Is hospice over-sedating my mom?
This might be a common question. Mom was signed on to hospice nine days ago. She has COPD, dementia and early-stage heart failure. She is in Memory Care. The staff has stated her most severe condition is COPD and that is what she is mostly being treated for. Prior to hospice, she was alert and going down to meals each day and participating in conversations. She did have a dry cough from COPD and labored breathing. Hospice recommended a small dose of morphine to reduce the cough and as they explained "to relax the airway". They started that one week ago. Since then, mom's cough got better, but she has been in a glazed over haze ever since. She is barely alert. She sits in a chair and has delayed responses to everything around her. Yesterday, I talked to the hospice nurse and told her I thought it was too much. The nurse disagreed and said mom needed it to prevent "air hunger" and is more comfortable with it than without it. I felt like if I disagreed too much, I was depriving my mother of "comfort". What is more, is that the hospice nurse said staff told her mom was not sleeping through the night and needed rest. I told her it is likely because other medications make her drowsy and she sleeps during the day instead. I asked about alternatives to facilitate sleep that did not involve further drugging my mother, but she did not engage in that conversation all. She said to regulate mom, they recommend Seroquel. Mom is currently on a low dose (25mg), and she recommended increasing it to 50mg at night. I told her my mom is already too "doped up" and I did not agree with adding another sedating medication. I pointed out that my mom is only 95 pounds and asked what the two strong new meds would do to her. She did not give me any answer and kept saying mom needed both meds "to be comfortable". My sister has POA for her. I do not have much of a relationship with my sister so coordinating plans is nearly impossible. At 9:00 this morning the hospice nurse sent a text to both me and my sister that the facility staff left an "after hours" message that mom's condition had gotten worse overnight. First - Why did it take hospice until 9:00 in the morning to update on an urgent change reported in the middle of the night?
I went to visit mom and talk to the hospice nurse, and mom was lying in bed and barely responsive. Her mouth was open, eyes closed, and breathing was labored. In spite of my objections, the nurse said they increased the Seroquel dose to put mom to sleep last night. My mom was a zombie this morning, and even more of a zombie that just 12 hours earlier. The only change I know of is they increased the Seroquel. On top of this, the nurse said they want to start mom the Ativan and Morphine combo. I know what that means. It means mom goes completely unconscious and unresponsive until the end which is likely within hours to days. Is this the way hospice "allows the body to die naturally?" It seems more like putting a pet to sleep to me.
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If you do demand to take it away and I hope you will not, yes, you will be depriving her of comfort. Her organs might be shutting down as well, which is painful. I'm sorry this is happening, it is very sad. I hate to see people so terrified of these drugs, especially toward the end when they are very very helpful for keeping a dying person comfortable. I truly wish I had been able to convince my mom to take the morphine earlier.
Let Hospice do what Hospice does. Your mom has lived her life, and she was lucky to have a kind and concerned daughter who cares about her. Step back from decision-making. That's not why you're there. Hold mom's hand. Pray with her if you like. Tell her you love her.
That's what I'd want my daughter to do for me.
Would you rather her more alert but anxious because she can’t breathe? Have you personally experienced labored breathing and air hunger?
Your mother or her POA chose this route because it’s what your mother wanted.
It’s jarring to watch someone die. This is not a bad death— there is such a thing as a very bad death and you don’t want that for your mom, trust me.
I’m so sorry your mom is dying. HUGS.
I suppose sedation makes the dying process easier, for lack of a better way to describe it. Of course, they are "peaceful" - they are out of it.
Yes, it is the hardest thing to witness. Yes, I am second guessing everyone in the process.
This is a very difficult time for us, to watch our mother's decline. I too wanted to blame hospice for overmedicating mom so, as POA, I told them to dx the Ativan which they did. Mom was still out of it and continuing to decline w/o it. Sometimes a decline coincides with an increase in meds. What I do know is this, your poor mom is 95 lbs with dementia and COPD working against her at this point. Allow her to get the comfort care she needs so she can rest and relax at this point in her journey. It's hard, the hardest thing you'll ever witness. You'll second guess yourself. You'll second guess hospice. You'll rail at God. And you'll cry. I went through it twice with my parents. It was their time to die. Idk if hospice sped up their journey by a few days, and in the end, I don't care. Because they were both at peace when they did cross over to meet God.
Sending you a hug and a prayer for peace.