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I would assume the daughter is acting on her mother's previously expressed wishes which is very reasonable.
Tracy may not be a very experienced or untrained caregiver and feels everything possible should be done for her patient which is a very laudible sentiment.
Having hospice come in would be a good idea and provide extra help and support but if the lady is being adequately cared for and does not need things like aggressive pain control it is not really necessary. Nice but not vital.
Those who are not familiar with end of life care can find it hard to just let things be which seems to be what the daughter has decided and not put Mom through distressing tests like MRIs. I don't think Medicare would not approve the tests but I could be wrong. She certainly would meet the requirements. The amount of stuff they have approved for me is mind boggling and I am ten years younger and able to tolerate these procedures.
Yeah...you can go ahead and do I...but, insurance won't pay and Medicare won't pay. With no treatment options, no point to doing expensive tests.
Mom was already on the medication to do the best they could to control it. That is that
Also I read another post that says there is NOTHING they can do for TIA & THAT'S THE TRUTH nothing can be done for A 90 year old haveing a TIA just wait it out ...SAD I KNOW....
If Tracy felt the woman was being abused or otherwise yes but it doesn’t appear to be the case.
As for diagnosing Tracy - no disrespect meant - that is not your scope of practice. I’m an RN & I don’t diagnose either. I am not a physician.
I suggest you sit with the person’s daughter and discuss your concerns. If the POA stated to you that no heroic measures were to be taken, then you have to trust that the POA is carrying out the wishes of her mother.
Tracey3, if you feel that what you are being asked to do -- ignore symptoms that you think should have medical attention -- goes against your principles and is unethical, then I wonder if you would be better able to live up to your own standards in a different caregiving position. You have reported the situation to the visiting nurse. You have explained your concerns to the medical POA (the daughter). Perhaps it is time to move on, having done what you can do.
I can relate hypothetically to the daughter's situation (without knowing the background) and to what NomadSE says. It can extremely difficult to make decisions for a loved one when other people don't approve of those decisions, even when you firmly believe your decisions are in the best interest of the loved one.
I knew that my husband had VERY strong feelings against prolonging his life after he developed dementia. If he were having a heart attack I think I could abide by his DNR wishes. But he had a different kind of medical emergency altogether. Do I ignore the symptoms and hope he dies? He was conscious. I was holding him. I said, "I'm going to lay you down and call 911." He said, "OK." Turned out he had a bleeding ulcer. I don't think anyone at all would have the right to judge me, whichever way I made that terribly painful decision.
Client has appointed Daughter to make medical decisions. Daughter is doing that. Caregiver is disturbed by those decisions. None of this seems worthy of name-calling, in my opinion.
What we have here is a caregiver who wants to take over the role of healthcare POA and wants us to validate her concerns about the daughter's decisions. I'm just calling it like I see it. And I don't see it is any of our place to second guess the healthcare POA's decisions for her mother.
"She is seen by a home health nurse periodically and the nurse had also told the daughter to take her to the hospital." I wouldn't think that 2 people would be "high and mighty" on the same issue, especially a home care nurse.
As to blood thinners, sure, they can cause hematomas, but they can also perform a vital function in keeping the blood within a therapeutic range for patients who need that kind of control. My father took Coumadin for years; if I needed it, I wouldn't hesitate to take it and I'm generally anti-medicine. But I'd rather have bruising than a stroke.
And I also saw the scary and unsettling repercussions when his blood was out of therapeutic range and he began hemorrhaging.
I can tell you right now that there is nothing they can do for a TIA. Nothing, other than start the patient on blood thinners which are a whole nother can of worms with bruising and bleeding. So if the daughter doesn't want to go that route and the mother has given her daughter the right to make healthcare decisions, then pardon me, but who the blankety blank do you think you are to fuss about it?
My mother is only 78, but she has dementia and doesn't know me sometimes and it's only going to get worse. It will NEVER get better for her. I did take her to the ER for a TIA and it helped me in that she's in rehab now and I have a bit of a break, but in the future I won't be doing that. I won't be doing any lifesaving procedures on her anymore because she doesn't need her suffering prolonged. And while I won't hasten her end, I'm not going to drag it out needlessly either.
So your post kind of strikes a nerve for me, because if I ever found out that a caregiver was having a case of the high and mightys over my decisions for my mother that would be the last day that caregiver was at my home.
You could also ask if a supervisor could send her out to double check the mother, with the goal of doing as much of a cardiac workup as a visiting nurse can. She should be able to tell from the heart beat if something is amiss.
You can also try to take her pulse and monitor that, keeping track of it in your records or the chart (if any) at the house.
My mom exhibited stroke symptoms, I called an ambulance, EMT's thought it was a stroke, so did doc's in ER. It wasn't it was a UTI. The first of seven over the next year.
If the TIA's or related diseases have never been assessed by the lady's doctor, then I agree it's high time they were - there are things that can reduce her risk of something more serious. But if she's already being treated, then I can see the daughter's point of view that there's not a lot of point in going to the ER about a TIA - by the time anyone does a CT scan it will likely have vanished without trace.
But in any case, if the lady is of sound mind you don't need the daughter's permission to seek medical attention, the lady can agree to that herself. Have you tried asking her if she would like to see a doctor?
If you work through an agency, I would talk to the supervisor.
Have you asked the daughter if she has considered Hospice or Palliative care for her mom?