Could this be something to look into?

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Dying cousin admitted to a subacute care facility. Rectal cancer and COPD ( 17 % lung function) We all know it is end of life. Day 1 & 2 she could sorta speak but was doped up with morphine, She kissed my hand on Tuesday. Got there Wed morning at 11 am nobody was around. I walked in and she was aspirating. I called her name she was not responsive, even after touching her arm, hand and forehead. I pushed the call button, walked to the hall and waited 1 minute for a person to show up ( it was fast to my surprise)I said she needs help she is aspirating . The gal was a CNA, and took one look at her and said I will be right back. (I took a picture of my cousins) She came back with a Nurse who looked at me and asked how long my cousin had been like this. I replied I just got here, I have no idea. It was 11 am . The nurse turned to get the suction kit and started to take care of it, the nurse got it cleaned up and out of her mouth. Then instructed the CNA to get her nurse. They all left the room. Yes she was struggling to breath but it was normal with her COPD. Then Her nurse comes in and does a small physical exam and says ok.. it won't be long now, I am going to call the family. I stayed the day with her husband and adult kids, around 1 pm I touched her wrist looking for a pulse there was none, Her carotid artery had no pulse either, I looked at the Hospice Nurse who then did an exam and she couldn't hear a blood pressure or find her pulse either, but she was still breathing. I told the Nurse, " I know what you know" and she nodded. I left at 5 pm to get dinner. I was not sure she would still be alive when I came back . I came back at 8 pm and there was no change. We got the call at 1 am that she had passed away. I have not told her husband of how I found her. Only my family knows. could this be something to look into , or should I just assume the facility was just understaffed. Yes some details are left out, but not many. The nurses hurried to clean up her shoulder, and back as the fluids had drifted down onto her back and shoulder. Her sheets and pillows and gown had to be changed. they hurried so family didn't see her in the condition that I did. I believe she had been like that for a long while before I came in. She was in Hospice care at the time. However nobody was there when I got there.

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I'm really sorry you had to witness this.

The secretions at the very end of life can be dramatic, and as an amateur guess I think that's what you must have seen. They are what causes the "death rattle." If the phase is prolonged, the patient can be given - ? - hyoscine? - I'm pretty sure - to suppress the secretions, but I know that in my mother's case there simply wasn't the time or the need.

Given how promptly the nursing staff responded to your call for help it doesn't sound as if there are major problems there. Again, I'm sorry for how distressing it must have been to see your cousin like that; but it can happen very quickly, I don't think it's a sign that she was neglected for a long period.
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Reply to Countrymouse
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Thank you for all the kind and wonderful answers. I feel if I tell my cousins husband how I found her it would just make things worse for him and his family. I feel she was given excellent care, and many of you are correct in that Hospice while wonderful simply can not sit 24/7 with someone. Bottom line then to end the conversation is: SHE did it her way. On her terms and leaves behind wonderful memories and a lie that was well lived. She fought hard, but it was her time to go to her heavenly home. .
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Reply to rxsandee
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It would bother me, wondering that, too.

Well.

The thing is. Suppose there is a way of asking when she was last checked over; and suppose further that there is a way of guaranteeing you get a plainly truthful answer to that question.

What answer is going to be okay? Where are you going to draw the line? And suppose the line was crossed, a bit, not egregiously, but a bit, what then?

Your cousin was aspirating. (I don't mean to pore over the gory details, I'm just trying to put myself in your shoes and follow it through). How long had she been left unattended? How frequently was she supposed to be checked? Do her notes indicate that she was? Was the schedule of checks adequate to prevent her becoming so congested as she was? Was she expected to, and able to, use a call button? - if so, had she?

Again, unless you think she'd literally been left unattended since breakfast - God forbid! - or had called for help and been ignored, and it doesn't sound as if you think it's that bad a place? - I can't think what answers are going to set your mind at rest. What happened to her was horrible. It doesn't follow that it was preventable.

Talking over what you witnessed with somebody else who has been through it might help, do you think? It was the stuff of nightmares, I hope you didn't think I was unsympathetic to that.
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Reply to Countrymouse
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Ok, I see my question was off base in how I must have worded it. I understand grief, in truth I have had courses in grief counseling training and worked for a cemetery for 10 yrs, Death is no stranger. I just went through this in Feb with my uncle. I had no problem with his care or the facility he was in. I was just asking if it was off kilter or weird to anyone else, you know like a gut feeling is all. I am at peace with her death, She is no longer suffering and in pain. I was just expecting Hospice to be there, close by, she had clearly been this way long enough for fluids to pool onto her back, shoulders and neck. I am not going to go any further with this, I was just curious is all. Clearly the personnel had no idea how long she had been like this, they asked me. Thank you for all the lovely responses and thank you for the time spent answering. Bless all of you 
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Reply to rxsandee
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My Mom was on Hospice for metastatic uterine cancer, in my sisters for 5 months, except for her final 8 days, she was transferred to a private Hospice hospital, as she was actively dying, and the Nurses thought it best that she not die in my sister's home where there were lots of little Great Grandchildren around, and to give us all a rest and peace of mind in those final days, and all 6 of us kids (and our Mom) agreed it was the best choice.

Hospice facilities are like any other hospital environment, in that the patient's rooms are not staffed 24/7, but the patient is well looked after, and the Nurses do come into the rooms frequently, ours was the Best experience ever.

Sadly, the whole reason for them being there is that death is imminent, and we have to come to terms with this fact. We felt our Mom had excellent care there, but also, the mere fact that we come from a large and close family, our Mom was hardly ever alone during that time. Our Mom passed peacefully, with all 6 of her children by her side, it was a very emotional goodbye, and yet a welcome relief, in that our Mom was no longer in pain, and was now reunited with our recently departed Father, exactly where she wanted to be.

I think you have to put your faith in that the Nursing staff responded quickly, as that situation could have happened at any moment, and that your cousin is now at peace. It is sad, but she Was expected to pass soon, and yet very difficult for you,  to have witnessed some uncomfortable moments that she had near the end of her life. I think the Nurses did every thing that they were supposed to have done, at that very moment, so I would leave it there, knowing that you were there for her, being a wonderful cousin, there to love and support her til the very end. God bless!
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Reply to staceyb
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I think she is just asking and I think its a valid question. No, it didn't change the outcome but...Hospice patients are to be kept comfortable. Did she find her cousin as things were happening or had she been laying there for a while? You will never know. You can look at it this way, you found her and were able to bring it to the staffs attention so she could be cleaned up for family. Better you then a hysterical immediate family member. I would just let it go.
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Reply to JoAnn29
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I am sorry that you had to witness your cousin as she was aspirating. It isn't pleasant to watch and it tends to stay in your memory for a while.

No, I do not think that what happened to your cousin needs "to be look into", nor should you assume that the "facility was just understaffed". The typical “Nurse-to-Patient” ratio is: 1 nurse to 4-8 patients in a hospital and in a nursing home, it might be 1 nurse & 2-3 CNAs to 20+ residents. How can the nurse be in every patient's or resident's room at that same time? What evidence do you have that your cousin "had been like that for a long while before I came in"?

In regards to "She was in Hospice care at the time. However nobody was there when I got there."--unless her family had hired someone to sit at your cousin's bedside 24 hours/day with no breaks, then of course, there would have been times that she would have been alone. The nursing staff had other patients to take care of as well as taking care of your cousin. So that is a non-issue.

The CNA responded quickly (within 1 minute according to you) and so did the nurse and they both cared for your cousin as soon as they entered the room. They didn't look at her and say to you, "We'll be back later to clean her up." They cleaned your cousin up immediately. Sometimes the amount of fluid that the body expels as it is dying is small and other times, the fluid can get the whole bed wet. It just depends on the person's body. The nurse and CNA did exactly what they were supposed to do at the time and you saw how well they took take of your cousin.

Grief has a tendency to cause us to “relive” certain circumstances, especially unexpected and/or unpleasant ones. I see no need to tell your cousin’s family any details other than what you have told them. If they ask what condition your cousin was in when you arrived, you can simply say, “She had vomited, I called for the nurse. A CNA and a nurse responded within a minute and took care of her.”

“In times of sorrow and deep grief, we must look to God to bring relief. As day by day, our hearts grow stronger and we don’t question any longer. But accept His will as day by day, our lives go on their way.” by Jessica St. James
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Reply to DeeAnna
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What is the alternative, Rxsandee? The family could pay for a private 24 hour, round the clock nurse staff. Other than that, your cousin is in a place where she received good care, from what it sounds like, and I'm not sure what you would want changed.

Are you venting from grief? I understand that very much. It's so difficult to see death and all of its ugliness when it's our Loved Ones.  I'm so sorry.  It leaves a mark on our brains, to be sure.  

But what are you thinking should have been changed about cousin's condition? She wasn't being monitored every minute, but that is normal, and she was on Hospice care so that she was kept comfortable.

I don't want to assume your meaning. What exactly is bothering you about "how long she may have been like that?" Do you think there is possible neglect by the staff? Do you think cousin was in pain?
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Reply to AliBoBali
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I am very sorry for your loss, but you need to ask yourself what you hope to gain by "looking into" this and whether it would upset her husband and children. Please find comfort in the fact that your cousin's pain has ended and that she is now in a better place.
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Reply to AlfredR
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RxSandee, good choice, no sense in upsetting the family. I know that it was upsetting to find her that way, but thankfully you did, and the Nurses did take care of her. I do hope the end was peaceful for her.

I'm glad that she did it her way, as many folks don't always get that choice. I am so sorry for your loss! Take care!
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