Should I treat for infections while on comfort care, end of life care hospice?

Mom is on a blowup mattress and the sides cradle her to keep her in. Amazingly she has no bed sores. They turn her, use lotion and her feet are encased in foam pads. There is a puffy soft mattress thing in her geri chair. They are truly trying to keep her comfortable every way they can. She has no breathing problems and they have diapers on her, and we have instructed no IV's or feeding tubes. She keeps going down, barely eating, then rallying and eating. I do think they should be giving her more water though as her mouth hangs open all the time and seems really dry. This is so awful. Thank you for all your prayers everyone. Please God, take my Mom home so she can be with my Dad and be happy again.

The use of antibiotics is a tough one for a family to decide. My brother and I had to address this when filling out our Moms' POLST form. After careful consideration we decide no antibiotics for any infectious process, including UTIs. To some it may sound cruel, but like you, our Mom will not recover she has advanced dementia. In a way, giving antibiotics is like giving CPR to the immune system. They are powerful drugs and yes there is a time and a place for them, just like there is for CPR. The elderly dying of infectious disease, for example pneumonia or UTI, is not new. In fact pneumonia used to be called "an old mans' friend". The problem we all now face, is antibiotics are used all the time and we've gotten to where we take them for granted. Now each person and family must make a decision when is it appropriate to use them. It's a tough decision. When making the decision for our Mom we asked ourselves a couple questions. 1. Will treating an infection improve Moms' overall quality of life? 2. Will treating an infection cure it or is it most likely to return? Answering these helped us make the decision. Another thing to consider is that infectious diseases don't always affect the elderly like they do younger people. UTIs are a good example. A lot of the elderly will test positive for a UTI but they are asymptomatic, they don't have the symptoms. They don't have the pain, burning or urinary frequency that younger people do, but they may have increased confusion and disorientation.
Our treatment goal for our Mom is to use whatever medication is necessary to keep her comfortable but not to prolong her life. To us, the use of an antibiotic would only prolong her life. It would not improve the overall quality of her life.

Mom looked worse than ever today and barely lucid, talking but barely understandable, and not comprehending what I wrote on the white board. But still she had already gotten her legs halfway over the side of the bed, twice. I tried to move her but she is nothing but bones and so fragile I was afraid I would hurt her. Same report from nurses, she is strong, determined and keeps them busy. Yesterday morning her BP was 70/40 and they thought they would have to call me. In a few hours she was sitting up and ate most of her lunch, BP back to her low normal. She still pulls her splint off every day and has to be sedated and even then thrashes around. We can't tell if she is in pain or not - she usually doesn't recognize when she is. She is totally helpless and getting complete nursing care but doesn't know why she is there. For someone who has never enjoyed anything in life its hard to understand why she is such a fighter to stay alive. How much longer can this go on? We just want her to go peacefully to sleep and not suffer living like a 3 month old baby.

Amy, if this was my mom, I'd keep her comfortable and not be aggressive about treatments. There's a reason that pneumonuia is called "the old people's friend"

Amy, I have nothing to add to the excellent advice and support you've already gotten on this thread. Just wanted to offer my best wishes for you in this difficult process. Stay strong.

I agree with Baba, from my reading pneumonia is not a bad way to go. I have to admit sometimes I wish for something like that to help bring my mom's life to an end.

AmyGrace, same thing with my Mom, heart was healthy but everything else was gone like her hearing, her vision, she couldn't sit up or stand up, she was befuddled most of the time, and always appeared so uncomfortable because she had lost weight.

My Mom was also trying to climb out of bed and numerous times her room-mate would signal the nurse as Mom would get either caught up in the rails below the bed [it was set as low as it could be] or she fell on the mat.... also kept trying to climb out of her geri-recliner getting her legs tangled up in the metal parts.

But that heart was healthy as all get out !! The doctors/nurses/aides were amazed my Mom was still with us at that time. I, too, was so physically and mentally exhausted... I thought my Mom was going to outlive me.

AmyGrace, my Mom had issues with her geri-recliner, too. One time the nurses used a seat belt type of thing but Mom was pretty quick at unbuckling it... it comes from years of experience as she hated the seat belts in the car... while driving I could hear "click", and had to call back to Mom to put that seat belt back on.

As Veronica91had mentioned, pillows can help, the nurses would put a pillow under Mom's knees while in the recliner, and that would help slow Mom down from trying to climb out.

My Mom also had the air mattress where the side would cradle her, but she would still find some way to try to climb out. It was so sad to see. I was always trying to put her legs back to the middle of the bed, and my gosh Mom was so terribly thin. And Mom would also pick at the sheets, like she was trying to make something that looked like an old fashioned fan.

Like you, every time I left after seeing Mom I would think, please Lord take her.

Oh wow. Just got a call from the NH. Mom managed to get out of the bed and fall on the floor again. She's ok, didn't get hurt because the floor is padded and the bed very low. They said she was scared, and needed comforting, but didn't really know what happened. Even with the bed alarmed, and the room right next to the nurses station, she manages to get herself out of the bed in the 5 seconds before someone can get there. She simply doesn't know what she is doing any more and she needs to be monitored every minute which they obviously can't do. She will be sound asleep, and the next minute she is up, sedated or not. One day at a time, but I know eventually this has to end badly.

It is ironic that the very people who regularly deal with elders dying seem so reluctant to acknowledge that fact and offer practical advice. Maybe some families prefer to remain in denial, but I would want all the truthful information they could give me. Even if a hospice group is not willing to travel so far out of their home base on a regular basis, would it be possible to hire a palliative nurse on a consulting basis? I think you are a lot like me, you just want some straight answers without having to go searching for them on the web.
I have heard a palliative nurse say that they can control their deaths up to a point, if she wants you there she will hold on until you are present, if she goes at night it will be because she preferred it that way.