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I want to get my parent an IV to get hydrated. He has lost so so much weight but is still lively and wants to do things but too weak to do it or scared. But he is alive. I don't want to treat him like he's not alive or something because he's not. Hospice does not do needles. Only xrays and urine tests. No blood work or anything like that. I am going to ask anyway and see what they suggest.


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As difficult as it is we have to understand that as the body declines, and organs shut down the "need" for food is not what it is when you are healthy. the body uses nutrition to keep "important" things going. The heart, brain, lungs. But even those begin to "cut back" on what they do. Circulation to extremities slows so that circulation to the brain, lungs is maintained that is why hands, feet then arms and legs become colder. Skin mottling happens.
Feeding someone that is eating less (because of illness, decline not selectively eating less) the food will not digest properly and can lead to more problems.
Hospice generally will not put in a feeding tube BUT Hospice will accept a patient with a feeding tube and they will help maintain it. Hospice will not do IV's for hydration and nutrition either.
Continue OFFERING food and liquids but do not force either.
Moistening swabs to keep mouth moist is fine.
Breathing will change.
There will be a build up of saliva, secretion in the mouth and throat. Clear the mouth but not the throat as that can cause gagging. To help turn your dad on his side so fluid can drain.
Your dad will not feel hunger the way you or I do when we have missed a meal.
Trying to give fluids can have a serious effect as well. As the circulation slows, as the kidneys slow there is no effective way to eliminate the fluids if they are given. The easiest way the body would get rid of the fluid would be through the skin possibly causing sores that would not heal. (little circulation to the skin so skin breakdown occurs.)
Sorry if this is not the response you wanted.
Please listen to the Hospice Nurse, I am sure he or she will tell you that feeding tubes and IV's are not in the best interest of the patient.

And in theory yes you could remove your dad from Hospice have their PCP then do the procedure of placing a feeding tube then go back on Hospice and Hospice would accept your dad back. But why put him through that for an extra day or two if he survives the surgery?
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Cover99 Sep 2021
PCP has probably already signed off since OP's dad is in hospice. They're not interested in a patient that is in the dying process, only those that are still living.
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If you don't want a DNR signed, and you want to use an IV for fluids, why did you agree to hospice services for your father? If you want comfort care during the end of his life, you use hospice services. If you want IVs and other medical interventions taken to prolong his life by a bit, then you fire hospice and get him back to the hospital for more poking and prodding.

If you ask hospice about IVs, they'll tell you what I told you. You and your father have a choice about how you would like to manage his end of life care. You cannot have both medical intervention and no medical intervention at the same time. It's an either or situation. Alzheimer's will take his life, unfortunately, and he will stop eating one way or another. Hospice will keep him comfortable the entire time; the hospital will prolong his passing by a matter of days or weeks, maybe, and his comfort will be questionable along the way.

Right now my mother who's 94.5 is fighting off hospice care tooth and nail, and suffering horrible pain in the process. Pain she begs the doctor to help her with. But the doctor can't write her a prescription for a strong opiate pill because she can't tolerate it. Hospice can administer morphine shots which she'll be able to tolerate because her stomach won't react. So that's her situation. She's choosing to suffer rather than ask hospice to help her because she insists it means she's "going to die". As we all are, in reality....its just a matter of how hard the journey to the final destination is going to be, right? We will pass when God is ready to take us, not when "hospice" intervenes to help us stay comfortable.

I know this is hard, and I know you think you have a better answer for your father than the hospice doctors or anyone else. Sometimes, in our zest to help, we wind up creating more problems than we cure. Because we're looking at things from an emotional standpoint. The medical pros are not. They're looking at things pragmatically, as in what's best for the patient who they don't love and aren't related to. Ask THEM what's best for your dad to keep him out of pain and suffering the least amount of anxiety and discomfort humanly possible up until he takes his final breath. THAT is your true goal here. Not what's best for you, the daughter, because that answer is Dad stays here with you for another 10 or 20 years, and that's not possible, sadly.

So now, do the right thing for him and try not to question the choice.

Wishing you the best of luck, peace with the decision, and courage to see it through.
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Riverdale Sep 2021
Such a wonderful and thorough answer. Sorry to hear about your mother. My mother is on round the clock opiates as you may know from a post I have. I find myself wishing for that as she has 3 sources of great pain and she is easier to communicate with when she is in less pain and discomfort. When I bring her a protein shake she doesn't want her lunch those days.
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When a person comes to the end of life appetite goes away. If your dad is hungry he will eat something. As my father's life was ending he was eating much less. The staff would encourage him to eat, but once he was done, he was done. As he neared death he lost weight.

Offer dad food, but if he says he's not hungry let it go. You can also offer him some protein drinks that are higher in calories.

Check with the hospice nurse in charge of dad's care.
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If you insist on IV food or hydration, you'll have to take him off hospice.

You need to talk to someone with hospice to understand what's going on here. You won't be able to stop what's happening naturally, so you need some emotional support now.
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Did your LO sign a DNR? If so, I don't think anyone will prescribe an IV depending on the wording in that document. I think you must work through your LO's physician.
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LooseIt Sep 2021
No. We did not sign a DNR. He didn't want that. We were forced to sign one for my Mom when we had her transported to a rehab facility and he didn't like that.
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Talk to the hospice team. A conversation with your dad to determine what HE wants is imperative - often hospice patients find it very hard to disagree with loved ones who want measures to prolong life, even when the patient understands that they are getting to the end.
These are conversations that hospice can have, and if the nurse won't do it get the social worker or the chaplain.
IV fluids prolong the dying process.
Placement of a feeding tube may or may not be medically indicated.
He may need to revoke his consent to enrollment in hospice care if he wishes to pursue these routes.
Please try not to pressure him to make a decision based on what you wish would happen.
Will be sending good energy to you, Looselt. This is a hard place to be.
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I thought Hospice required a DNR. Thats what Hospice is, no extreme measures to keep someone alive. When it comes down to eating, feed or not to feed your parent will pass because the part of the brain that controls breathing and heart will die and so will ur parent. By feeding a body that is shutting down does more harm than good.
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