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So the head of nursing and director at the MC my grandpa is at, is requesting my family think about having hospice come in.



He has vascular dementia and his sundowning is so bad at night that he doesn’t get any rest and the staff can’t hardly leave his side. Then he is exhausted the next day. They’ve tried several medications and nothing soothes him and they think hospice could better help him.



I do understand that he is 94 and vascular dementia is awful, but signing away his option to go to the hospital seems cruel I guess. My family is very against it, but they aren’t here and dealing with it.

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I had hospice for my father. It was hard to know that he was going to leave sooner than later. However, it was a blessing to know that people expert in helping others without having to put them through invasive procedures. They will help your grandfather by giving him what he needs to be comfortable. You can make the decision knowing it will be helpful to your grandfather and to you. Don't be bullied by other family members.
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The choice for hospice can feel like leaving a familiar well lit path onto a dark unknown one.

I think of them as 'curative' & 'comfort care' pathways.

We are familiar with the modern style of curative: appointments, treatments, tests, medications.

It's natural to feel we are not doing enough when slowing down or stopping treatments. But as Mountaingirl wrote, consider what are *invasive actions*. Some people believe in life at all costs, invasive treatments included. I personally don't.

As Del356 mentioned, people can go in & out of Hospice too. Can rejoin the curative approach again if they rally.

For any family member accusing 'giving up' try rephrasing as 'slowing down' instead.

Peace to you & your Grandpa.
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Having hospice come in for my father was the best decision I made for him. He was suffering and the next steps they would have taken at the hospital would have been very invasive. If he had survived the hospital, he would have had a low quality of life and spent the rest of his time in SNF. The hospital is not the same type of environment as their own home or being in a hospice facility. The experience for everyone is much more supportive in a hospice.

If they take him to the hospital, what are your expectations? Would you feel comfortable if they took invasive actions that didn't further his life or improve his standard of life? At his age, I think it is unlikely the results of a hospital visit would be a positive experience. Thankfully my father was clear about what he wanted so I followed his instructions, even though it was hard as I knew it meant he was dying. But, as I said, I am so thankful for our hospice facility for making a difficult situation better.
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Lost313 Apr 2022
Thank you for your answer. I wish I had talked with him more about this, but it just never came up. He does have a DNR, and that makes me feel like he wouldn’t want invasive painful treatment when it’s not going to do much in the long run.
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People can go in/out of hospice, or be in hospice sometimes for many months. Is family against it b/c they are viewing it as an immediate death sentence?

I had some issues with hospice, noted in detail in another thread; I only let them in when I didn't know how to take care of my husband any longer in his last eight days. (Initially, I thought if he knew hospice was coming in, that he'd give up the fight, but that was my own misguided thinking--he wasn't going to make it beyond a matter of days, period. And he accepted hospice without a qualm. It was a hospital that he absolutely wanted NO part of.)

A friend asked hospice to leave when she didn't like how a nurse spoke with her, wouldn't listen.

People are grateful for hospice, though, and rightfully so. I might have had some issues with them but I do not regret the decision.

IMHO, when we decide for comfort over care, when there is no chance of recovery and quality of life is non-existent or nearly so, it is the kindest thing we can do.

Your grandfather's cycle will just continue as is. You mentioned signing off on his option of going to the hospital seeming cruel. I understand that completely. But how disruptive would a single hospital visit be to him, and there would be more than one in all likelihood.

We often think of ourselves when we think of something like hospice inasmuch as we want them alive for our own sakes. We're really not grasping or accepting the life we are asking another to live...for us...and it sounds selfish to do that b/c it is.

Think of hospice as a way to ease his suffering in the time he has left. Which is the purpose of hospice, to die with some modicum of grace and less pain.

Warm wishes to you and your grandpa.
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Lost313 Apr 2022
Thank you. I am getting push back from family, but they are distant. They don’t see him or get the phone calls from the staff. I think they view it as a death sentence and giving up on him. I think I’m the only one who realizes there is only one way out of this and we can make it harder or easier for him.

I have talked with the company and they helped ease my mind. They told me I could revoke it any time and that I had a lot of say in what was happening. I’m waiting on family to throw a fit but I’m leaning towards using it.
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Since your grandfather cannot weigh in on this it is in the hands of the MPOA to decide what is in his best interest and what he would want for himself were he able to give his own opinion. This matter should be left in the hands of the MPOA without a whole lot of interference in my own humble opinion. I hope, when your grandfather was able to express his wishes, he did so to his MPOA.
I believe, as a nurse, that the prolonging of life in extreme old age when the person is CLEARLY suffering simply by having to live life on a daily basis is cruel. That's a personal opinion. I would hope, and have written in my OWN MPOA, and discussed with my POA for health, that I would not want to go on in this manner. I have no fear of death. I do fear the torture I have seen people endure by being brought back every time the grim reaper nears the door.
Leave this to the person designated to make the decision. I hope that he or she will follow the recommendation of the doctor.
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Lost313 Apr 2022
Thank you I am the MPOA. He has a DNR but we never talked hospice, feeding tubes, etc. That is my fault, and I’m regretting it big time now. I think you and I share a similar thought process in end of life care. I don’t believe in letting someone suffer for any reason. I just want him to have the most comfort he can for whatever amount of time he has left. I feel that if he doesn’t have a fall it will be a couple of months, but I don’t think years are in the cards for him.
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Is there a geriatric psychiatrist managing his meds?
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Lost313 Apr 2022
No there isn’t. He has just a regular doctor that serves MC
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