How can you know when someone is dying, and what do you do once they're gone?

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I'm getting worried that my Grandma is getting to the end. I've told you guys bits a pieces, but she's still not eating. The only thing we can get her to eat is 3 bites of a baby oatmeal, because it's the only thing that "doesn't taste sweet", she sees people all the time who passed away years ago, keeps saying she wants to go home, that she's been to this park and took a nap in the grass. This morning she woke up scared saying she felt like she went to a funeral. Today is the 5 year anniversary of my Grandpa passing from Lung cancer, and she keeps saying that she knows he's here, but he must just e at work. She is fighting me just do anything. She's not going to the bathroom as often, she does this half sleep where it's almost like she's sleepwalking. She can be completely oblivious to the world, but still be able to wander the house. She's sleeps all day long. Plus no matter what I do, I can't warm her up. I tried thermal clothes that are designed for snow. Have those on her with sweats on top of that, with her shirt tucked in. Fuzzy winter socks on her, gloves, and then 5 blankets, it's 80 in my house (X.X), warm outside, and she's still cold. She is getting very weak, and can't walk without help. Even with help she almost falls every couple steps.


We have an appointment with her doctor April 14. Her doctors out of the country, so I can't get her in until then. I'm hoping to get a referral for hospice, but is the end coming? If so, what do I do when she's gone? We already have arrangements with a funeral home for her. Do I call them directly, do I call hospice, or do I call 911? If I call 911 will the try to revive her? If so, where can I get a DNR?

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KayKay, when your grandma's PCP office opens call the office manager directly, get her name while you are at it, and explain the situation. I once was a home care nurse and recognized that my patient was dying, and there were no doubts about it. His practice was huge but I managed to get him on the phone (insisting upon it) & he did call me back. I explained the situation and stressed that it had to be dealt with TODAY. That PCP actually did a house call that afternoon, examined my patient, spoke with the family at the home (separately) & wrote the order for Hospice the same day.
Take this chance if you think she can make it until the office opens. I was very surprised the doctor did this, and realized that wow! Doctors are by profession a caring bunch  and take an oath of "first do no harm" and he stuck with it.
You never know until you try.
Good luck!
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@rm I'm so sorry for your loss, and thank you for sharing your story. It's never easy losing someone. Hopefully I will have hospice by then, so it makes me feel a little better knowing that I can do everything and I don't have to deal with police and all of that.
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Dear KayKay,

I'm so sorry to hear what you are going through. I know you are trying to help your grandmother the best you can. It does sound like she is getting closer to passing and I know its very hard to witness.

Thinking of you during this difficult time. Sending you all my thoughts and prayers.
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@cm I don't know what I can do. Unless I can magically get POA, and I'm not sure if it's needed or will be possible at this point. I have no idea what I'm going to do.
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KayKay - what you are describing does sound a lot like the end is near - not imminent- but near, according to the stages traditionally described on hospice web sites. It might help you a bit to go on line a google "hospice" or "signs of death". That is, if that type of thing won't get you more apprehensive.

I don't know why but when my mother was on hospice and the end was getting closer it somehow made me feel calmer to know what to expect. Not to say your grandmother will pass in the way and time hospice says it usually happens. My mother did not up until the very final stages - the last day or so. My father on the other hand - went through almost every step and stage from the earliest signs to the last - as if he read the pamphlets and used them as an instructional guide. But that was both my parents staying true to their nature.

I'm of the understanding that if someone passes at home - even if they are sick and/or elderly- that 911 must be called - unless hospice is involved by then. Then you call hospice and they take care of the rest.

This must be a difficult time for you - I'm sorry for what you're going through. Losing someone you love is never easy but watching it slowly happening before your eyes must be very painful. Take care.
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Sorry, yes of course - your uncle, not your father. Apologies.

Terrible that he's not responding. What can you do.
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@cm Ok, I'll give them a call. Thank you.

We haven't even been able to get in contact with my Uncle. We've called, texted, emailed, and sent him messages over Facebook. We haven't heard a peep from him. So it's still just me until we can get approved for hospice. We considered the AL or a NH, but it's just way to expensive for us.
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What you do is call the medical insurance office, explain that given your grandmother's extreme frailty and falls risk she can't travel the distance to her doctor's office, and ask them how you *should* obtain the necessary referrals. Don't ask in a challenging way, be positive - they almost certainly will be able to suggest a way round it.

If that doesn't work call your doctor's office and ask them to recommend an alternative practice. If they don't routinely make house calls they should have links to a practice which does. Somebody's got to look after housebound patients, after all, no?

And if all else fails, don't call 911. Call a cab, tuck her into it, take her calmly to ER, tell them the recent history, and explain to them that you need her evaluated for hospice and this is your last resort. Even if it's complete bedlam you can keep her quiet in a corner and make sure she's comfortable. Take a pillow and a blanket, and a good book. And don't turn your back on her.

Has your father sprung into action yet? Or is this still all on you?
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@CM, no we're not waiting that long to get her into a doctor. If need be we will take her to the hospital. Her doctors office is crazy busy, and you have to make appointments almost 2 months in advanced, and they don't do walk ins or house calls. So the only way to have her seen is we have to take her all the way across town for her doctor, and the insurance is denying any type of hospice care without her primary's referral.

I have no idea what to do other than a hospital, and she's deathly afraid of hospitals.
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You are not seriously going to wait a fortnight before you seek medical attention?! Surely!

Call your doctor's office, explain the situation, and ask for help. Do that first thing tomorrow. Ideally whoever is covering for her regular doctor will make a house call; if not, then you'll need to get her in there to be seen; but either way you need professional advice. You can't just faff about and pretend this isn't happening.
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