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She has been prescribed every medication avail for end of life? The hospice nurse has given her fleets, suppositories still no bowel movement. Are there any other options for my grandmother?


Because she is on hospice, taking her to be examined outside of a nurse coming to the home is out of the question. We as family members are not on the same page. I, one of the granddaughters, am ready to revoke hospice care and get her treated, but my mom on the other hand feels I'm in denial and says it's too late to try to find out what is going on with my grandmother/her mother. For the record, a neurologist never saw my grandma before placing her on hospice. Only her new doctor that only saw her once, the day he said hospice care was needed.

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As I understand it, hospice is there to ensure the patient is kept comfortable when there is little to no prospect of recovery.
Legally, the authority rests with grandmother's medical power of attorney - the person she chose to represent her medical choices when unable to do so for herself.

She may have discussed and hopefully prepared an 'advanced care plan' earlier for such inevitability. Operations and life supports for some can be an unnecessary burden where the patient's rights can be overlooked for lack of communication - and is that what you would want for her? ...or yourself?

While it is always tough to simply let go, one must also consider how grandmother wished to live and complete her life journey.
I hope you can find peace, and possibly even joy, that life runs its course, and you can be there to comfort and support grandmother and those around her in what is certainly sad, but a very special time to show love and acceptance.
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"because she is on hospice taking her to be examined outside of a nurse coming to the home is out of the question"

Is this something you/mom has confirmed with hospice, or is this just an assumption?

When my mom was on hospice, we were told there are exceptions to the "no ER/hospital visits" rule; we would just have to check with hospice before the visit. For example, if mom had taken a bad fall and, say, broke her leg, that absolutely warranted an approved visit to the ER for treatment.

Fecal impaction is a serious medical condition that is also a matter of improving quality of life. If she hasn't had a bowel movement in days, despite "at home" remedies being tried, I would think that hospice would be on board with approving a visit to the ER. At the very least, I would have whoever is grandma's POA (if grandma herself is unable to do so) call and ask hospice about it.
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Can your grandmother swallow? Has she been given stool softeners? The gel can come out of the capsule punctured with a pin so that the oil is easily swallowed with normal saliva. Colace is but one of these types pills and they are over the counter, not prescription. This is not "treatment" and breaks no hospice rules, as this is a part of "comfort care". Impactions can be very painful. Speak with hospice. You tell us little about grandmother's current condition, age, etc. and hospice is the one to know what to do best.
Also fleets makes an oil emema that makes for a MESS but allows stool to be disimpacted with east. As grandmother likely already wears incontinence supplies this is not much of a problem. It would mean stool easily removed from lower colon and no need for transit to hospital.
This is all not unusual for elders, whether in hospice or not, and a trip to hospital for this isn't appropriate even for those being treated unless in the most dire circumstances.
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Clairesmum Mar 2022
actually, hospice (ideally) manages (or at least knows about) all medications in use, including over the counter stuff. the use of stool softeners is likely already part of the treatment plan for this patient.
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Hospice is needed for something for sure… removing your grandmother could impact the care she is getting for whatever her diagnosis is that triggered hospice.

whomever the POA is, consult with that person to ask what else can be done..The POA should address… if your grandmother needs a hospital visit , hospice can put that into place….

My mom has a nurse come weekly , she makes certain my mom has everything she needs to make her comfortable and address any health issues, a CNA comes twice a week for personal care, on first visit, even did a manicure with my mom which made her happy..a minister 3 times a month , a social worker monthly…
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What about nonmeds? Can she slurp soup? Juices? I always try a food remedy before turning to meds.
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Having a loved one placed on hospice care when you are not sure you understand why or agree with the comfort care focus is really hard. The hospice team can provide support to you, too. Perhaps your grandmother's social worker or spiritual care team member can meet with you or talk on the phone, and answer some of your questions about why hospice and why now.
The person who is the health care decision maker is the one guiding the care here. I'm guessing it is your mom.
Maybe you can be at the house the next time the nurse care manager visits your grandmother, along with your mom? Just listening to their discussion, and then asking questions to clarify what you heard might help your distress.
Bowel management is a key nursing responsibility, and there are times that disimpaction is the only way to remove stool. Her medical issues, past bowel history, being bed bound, oral intake, current meds for comfort, etc. all are factors.
Constipation at end of life is very very common.
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When my husband was under hospice care and on narcotic pain medication and became constipated, and after trying everything you can imagine to get him to go, his nurse gave him Relistor(which is a shot)that literally started working in about 15 minutes after being administered, and cleaned him out quite well.
You may want to ask her nurse about that.
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Cover99 Mar 2022
TMI lol
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Leatrice, do you think your Mom can swallow Apple cider? It's an old fashioned remedy that my sig-other uses as he's on a medicine that tends to bind him up, the cider works quite well.
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