Hospice for un-treatable bleeding ulcer and over medicating with Ativan? Is this the end?

I'm assuming that hospice has taken over your mom's medication? If so express your concerns to them and see if your mom can take less Ativan.

If your mom is putting her feet over the side of the bed it's just one little step to the floor. It would be instinct for your mom to step onto the floor if her legs are dangling over the side of the bed. Is she bed ridden? Does she need supervision if she's up and moving around? Does she require a walker or wheelchair? If she's in hospice I'm also going to assume that she doesn't need to be hopping out of bed and wandering around with no supervision.

Ativan might be considered a "chemical restraint" so your mom doesn't get out of bed on her own especially if she's a fall risk and most people in hospice are fall risks. Hospice can provide you with a hospital bed that has rails which will prevent your mom from sitting up and swinging her feet over the side of the bed.

The goal is to keep her safe and pain-free. If she falls it's because she wasn't safe and she will not be able to remain pain-free if she injures herself as a result of a fall.

As for the diagnosis of an untreatable bleeding ulcer you would have to also talk to hospice about whether they consider that an end-stage disease. Apparently they might since she was put on hospice. Only people who are terminal go on hospice. A bleeding ulcer that's not repaired surgically can cause all kinds of problems in the body and I would urge you talk to her hospice team with any questions you have about the diagnosis.

What you are seeing with your mother could be end of life or excessive medication. no way for us to know.
Certainly talk to the hospice nurse and the nurses at the nursing home to get a clearer picture of her condition. If she says she likes dangling her legs and many people do perhaps she can be got up in a chair.
If her ulcer is continuing to bleed she will certainly die from that fairly soon and the Ativan may be given to make her less aware of what is going on.
As you live out of state I am assuming you are not her primary caregiver so you need to also talk to whoever is rather than jumping to conclusions. It must have been a great shock to you to see the decline in your mother when you visited but this frequently happens when someone is ready for hospice. Hospice does not give people drugs to shorten their lives they use what is prescribed to keep the patient as comfortable and worry free as possible. The side effects may be excessive drowsiness especially when new drugs are introduced and dosage is adjusted but do you want Mom to suffer the alternative?

You might want to talk at length with her nurses, because there appears to be more than a bleeding ulcer at work. Patients, especially older ones, usually have an assortment of other ailments at work. A good guardian will follow the advice of the treatment team and the wishes of the patient. It is a tremendous burden to bear, especially when family cannot accept the end is near. Let's say they stop the Ativan and the Morphine. The patient would be in tremendous physical pain and emotional turmoil. Ask the rabbi to talk to you about her status and together you place her in the hands of God, and ask your angels to guide you both.

Karen, with CHF the patients heart rate can go up and down. My MIL's O2 has dropped from 99% to 95% in six months. Her confusion has increased, her fingers are sometimes cold or numb, even cramp at times. When she hits 90% we have to decide whether or not to give oxygen. Supplemental O2 can increase the risk of stroke, and she's already had at least two of those. It's only a temporary fix. MIL also has leg swelling, a sign of fluid buildup, and that will eventually get to her lungs. So we live one day at a time, as you might. We buy time, we wonder when God will take her home.

Thank you Eyerishiass. I have been in touch with the Hospice nurse several times. Mom is in a guardianship program with some lawyer people (they think because I live out of state), but I didn't know it was going to be a legal mumbojumble and they signed off on Hospice and the DNR status; I had no say though I did voice my opinion in no uncertain terms. As far as dangling her feet, yes I was concerned about her getting out of bed too Turns out no bed rails at least in that nursing home, but who knows why. Then a friend told me that nursing homes are not allowed to use rails? Never heard about that. The Hospice nurse said that if a patient has peripheral vascular disease (circulation issues) , they like to dangle their feet off of the bed. Still I am concerned about the Ativan in too high a dose that she is out of it completely and won't eat or even try to communicate. She did get a "special wheelchair" (a reclining one) so they can take her out of her room and she saw a show the other day with music and singing and yesterday they took her out of her room for Sabbath services, which she likes. The only thing is she cannot communicate enough to tell me how it was and if she liked it, etc. She barely talks anyway. So very frustrating. This is my vent and thank you for letting me share it.

The bleeding ulcer issue will make your mother anemic. Blood carries oxygen and when anemic, people have more trouble breathing. The CHF compounds the breathing issue. She may be putting her legs over rails because she is hypoxic(not enough oxygen) which may make her confused. It is really hard to know. Since she had A-fib, it is likely she was taking anticoagulant medicine which exacerbated the bleeding. Simply stopping the blood thinners may stop the bleeding. I have seen nursing homes put people in hospice just to get extra care for patients the nursing home does not have to provide. It is not uncommon for people to be put on hospice and last for months/ years. It depends what stage of CHF she is in. My neighbors father was put on hospice 3 years ago. You need to speak to the doctor and ask what the prognosis is.

The fact that you have these genuine concerns regarding end of life sounds like someone whose job it is to communicate with you dropped the ball. It puts you in a situation in which you have to ask the question whether your mother is now at the end stage of her life. Your doctor should have been very clear what his prognosis is and what approach the treatment plan is following. As for her being over medicated, if you have the poa, you are not only entitled to this information, you shouldn't have to ask for it. Unfortunately, I've discovered that many nursing homes/hospices aren't forthcoming with the information even if you have the legal right to it. This is a situation where you need to be firm but assertive and be clear that you know your rights. Have your poa with you and have it read and highlighted so they know you are not going to accept vague responses or permit them to blow you off. I am concerned also with your statement that she is being over medicated. Over-medicating a patient is never acceptable, you need to find out what level of medication she is on, what level the doctor feels is acceptable, and whether those two numbers are the same. If they have her on a level that is so high she has become a zombie, find out why. It is hard when patients must be kept safe, as do other patients and staff, but if they are at the point where they are treating her only to make her comfortable, and she is at the end stage, it is a tough line to walk in determining how far is too far. Are they medicating her for her benefit or to make her easier for them to deal with, or is there a valid concern she may be hurt or hurt someone else? Because your need to have your visits and visitors who come to see her be meaningful is important in the process of handling a dying parent/loved one, every moment is precious. Without a valid reason to put her in this state by any means, they should strive to have her as lucid as they can so loved ones can say good bye. It is a shame the burden is on you here, but follow your instincts and don't back down. If the facts are as you say, this situation can be remedied. Good luck to you, we are all behind you!

My thoughts are with your family, it's so difficult to be far away. She may not respond, but the thought really does count.

Karen you have your own serious health issues to deal with so it is good that someone else is dealing with the day to day care of your mother. Contact the hospice nurse and ask her to update you every time she sees Mom.
Hospice is not a death sentence. They will ensure she gets the appropriate care to keep her comfortable and advocate for her, prevent unessesary interventions and help with diet choices and provide volunteers to read to her.
Go ahead with you gift parcels especially if that is something you always do. Even if she does not understand who they came from on some level she will associate it with you. keep sending letters and pretty card. They are something uplifting for her to look at . Try and stop crying and start writing those notes.

Thank you Give a Hug.