Sleeping through meals versus eating at nursing home. What is better?

Karsten, no burden; ask all you want. I always feel privileged when I can share personal experience that might help someone else. I think the others here feel the same way.

Karsten, I'm sure that his not eating wasn't the cause of his death but a symptom that he was transitioning, and the fact that he threw up just means that his body wasn't able to get any sustenance from food any more. They weren't holding him down and forcing him to eat, he opened his mouth and ate - he may even have derived some pleasure from his last meal. Stop beating yourself up over this.
((HUGS))

Karsten, my point is that you need to have a care meeting so that the orders in Dad's charts are changed. Talking to each shift results in THAT shift complying with what you want. It does NOT mean that it's changed going forward. For THAT to change, you need for the Doc, DON or someone in authority to change the orders in the chart. The day to day staff are not authorized to make those kind of changes.

THAT took us about 6 months to understand.

Since your dad is on Hospice, there are a lot of players, each with their own opinion. It is REALLY helpful to get them all in the same room, at least by phone and discuss issues like "do we wake him for meals" and "should he be put to bed in the afternoon for a nap".

The most satisfactory yet infuriating care meeting we had for mom was one in which we got everyone, including the potential hospice organization nurse in the same room and I mentioned that mom had a collapsed lung.

Everyone started and said "who told you THAT?" (Um, her nurse, on the phone, yesterday morning).

No, Mom did NOT have a collapsed lung. But if I hadn't gotten everyone together, we never would have known that.

Ask, nay DEMAND and care meeting this week. Make sure the NH doc has examined dad beforehand so there's not that excuse. Come out of this meeting with a coherent, unified plan for dad's care.

Next day, ask the nurse on each shift to tell you what the care notes say and make sure that they line up with what you all agreed to.

Karsten, I'm going to take gentle issue with waking someone for meals, especially someone on hospice. We went through that with my father. Sometimes sleep becomes more elusive as it segues into sleeping much, much more. Being awaken to eat disrupts the sleep pattern.

We also were advised to let him sleep; if he awoke, then he could be fed. If not, there was the next meal. He was already seguing into sleeping more and eating less day by day.

What you can do is observe his sleep patterns to see if there's a schedule, and ask that his meals be brought at the average time he awakes.

Speaking from experience, this is much better for the patient than waking up someone who really needs his sleep. It shouldn't be that difficult to refrigerate his meals and reheat them to match his sleeping and wakening cycle.

It was also explained to me that eating can tire out someone on hospice, resulting in longer sleep times after eating. It's so easy for us that eating is nourishing, but after seeing my father struggle to eat, I realized how much effort he expended, and that contributed to his fatigue.

If you want your father to drink cola, and it hasn't been thickened, there are some different issues, although it may already have been factored in, depending on his DNR status. This is something we also went through.

If in a hospital a dysphagia patient drinks unthickened liquids, and is full code, the facility is obligated to resuscitate him if he codes. His eating would not be in compliance with hospital policies.

The last months of Dad's life were complicated, so I don't remember for sure if we discussed a no code status in conjunction with non compliance with a dysphagia diet, but it's possible that this could be the reason why they don't want him to drink something like coke, which really is an unhealthy drink for anyone anyway.

If he's not a full code, and wants to drink coke, typically the family must be made aware that he could choke, aspirate, and/or possibly develop aspiration pneumonia or have a severe reaction (cyanosis) from the choking.

Karsten, my approach was to decide if I felt the advice to let my father sleep was realistic, and legitimate, then I agreed to let him sleep through meals. If I felt otherwise, I would have expressed that concern, and if necessary, gone to the unit nurse or DON to ensure that it happened.

I recall something else, then when he was first awakened to eat, he was so tired that he choked more easily and ate less, then often fell asleep while attempting to eat.

Perhaps it is different where you are but I will tell you something I have observed in the year my mother has been in a nursing home - food is not available between meals and people who consistently don't eat do not live very long.

cwillie. That is my concern. Though the did tell me that last night after my dad eventually did wake up they heated up my dads food and he ate pretty well. While they scheduled a care conference for a couple weeks out, tomorrow I will be demanding one right away. Overall, however, the current SNF is so good compared to where he was before. I worry my decision to have him at the MC before took time off him, not to mention the added trip stressed him out. Wish I would have had him at this SNF to begin with. But still. I have to keep my eye on them.

If father is now palliative ( end of life) he should not be woken up to feed. I agree it could be kept in fridge & offered when he wakes. He should not e forced to do anything but just made comfortable & pain free. The body organs begins to shut down towards the end, so hunger naturally diminishes. Forcing food or drink at this stage can cause more problems ( RN, palliative care)

Karsten, don't try and second guess yourself. Even though we hope we'll recognize the signs it doesn't always work that way. You had no way of knowing what would happen and I'm sure you didn't cause it. Sometimes they just fade away and sometimes it's quite sudden. My mom was a healthy eater up until 24 hours before she died. Up and walking around too. And then gone in what was likely just a few hours. I'm sorry for your loss, but please don't feel that your actions had anything to do with it. And certainly they were based on wanting the best for him.

My mother was living in a SNF and was on hospice services from an outside organization. Both entities did their best concerning mom's care, but they didn't always see "eye-to-eye." The main issues were around food and oxygen supplementation. Hospice basically thought mom should be able to eat what she wanted at regular meal times. There is the danger of aspiration pneumonia, which is important to note because your loved one is on hospice. It is my understanding that aspiration pneumonia will likely make it impossible for you loved one to take medication orally and hospice doesn't introduce IV medications. So aspirating food may end their life, but so will not eating because one sleeps through meals. The first is a scenario that occurs suddenly and might challenge your commitment to hospice. If your loved one was at home, I suspect that hospice would rule and you would be fine with that. Hospice services in a SNF isn't as common and my experience is there are slight differences in approach that need to be thoughtfully reconciled. How? Compromise. If dad sleeps through breakfast, make sure he is woken up and fed lunch. In mom's case, I wanted to know that she was getting fed (if she wanted it) so I scheduled her hospice CNA to be with her at lunchtime. You get the idea. Get that care plan meeting as soon as possible, and remember compromise. They all wish the best for your loved one.