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Mom is 93, has dementia and lives in a memory care facility. Quality of life is poor and we're looking at the end of funds and transfer to a medicaid facility which might be beyond visiting distance. I have full power of attorney and pay all bills. ( son ). I'd like to transition to comfort care only. The POLST form has been updated to reflect that. However the doctor states they need to meet with both of us before considering a medication stop order. I've set up the appointment but not sure what I'll do if mom is questioned and says she wants to keep taking the meds. I could stop paying the pharmacy, and have told them not to send any more. This morning mom said " have you seen your parents lately." So I'm not optimistic about a meaningful Dr. consultation.

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It's been an interesting discussion. The consultation appointment for mom and her doctor is tomorrow.
Thanks for the input.
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It isn't a question of whether a drug sustains life. It's a question of whether it makes your mother feel better. And the kind of drugs that you're talking about, which may make her feel better, and while they may also incidentally prolong her life, won't keep her going indefinitely and aren't heroic measures.

To repeat: an experienced doctor will give you good advice, and certainly will want to remove any px's that are of no further benefit to your mother.

Judging your mother's quality of life by what you would or wouldn't like is a schoolboy error in terms of ethics. Bear in mind that with age and experience you may come to a very different point of view. What matters now is what is best for your mother: if she is content, unafraid and not in pain, it doesn't matter whether she knows who you are and it doesn't even matter if twenty or thirty years ago she'd have said "shoot me if I ever go gaga." Or not unless she wrote it down and signed it, anyway.

I'm sorry if this seems harsh, it's just that you have rather given the impression of working to a schedule, and being in a bit of a hurry about it at that.
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We could define the necessities of life to include liver transplants, cosmetic surgery and a whole host of other things that aren't. I guess today we consider beta blockers a necessity of life. I'd define them as a means to stave off natural death. As far as Medicaid, there's no downside to it for me personally. My brother calls many of the the facilities that have a large percentage of Medicaid patients as "snake pits." Since I visit my mom every week, I do think I'm qualified to judge her quality of life. Turning it around another way, I personally wouldn't want to just "exist" in a wheelchair, loaded up with meds, sleeping most of the day and asking my children "have you seen your parents lately." I don't see the end of the physical body as the end of things and view my current direction as letting God take over, rather than the medical/nursing home worlds.
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Burnhaven,
Slowing this down, needing time to reconsider motivations that are NOT insurance, financial, or convenience related.
I am not accusing you of faulty motivations. However, who is qualified to judge anyone's quality of life? Get a second opinion. Patients have actually improved in hospice once all the meds are removed, then they are graduated from hospice as death is not imminent.
Peace to you and yours.
You are in a difficult situation, and I am so sorry you are suffering loss of your Mom.
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The goal is to avoid Medicaid? Uh? Why?

Medicaid is there precisely to provide for people once their own resources are exhausted. Your mother trusted you to act in her best interests when she gave you the substantial authority of POA. How is it in her best interest to avoid a benefit to which she is entitled?

You should be seeking agreement in principle from her current facility that they will accept her, as an established, settled resident, once she transfers. You say there's no guarantee they will; that doesn't mean it can't be negotiated. Better get to work on it, eh.
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The tone of your post is making me feel a little squeamish. You can't stop medicating someone just because in your opinion their QOL is poor and you want to hurry things along so you can avoid medicaid. I could have stopped giving my mom her prescribed meds, and for that matter feeding her too, but although on most days she seems to be an empty shell she is not dying, and to withhold the necessaries of life would be something other than merciful in the eyes of the law.
(and just to add, I am pro death with dignity)
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The goal is to avoid Medicaid altogether. We're not on Medicaid yet but will be late this year.
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On this forum, although you do see people making astounding sacrifices (including some one might think were possibly excessive or at least unmerited), there is I'd say a strong feeling in favour of self-preservation first - certainly of spouses and children first.

Of course nobody wants to see their parent in a h3ll-hole. But there is "undesirable" and then there's "rather be dead."

Are you having a lot of trouble with Medicaid? Any specific problems that people (not me, not my area) might be able to help with?
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Great responses. Thanks. What wasn't addressed above though, is the distinct possibility of having to transfer her to a less-than-desirable facility, possibly where I couldn't visit. That would certainly fall into the category of suffering, on her part. Medicaid is currently under the microscope so we don't know what's going to happen with it. I've seen people post on such forums things like " I will bankrupt my family, kids, grandkids, the country to keep my 110 year old parent alive another week." Nobody above is sounding like that, but we have to look at the entire picture.
Yes, we are discussing hospice and as I mentioned, her current memory care unit can accommodate that.
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My mom has CHF and chronic HPB. When we checked into the possibility of hospice two years ago, they NEVER mentioned discontinuation of bp meds as a suggestion.
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Natural causes will come whether you stop the B/P meds or not. What stopping then may do is cause her to have a heart attack or stroke which will add to her suffering There are drugs that really don't matter at this stage like cholesterol drugs so a review of everything she is taking is certainly in order. Maybe a hospice consultation may be in order.
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Allowing natural causes to take their course is fine - I am in total agreement with the principle - but failure to alleviate their distressing symptoms when it is readily possible to do so is not fine. Of course it could be done by substituting morphine for the present cocktail, in a hospice-like environment perhaps, but that would be euthanasia: a useful test for euthanasia is to ask "do we have an alternative that will be as effective without the drawbacks?" And at the moment, apparently, yes you do.

I'm sure the doctor will give you good advice.
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Thanks for your responses. We are "actively postponing" death by administering a complicated "cocktail" of drugs now. I don't see this as Euthanasia and only those really close to the situation can see all sides. But I do appreciate the feedback. Yes, we are actively choosing to allow natural causes to take their course and consider that the best route at this point. Her memory care home is able to transition her to a "hospice-like" experience as we do see comfort as top priority.
There is no guarantee her current home will keep her if she goes on Medicaid and I have to consider the possibility of locating her somewhere to far away to visit.
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"Removing a blood pressure medication before they enter the very last stage (called the active phase of dying) would amount to actively choosing to hasten death" Hospice Patients Alliance
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Your mother's doctor will take into account her ability (or lack of it) to understand what he is telling and asking her. Don't forget, he needs her informed consent to the px. If she can't comprehend the information, she can't give her consent. I shouldn't worry about it.

By the way, though. If the doctor disagrees that it is in your mother's best interests to stop this px, be sure you understand the clinical reasoning before you fire that one and get a second opinion. Blood pressure problems can make a person feel terrible, so there could a quality of life issue to stopping them.
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