the toxins in his blood just climbed to a level where he couldn't carry on. If the liver is not working, the ammonia and other metabolites will continue to build in the blood. The lungs can handle some of it, but not enough. The main thing I am sorry to read is that you weren't able to have the last days talking with him at least a little. Hospice was giving your father a low dose of morphine, which might have built up some in his body, but it did keep him from suffering.

I am so sorry that your father is gone. I am glad that you had hospice with you to help you through it. They may have hastened his death slightly by trying to keep him comfortable, but it would probably been by very little. If his liver was failing, he wouldn't have handled food well. I have the feeling that they made it as easy on him as they could. I hope that God is with you as you mourn his loss. One day you'll be able to tell him the extra things you wanted to say. I just hope that day isn't anytime soon.

jeannegibbs Oct 2013
No, I don't feel that hospice brought death on any faster. It made the final weeks more comfortable for my husband, and less stressful for me. The hospice nurse was surprised when I called to say he died -- all of us were thinking he had a few more weeks. He was not in pain and so not on morphine at all. He ate breakfast that morning. But, as Shakespeare puts it, "Death, a necessary end, will come when it will come."

In the letter explaining the autopsy results my husband's doctor said, "I am frankly amazed that he survived as long as he did despite the burden of very severe Lewy body disease and atherosclerosis."

I am sorry for the loss of your dear father. There is no precise way of knowing whether he would have gone a few days sooner or later without hospice care. You can feel confident that you did what you considered right. That is all any of us can do.

solegiver Oct 2013
My condolances to you. My dad is on hospice for cancer, but I take care of him at home. When I get a respite, and he goes into the hospice facility, he is definately more drugged. It is very noticable. (Atavan, and Seroquel). When I go to see him, he doesn't even know I'm there. It's terrible. When he's at home, he rarely if ever needs his Atavan. They always tell me how much they love my dad, etc. But it is so noticable he is over medicated when he's in their care.

captain Oct 2013
liquid morphine and ativan definately knocked my mother out and stopped her heart BUT the dying process was already in motion. these meds are given when the patient reaches a state of agitation. hospiss nurse told us they did not want mom to return to consciousness. death was expedited. i suspect that since time began mankind has brought comfort meds to their dying loved ones. you feel inclined to free them from their pain. ive killed several ailing animals in my lifetime and felt justified in doing so. there was no low dose with my mother. it was a full dropper of both liquids every 30 minutes untill respiratory distress killed her. still better than being aware as multiple organs / systems are shutting down.

suzy0519 Jan 2014
Yes, I feel my mother's death was rushed and I wished I had studied about the medications (morphine and Ativan) before I allowed them to give it to her. Allow me to tell my story briefly. In February of 2012 my mother was diagnosed with a rare blood cancer called Mylo-proliferative Disorder. On September 18. 2012 my mother had a stroke and in the moment she had the stroke she fell in her living room beside her easy chair she had just been reading at. On May 27, 2013 my mother passed away after hospice had been there only 2 weeks. I never knew what a difficult time I would have losing my mother but the way she went haunts me and I am just not getting past grieving. As I write this tears are flowing and I feel I can't catch my breath. Regardless of my mom's stoke she was sharp as a tack until the day following the beginning of the administering morphine and Ativan. My mom had a great appetite, she loved ice cream we used to eat together in the evenings, I remember the day after the administration of the drugs began, my mom said to me; "Suzy, stay close to Jesus". When I have visions of my mother the last 2 weeks of her life I feel so guilty that she died the way she did because I allowed them to give her the drugs, I didn't know that the combination would take her so fast, even she told me before she went into the drug induced coma, Suzy, they are taking me down fast so my medical bills don't grow. I brushed it off as oh mom, they are really helping you to make you comfortable and pain free. She knew, she knew they were killing her. They gave her morphine and Ativan around the clock when the nurses weren't there, they left instructions for me that gave the amounts and times to be given. The meds upset my mom's stomach at first we gave her food with the drugs, and later when there was no body response at all her natural reflex's would try to cough up the meds but she was too far into it. 3 days before my mother passed she went into a coma. On the day she passed I was in the next room with a baby monitor I had beside my bed, I had moved back home to take care of my mom after her stroke, I heard her over the baby monitor stop breathing, I ran to her side and took her pulse, she had stopped breathing but her heart was still beating, I cried out to God "please don't do this, I was afraid she had another stoke and she was going to remain like this, so I wailed to God 'if you want her take her but don't do this'. A few moments later she was gone. For the days and months that have followed I wanted to know what happened to my mother, did she have a stroke?, did she have a massive heart attack? No, she stopped breathing because of the morphine and Ativan combination they use it to give comfort they say but it is these two prescription drugs when combined together become lethal, they take your breath away. My mom came from a family of 9 children, all her siblings lived to be in their late 90's, my mom passed shortly after her 80th birthday. She was the most graceful woman I have ever known. Mom, I am so sorry, I didn't know!

stevensmom Jan 2014
Rosie, please accept my condolences on the passing of your dad. I have a hospice story to tell as well...

My 42 year old sister was diagnosed with Stage IV colorectal cancer in late August, 2007. She had surgery in September and had chemo and radiation, but neither did any good. She was able to return to part time work for a couple of months, but had to stop working because she could barely walk. Two days after she stopped working, she could no longer walk without a walker. Over the next week she stopped eating and became unresponsive. I called the emergency number and she was moved to the hospice facility. She was in so much pain from the ambulance ride that it took hospice about 3 hours to get her settled so we could see her. She was on a morphine pump but completely out of it. She did respond once when my other sister came in, but wasn't making any sense.

I had promised her that I would not let her be in pain. I knew the cancer had spread to her liver and lungs and probably her brain, but I didn't know about the brain for sure. She passed away after eight days. I don't know how much she could hear us, but I kept telling her it was OK to go and to go in peace.

Here's what I wanted to say: She knew she was dying and wanted to go peacefully. I feel that I was able to honor her wishes by keeping her on the morphine. The nurse told me that her form of cancer is one of the most painful types because the tumor pressed on the nerves to her legs.

Secondly, I have decided for myself that if I am ever diagnosed with the same kind of cancer (I have a high risk not only due to heredity but also because I have had ulcerative colitis since 1983) that I will only accept palliative care. I too want to go quickly and with as little pain as possible.

My heart goes out to you, Suzy, and I pray that you will be given peace in knowing that you loved your mother and she loved you. Peace to all who have been in our situation.

dogabone Jan 2014
What a topic for someone to start, (Did Hospice rush your loved ones death?)
The OP of this thread should be tared and feathered for making this statement "Topic".,(Did Hospice rush your loved ones death?)
Ya right sure!...Blame it on the helpful Hospice for your loved one's death?
Where was you when this was going on? If so, Why didn't you prevent it?
(She was in so much pain from the ambulance ride that it took hospice about 3 hours to get her settled) In Pain and you blame hospice for the pain? Come -on!
Your only allowed so much morphine for pain by Law. And your Loved one I'm sure was told to fill out a Living Will.
I must say How dare you attempt to throw blame on hospice. That's uncalled for without proof of some type of abuse from hospice of cause. If you seen something and didn't prevent that's your fault not hospice. Sounds very harsh what I'm saying to you. But,your accusing hospice for blame of death is wrong without proof of such claim. Knowone can control all pain to none without a result. There's no cure for cancer and no cure for the pain to none. I understand your sadness watching the pain of a loved one. No excuse to throw blame to others if you your self didn't attempt to prevent. Sounds like you your self needs to accept some blame before pointing to others. Hospice is the best in that time of need.

stevensmom Jan 2014
Dogabone, respectfully, you are way off the mark, no where did I blame hospice for my sister's death. Read my post again, especially this paragraph...

Here's what I wanted to say: She knew she was dying and wanted to go peacefully. I feel that I was able to honor her wishes by keeping her on the morphine. The nurse told me that her form of cancer is one of the most painful types because the tumor pressed on the nerves to her legs.

The reason it took the hospice staff three hours to get her settled was 1st...the paramedics could not get the gurney down the hall and into her room and had to put her in a sitting sling, very hard when someone has colorectal cancer. 2nd...we were in the middle of a blizzard and the facility was on the other side of town, about 10 miles away. It was a dangerous and bumpy ride. 3, It was very early in the morning.

The hospice people wanted to get her pain under control before they allowed us to see her. They put the morphine pump in once she got there; they may have had to give her some other pain meds too and allowed them time to work. They did NOT WANT one of our last memories of my sister to see her in incredible pain. When we were allowed in to see her, she was resting peacefully in bed with a robe on and her hair combed.

The reason I called the emergency number in the middle of the night was because I didn't think the meds I was giving her by mouth were taking care of her pain. I had promised to let her go without pain...that's why I didn't want the hospice facility to cut down on the morphine just so she would be able to MAYBE open her eyes and respond to us. I would never want someone to be in the position I was in, having to decide what is best for my sister in her final hours, but that it what we do when we care for someone. Instead of "blaming" hospice for my sister's death, they allowed her last days to be comfortable and without pain. I'm sure you want the same thing for your loved ones.

Please re-read everyone's posts....we all have the right to ask any question on this site without feeling attacked by someone else's opinion.

Veronica91 Jan 2014
Rosie I am so sorry for your loss, it is clearly very recent and painful to talk about. People with liver cancer typically fall into a coma before they die and it is important to continue with medications so even though they are unresponsive they remain pain free and any anxiety is relieved. Ativan and Morphine are the drugs of choice at the end of life especially in the home. The volume of liquid morphine is very small and can be absorbed in the mouth by slowly dripping it in. There is a very good blood supply to the mouth so it continues to be more effective than an IV or injection when the blood supply is shutting down along with other life preserving systems. very often the patient's pain will dramatically increase and it is quite a struggle to control it . Basically if the patient is in severe pain it is necessary to give the medication until the patient is comfortable. I have sat with many patients and administered the morphine until they were comfortable and sometimes unresponsive. At that point I would reduce the dose but continue on a 2-4 hour schedule and instruct the caregiver to continue. Often the patient and their family were pleading for the pain to be relieved. Did I hasten anyone's death? I don't know the answer to that but never did I set out to end their life. That's God's work. Many people will tell you that when you go on hospice they give you morphine and you die. This may appear to be true because many people wait far too long before calling hospice and may even die during admission before hospice has given them anything. others will pass that night or within a few days. We always liked to have the drugs in the house in case of need. We would tell the caregiver not to touch them but call for a nurse first and she would visit and assess the patient. But I digress but wanted to share what happens behind the scenes so to speak. Actually it is more beneficial to hospice if the patient continues to live, When they die we don't save anything and loose the Medicaid payment which is paid daily. so if some one dies after midnight we get paid for that day.
I have no experience with a for profit hospice it could be more beneficial by saving supplies and nurses time if the patient died quickly. I can not comment on that

rosie123 Jan 2014
Dogabone.. I asked the question because my brother accused me of putting dad in hospice and letting the staff over medicate him so he would die quicker. I then did a little research on that subject on the internet and found that some people believe that like he does. I am a member of this group so where better for me to get input of all kinds on this subject. It has informed and enlightened me as I read the responses. When I want an answer to something I ask. That is all it was.. a question. No blame, nothing. The staff treated dad like he was their own. For that I will be eternally grateful. I was his only caregiver for 4 yrs and finally I had someone to share the load with me and they did. Overall, the experience was very peaceful for me and hopefully for my dad too. I have informed my son that hospice is where I want to be when my time to leave this earth nears.

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