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My 93-year-old grandmother who has all timers and dementia has spent the last seven years of her life in a nursing home. My mother and her sister take turns visiting my grandmother daily. Other family members visit my grandmother as well. I visit my grandmother every other Sunday with my mom. My grandma's health has been diminishing because of her loss of appetite. She's always been a little bit chubby but she has been losing weight drastically because of her loss of appetite. My mom generally feeds her fresh fruit Jell-O and thickening liquids that the nursing home provides. We've all discussed that my grandmother probably gets no other nutrition besides when someone comes to visit and spoonfeeds for lunch or dinner.

A few weeks ago a hospice representative approach my mother and told my mother that their services would provide comfort for the family and my grandma as my grandmother's health continues to deteriorate.

Last week when I went to visit my grandmother I noticed that she had a brand-new chair that seeded her a lot better and she seemed more comfortable.

today when I arrived I thought my grandma was dead. I've never seen her look so poor and not in control whatsoever of her body functions.

We proceeded to the nurses station and found out that hospice has been administering morphine since Friday at midnight every six hours but the nursing staff could administer more every two hours if they felt my grandma was in pain. I asked the head nurse how has this happened that the family has not consented to morphine yet my grandmother has been given morphine for the past 48 hours... The head nurse said that hospice is supposed to contact the family to let them know but in order to stop giving her morphine they would have to have a doctors order faxed to them immediately... Where they would have no choice but to give her the dosage. I am mediately called hospice and left a message on their Emergency number. My mother said by the time she got home hospice had already called she return your phone call and they agreed they would call the nursing home and tell them to stop. This evening around 630 we were called by the nursing home letting us know my grandma's blood pressure was 74 and they said she may not have much time left to get to the nursing home immediately. Grandma was itching her skin and hair... The majority of the time she seemed disoriented and confused and still highly medicated. Her mouth was wide open and it looked like she desperately needed water or something moist to quench her thirst. A hospice care worker was there as well and said she would be willing to meet with me in the hall to discuss my grandma's condition. I told her I was not interested in speaking to her about my grandmother's condition and they have already caused enough problems. Miscommunication could be detrimental to my grandma's condition... And no one in the family had consented to my grandmother given morphine.

My question is do you think my grandmother will survive after having morphine in her system for more than 48 hours? The nursing home also told us that hospice had change the doses of some of her medicines and in fact she was placed on another medicine for anxiety; one that is not recommended for Alzheimer's and dementia patients- we were told the drug makes patient very lethargic.

Seroquel 25 mg -- is the drug and dosage.

My grandmother hasn't had food or liquids for several days now. I'm actually ticked that hospice could be so negligence and not inform the family about the morphine and we had to find out through the nursing staff at the hospital.

The nursing staff knows my grandmother for seven years -- it's not like no one came to visit her-- family was constantly surrounding her-- now hospice has come in and in within one weekend has caused her to be incoherent, non-responsive in a coma like state.



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ConfusedHoosier, think of it this way, your Grandmother is deciding what she wants to do and that is to go into her final chapter of her life, she is doing that by not wanting to eat or not wanting a lot of liquids. Let her have control of this choice. And let her rest peacefully, and if morphine helps her rest peacefully then let her have that medicine.

My Mom [97] is on hospice care.... hospice usually calls the POA and not the rest of the family members as they just want one person to make the decisions. I was told about the morphine and agreed it would help if my Mom had any discomfort. If hospice called everyone in the family, half would say yes, half would say no, and hospice would be at a standstill until everyone in the family comes to an agreement... and that is not fair to the Grandmother.

ConfusedHoosier, you are visiting your Grandmother once every two weeks, thus you are not seeing the ups and downs of what your Grandmother is going through. With my own Mom one day she would be alert, sitting in her Geri Recliner, and being chatty... the next day she would be in bed totally zoned out... next day back to being alert, same the following day, then the day after back to being zoned out and again the following day. My Mom also had her mouth wide opened and that was because she was breathing through her mouth, that does happen. Then there is delirium which is frightening to watch unless given a certain medicine to zone the patient out. Then the picking at one's clothing, the bedding, one's skin, etc. Whenever I see this in my Mom, I want her to close her final chapter sooner than later. The quality of life is gone.
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Confused, since you are not the POA I want to suggest that you trust your mom and aunt. It is their job to carry out Grandma's wishes. I am sure that the three of them discussed this and your mom and aunt have the very difficult job of carrying out grandma's instructions and wishes. Please do not make it harder on them. I will tell you my mom is 89 in later stages of Alzheimer's Disease and her instructions are no heroics, that means surgeries, tubes, whatever to keep her alive and suffer just one more day. She completed her documents 15 years ago when she was perfectly capable of making these decisions.

My suggestion for you is to call your siblings and whoever to tell them you all need to support your mom and aunt through this. Trust in them that they are doing as grandma wanted. Do not make this harder for mom and aunt than it already is. Then all of you call your moms and ask what you can do to help and let them know you love them.
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I agree Babalou. In my case hindsight is twenty twenty. At the time it was horrific
to me watching my Mom, knowing in her lucid moments which at the time were very few, that she was probably thirsty and so on. I would imagine her thinking why are they doing this to me. But in retrospect I don't believe she was thinking much of anything. However I was suffering big time watching someone I love wither away.

There is no easy way to let go of someone. She has been gone almost six mths. now and it still feels like it was just yesterday. I think they should have courses that teach people how to let go.
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Why did you put your grandmother on hospice? If you are unhappy with them, have her medical proxy change her care. I am a bit perplexed. Your gma hasn't been eating and has been in the NH for 7 years, suffering from Alzheimer's. She has her liquids thickened and has been losing weight. It sounds like it is time for you to give her permission to let go if she wants to. You may visit her once a week, but she has to live with her condition each day. Is she in pain? Is that why she was receiving morphine? Please let us know a bit more.
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I guess a lot of folks here are questioning if their loved ones are actually at the end of their lives. It CAN be ambiguous. My mom has been in granite health since her stroke/broken hip/ pleural effusion/chf two years ago. She's in a NH, gets pneumonia every few months. Over the summer, the pneumonia wasn't clearing up. We (at her behest)decidedly DON'T want her taken to the hospital and don't want heroic measures taken. The pneumonia gets treated in-house. But my sister in law, when things get dicey says "we don't want mom to feel like she's drowning" and "we should have her taken to the hospital so they can cure her". Somewhere, there is a disconnect in her understanding that mom is dying, and that the way to make in less painful FOR MOM is to get her on morphine BEFORE her lungs start filling with fluid. So, I get that there are lots of posters here know that their parents are dying, but who don't see that morphine might be a friend in the end.

They used to just show rosey pictures of childbirth, too. Life, death, birth; they are all messy and painful. I'm all for making things better through science.
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dear confused, my mom died of Alz. in January of this year. Yes she was being given morphine to ease her pain, and she WAS in pain! My mom couldn't talk or do anything at all during the end-stage. It was up to us (my dad and I) to read the signs, to know she was in pain. Sometimes she would cry out when we had to move her to change her diapers and it was obvious that she was in pain....othertimes you could see it in her face and eyes. I'm glad she was on the morphine to ease her pain. It is NOT being given as a form of euthansia, it is used to relieve pain and suffering. As for the not eating or drinking....well that is normal for a dying person to refuse both as their systems are failing....she could not digest food any longer and if given water she either would leave her mouth open and let it run out or she would spit it out. Yes, it makes US feel better to feed and give them water, but for the dying it is not better. There are special 'lollipops' that you can use to refresh their mouths but nothing will stop them from dying. Those of you who have written in that are guilt-ridden over their loved ones not eating or drinking .....please forgive yourselves...you did nothing wrong. Death is Blessings, Lindaz.
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What did you think that putting your loved one on hospice was going to mean? Did they say they would call a family member before each and every drug change or new dose? Or did they say the would take charge?

My husband died on hospice in our home. They gave me the drug kit, explained what each thing was for, and I was in charge of what to give when.

When my mother went on hospice in the nursing home, we understood that Hospice, rather than the NH, would be in charge of what drugs she would be given and when. That is kind of the point in bringing them in. Their goal is to keep the patient comfortable and pain-free. They did a great job. Mother graduated out of that program in a few months. That was a year ago. She is doing well. When her time comes, I would certainly have her back on hospice care.

It is always hard to say how much of what you are seeing, if any, is due to the drugs, and how much, if any, it might be worse without the drugs. Hospice has A LOT of experience with the dying. That's why they insist on that comfortable chair immediately, and demand and get different mattress pads or beds. And it is why they make the drug decisions they make. They are all about comfort care.

Remember, hospice is for persons expected to die within the next 6 months or so. People who are actively dying don't look and behave like they did before they were actively dying.

You say "My grandma's health has been diminishing because of her loss of appetite" but it is probably more true that her appetite has been diminishing because of increasing and accelerating loss of health. People who are on the last leg of their journey are often not interested in eating. And at the very end, eating when their body can no longer process food may make them suffer.

It is so very hard to see our loved ones' health decline before our very eyes. My heart goes out to all of you.

Not all hospices live up to their mission. Maybe you got a bad one. But I think it is very likely that you had/have a misunderstanding of what hospice was going to do. It can be extremely stressful to see a loved one in the final stages of life. I suspect that is really what is so upsetting to you. And it would be upsetting whether there was any morphine involved or not.

Who is in charge of medical decisions for your grandmother? That person can cancel the hospice program at any time. Personally, I think that would be a mistake, but it is perfectly possible to do it.
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Yes, your grandmother can survive even after having morphine. It is not morphine she is dying from. How long she can survive the conditions she has in another mystery.

The hospital that discharged her to hospice care thought my mother might not live out the week. That was 18 months ago. She's still enjoying bingo. Hospice thought my husband had at least several weeks left when he died. All anybody can do is give a best-guess.

I think you will find this article about morphine use by hospice very enlightening: http://www.hospicenet.org/html/pain_myths.html
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Oh, no -- a conspiracy theorist. :-O
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Grieving, why weren't you able to read what you signed? I've never heard of anyone making a statement to this effect. I do know that officials pressure people to sign, but everyone has the right to demand the time to read something before signing it.

And no one needs to be told to read anything before signing. This is in fact one of the problems with online shrink wrap agreements; people don't read the terms and conditions of websites they use.

If you were pressured, all you had to do was tell them to take a seat and you'll sign only if and after you've read everything. You have no legal obligation to sign w/o reading, and in fact it is your legal obligation to read everything you do sign. It's called "informed consent.

I do it every time and make people wait until I've read everything, regardless of whether they like it or not. If they make a remark about the time required for me to read everything, I hand them the papers and tell them I won't sign without reading.

We each have rights but won't enforce them if we allow ourselves to be pressured into signing something without reading.
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