I am having a problem following the Hospice and Care Center's rules for administering Morphine/other pain meds for my father.

Background...90 yr old male. First broken hip Oct 2013. 100% wheelchair dependency. He can stand with assistance and hold onto something when needed. Multiple falls and injuries.
He is VERY hyperactive, constantly wheeling himself, sometimes for 3 hours straight.
He is on Ativan for that but it doesn't seem to do much good. He has lacerated, bruised, swollen, pressure sores on his feet since he never sits still and because of poor circulation.
He was in a Nursing Home for 11 months. They were very good to him but he ceased to thrive. Lost 35 pounds in 11 months. Meals are only a few nibbles. No feelings of hunger. Still VERY verbal and able to communicate, although his responses may not be on topic. His COPD has worsened beyond belief the past 18 months. Very frail individual. Zero short term memory. He DOES have a very high pain tolerance his entire life.
During the 11 months in NH, I questioned admin staff multiple times re what else can be done. I asked about Hospice. I was told since he still had a very happy easy-going personality and loved to talk, that he was considered still a high quality of life.
He was moved 11 Mar 2015 to a closer care center, due to distance and finances since we are private pay.
On 25 March the doctor saw my father to prescribe his meds, routine visit. After a full hour of taking his medical history and evaluating, the doctor said "Have you even considered Hospice care? Your father is in end-stage Alzheimer's and is very frail and needs Hospice now". I was amazed that someone finally understood.
I met with Hospice on 30 March, spending 2 1/2 hours talking to a social worker and hospice nurse before signing the paperwork.
I explained how he is in pain from arthritis, his COPD, his feet, etc., but he couldn't find the way to say he hurt. That he would display stress and pain from wringing his hands, being very restless, definite signs that something was bothering him. They said that many ALZ patients did not feel pain the way others may, and they understood that many ALZ patients could not verbalize that they need pain relief.
Less than 33 hours later, at 10 pm on 31 Mar, I got a phone call from the care center that my father had fallen out of his wheelchair and was injured. The care center called the hospice nurse, called 911, and he was taken to the ER.
Two ER doctors said he had shattered his other hip and was in bad shape. Hospice and I agreed that there would be no aggressive treatment or surgery. To keep him comfortable, out of pain only.
Dad was transferred back to the care center on 02 Apr 2015 with Hospice doctor's orders to administer Morphine every 6 hours as needed.
After this long, drawn-out story (apologies but wanted to share background history),
I am now in a quandary.
He has only received Morphine a few times. When I ask why, the nurse will reply "I asked him did he hurt, he said 'no'. If he doesn't ask for pain meds, I can't give it to him".
That just seems....WRONG. I'm not trying to kill my father but I was under the impression that once Hospice told me they would start giving Morphine to keep him comfortable, that this would be a standing order.
Trying to get in touch with the hospice nurse is futile.
How does an ALZ patient get the message across if they can't say "Hey, how about some morphine NOW?"
He does have an apt with Hospice doctor on 07 Apr and I was hoping to get some suggestions from all of you on what to say to the Hospice doctor.
I know he hurts, but he can't always say the right words.

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My mother has expressive aphasia and dementia as the result of strokes. She also ALWAYS says no if you ask if she's in pain, even though you can see from her scrunched up face that's she is. No more PRN meds, ever. She is no longer mobile, so there is no fall risk.
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The same thing happened to my dad. The NH staff wouldn't give him his hospice pain meds because they were PRN and my dad couldn't verbalize if he was in pain. After a huge battle with the NH I finally got the hospice Dr. to change the order to every 4 hours instead of "as needed".
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If you can't get in touch with the Hospice nurse, something is seriously wrong with this situation. You're supposed to be able to reach someone from Hospice around the clock. If the doctor wrote the order "prn", the nurse can only give it at patient request. Doctor needs to change this to a sanding order (morphine every X hours, with additional prn).

Go back to your hospice paperwork. Is there an emergency number? Call it and tell them you need the order caged NOW.
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