I have a feeling of unease with the hospice taking over my mom at the SNF.

BTW, stressed123, my heart goes out to you! It was hard enough to need to give up the direct care of your mother and place her in a care setting, but then within a few weeks to face a hospice decision must feel devastating. This is precisely the situation my sisters and I were in with our mother. It hurts.

I hope you are not second-guessing your decision to place her in a care center. This further decline confirms your assessment that she needed/needs more than at-home care. None of this is your fault.

My mother was in a nursing home a little over 2 years. After she'd been there a few months her hip broke, she was hospitalized, and sent back to the NH on hospice. She continued to get the good care she'd been getting from NH and additional care from hospice folks. Hospice was awesome about cutting red tape. If they thought she needed a different bed she had it within hours, etc. They also could respond more immediately with drugs to her perceived needs. Mother regained her strength, was no longer considered to have a 6-month prognosis, and was taken off the hospice program. She lived another 2 years. Ironically she was not on hospice when she did die -- that happened very suddenly (for which we are grateful.)

My husband died on hospice at home. They stopped all of his many, many drugs. This was a blessing because it was increasingly difficult for him to take them. Not taking pills was like a little gift. But we did add a couple back in, because it became apparent that they contributed to his comfort.

Not being on baby aspirin or vitamin D will not hurry your mother's death. They do not extend life. If it turns out that your mother shows more signs of depression without the D, ask to have it added back. That would be a comfort measure.

Hospice is paid for by Medicare, and these decisions are not really about cost. Medicare paid for the drain. It was probably just easier to have it done before hospice started so that hospice didn't have to explain why they were doing this procedure. They could probably justified it on the basis of comfort/pain prevention, but easier all around if it could be done before hand.

Hospice is available to people who are not expected to live more than 6 months, if their condition progresses as usual. My mother's condition did not follow the expected pattern. My husband's condition did. They both benefited greatly by having the extra measure of attention and care.

First and foremost, I'm very sorry to hear about your mother. It is a very difficult position to be in and my heart goes out to you. Many people have responded, so what I have to share might be redundant. I have worked in hospice for approximately two years, but am not a nurse. However, my understanding of the medical side is that when someone meets criteria for hospice, comfort focused measures are then priority. The baby asprin was likely discontinued because it is no longer relevant for her condition. If she was expected to live another two years or so, it would be important to include it to prevent stroke. With her terminal illness, it is less likely she will experience a stroke and more likely to experience symptoms related to her terminal condition. Comfort measures focus on these primary symptoms: pain, constipation, breathing distress, and agitation. Someone on hospice doesn't necessarily have a lot of pain now, but pain is always a possible symptom towards the end of a terminal illness. Morphine is a standard medication used in end-of-life care, for pain and to decrease respiratory distress. But not all patient's use it or families allow it. Please emphasize with the hospice team that you'd like to be informed of changes in her plan of care and have changes explained. You don't have to accept what is recommended. Other medications can be used to provide similar results. You are her primary decision maker and have the right to refuse certain treatments. Also, not all hospices are the same. if you're not happy with this current company you have the right to transfer care or revoke at any time. Hospice truly isn't to hasten death, but to make whatever time remaining as comfortable as possible. Please do what you feel is best for your mother and always ask questions. I hope this is helpful.

I rejected hospice for my Dad...even though he was certainly within 6 months of passing.

The reason was exactly this. They would take him off the meds that were helping him, and only morphine for comfort. Well...hey, if that isn't "hurrying him along" I don't know what else to call it. He needed those meds to help with his conditions. Just masking the "discomfort" of allowing those conditions to move forward without medication wasn't something I could agree to...and if I let hospice in..they would make the decisions. So..I rejected hospice.

If you are more comfortable having the SNF continue to provide excellent care it is your choice not to continue with hospice care. Hospice does recommend discontinuing that they consider unesessary medications as a matter of policy but it is not written in stone. Most people have strong feelings about the use of morphine in end of life care and this often causes them to refuse hospice care. The fact of the matter is that many patients do get a sudden massive build up of fluid in the lungs close to death and if there is morphine available the patient can get instant relief. I am against the routine use of morphine unless it is needed. For patient's I personally cared for it was always a relief to know there was morphine in the house and the caregiver had been instructed on how to use it. When it may take an hour or more for a nurse to be able to reach a patient in distress the caregiver could immediate administer a dose and give the patient fast relief. They would then be told to call if the dose was not effective and the nurse could give further instructions and make a visit. We were always told to make a visit so they could be there when the patient received their first dose and remain untill the effect became apparent. if morphine is being used for shortness of breath or congestion the dose is usually small. If it is used for pain then after several days the patient's needs will be assessed and an extended relief medication given with morphine being available for break through pain as needed. Pain management is always of paramount importance. The issue of addiction is not addressed because if some one has pain they have a right to e treated. When dealing with an addict minimal amounts are only made available often on a daily basis so it can not be miss used, stolen or sold. For example if a patient has a fentynal patch only one will be provided and a nurse will visit in 72 hours and change it him/her self. Believe it or not but family members do steal drugs from a patient who is terminally ill or the patient may pretend to have spilled the bottle and request more.
Hospice is available in the worst of the slums in the inner cities and although the nurses are usually respected it can be necessary for an armed security officer to accompany a nurse on home visits. I did have one ocassion to request police
help dealing with a patient who had become violent and they were able to
provide much needed assistance
Hospice actively discourages the use of artificial feeding either IV or by tube and may agree to drain a fluid build up a few times but not routinely because this is considered active treatment. Naturally if you want to continue with this treatment you are free to do so but without hospice. When someone already has a feeding tube it is left in place and the feeding continued until it becomes apparent the patient is no longer absorbing the feed
I realize this has little to do with someone refusing to let his nails be cut but they are things about hospice that those who have never used their services tend to know little about and base their decisions on hearsay.

Can you ask the hospice staff directly ?

Hospice provides comfort medications only. Morphine does help open airways. It also relieves the pain from the cancer. It relieves the panic. Understand she is not going to get better as the cancer will progress. There will be more pain and that is the primary concern when the patient is terminal.

Thanks for your quick responses. It's the fact that she's in NO pain that makes it difficult for me to grasp all this. I know it's preemptive to have all this on board now so we're not caught with our pants down in the middle of the night should morphine be needed. I just thought the withdrawing of a baby aspirin to prevent a stroke seemed unnecessary. Yes, I am second guessing myself. Thanks for sharing your experience Jeanne, always helps to know you're not alone.
My Moms supplemental insurance paid for the drain (we live on the border of two states and all the nearby doctors are in another state, and our state mediCal took too long for an appointment) because Hospice said she needed it but they wouldn't pay for it. I think I am just afraid they will dope her unnecessarily.
It's her time to be free and I know this. I just don't want to feel like I hastened it. I'm told that's a common fear when people first come to Hospice. That, and the fact that her doctor said a definite NO to the morphine. I guess it's out of her hands now. (If she was easier to get ahold of I wouldn't be asking these questions here)
Thank you again. It's hard to let go when you've been their everything for so long, huh?

Stressed, I'm so sorry that you are facing these decisions. With my mom, who has chf, post stroke, dementia and seemingly stable pleural effusions, we were offered hospice about a year ago. We chose to go with, not Hospice, but palliative care, making sure that " morphine as needed" is on her list of prn medications. That is precisely because, if mom goes south in the middle of the night, they can give her morphine for panic and airway relief.

As Jeanne said, the hospice decisions are not based on money, as on not extending life. But i have found that the hospice provider we talked to willing to be flexible about certain medications. Please let us know how you are doing!

Thank you shinnie and Veronica for the input. It all helps!