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Rosie - ref your brother's thoughtless, knee-jerk accusation: ouch. People say such stupid things, and then it takes a very tough cookie indeed to ignore them as completely as one probably should, and just let them lash out.

This topic touches on the hardest questions of all, hardest because we will never, can never know the answers. My brother was there when my father suffered a fatal heart attack: did he do everything he could or should have done? Could my father have survived if he'd had better first aid? I'll never know, and I'm not going to ask. My friend's father took ten days to die on the Liverpool Care Pathway: she'll never know if the approach was the right one, if she should have asked more challenging questions, if she should have overridden her mother and taken charge… It eats her up. My uncle died after someone made a serious - foolish but not malicious - error at an accident scene: in a way it would be a comfort to point the finger in public and say "This Was YOUR Fault!" - but it wouldn't change anything; and that person probably already feels enough guilt and shame.

I don't know if there is a moral. Most people, most of the time, are just doing their level best, whether they're professionals, relatives, friends or men-in-the-street. The hardest part is letting go of those unanswerable questions afterwards.
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Redhead it sounds as though your experiences were with a "for profit" hospice which is a business like any other that wishes to make profit. Of course as everywhere there are good and bad in this industry.
If you have suspicions and evidence of fraud or price gouging please contact your states health department and Medicare and share your concerns with them, this may have been a crime.
I realize that you are very upset by the circumstances of Mom's death but what you describe could have simply been a natural progression of her illness. You are within your rights to request a copy of your mothers record which should indicate how much and how often any medication was used. another useful thing would be to discuss your concerns with your mother's doctor. You could also contact a malpractice lawyer. Be at Peace
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My family firmly believes the hospice put my mother 'to sleep'. They claimed she wasn't dying fast enough, she should be moved to a nursing home. their doctor was very inept. Our physician disagreed with them and mom stayed in the hospice. She had about 2 weeks left, but died in 3 days. She'd be up and around talking and walking but all of a sudden all she could do was sleep and was incoherent when awake. We think they gave her morphine shots and did her in. There's no other explanation. The hospice management were simply awful to us, and the bill included bogus charges like 'at home care' when they never set foot in any of our homes. They took us and Medicare for a big ride and 'helped' my mother die.
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First I want to give my sympathies for everyone who has lost a loved one, especially to rosie123 who started this thread. This is a legitimate concern to be discussed regardless how we may all feel regarding hospice.

My father was advanced stage Alzheimer's when he developed pneumonia for the second time in 2 months. The second time he was not responding to antibiotics, they could not feed him pureed foods because he could no longer swallow. He was completely unresponsive to us and the the staff. Dad made it clear he did not want to be kept alive by feeding tubes, ventilators or any type of machines. We honored his wishes and health directive, all food and water was stopped, he only received morphine. He passed away 5 days later. I admit that during those 5 days I struggled with thinking we were starving him and dehydrating him so he would pass sooner. After I talked with an RN, she explained to me that by stopping food and water, you are making the person more comfortable as their bodily organs are shutting down. Food and water will cause them to bloat, being much more uncomfortable. I felt better about what we decided as a family and I do not regret it because I know my father is in a better place where he is free of Alzheimer's, free of pain.

My nephew of 38 years, passed last May from colon cancer that had spread to his liver and lungs. He had 2 different surgeries, chemotherapy only to have the cancer return within 2 years with a vengeance. He battled it for 8 years. The last few months of his life, he suffered with great pain anytime he had to go for a dr. appt., or when the family would take him to a place he wanted to see one last time. The movements of being in a car, up and walking caused him so much pain, it took 2-3 days to get it under control again. He was taking morphine and methadone to control the pain. The day before he passed away, he was up walking to go the bathroom on his own. He was basically alert, conversing with family. The next day, he was in and out of consciousness, finally went into a coma and passed away. I don't think any us of can understand fully how a loved can seem basically fine in regards to being mobile, alert, eating,....then they are gone when in the final stages of a disease.

My aunt lived with a feeding tube for 12 years (Alzheimer's), she was unresponsive to everything and everyone.

Don't second guess yourself especially when they are in final stages. It is heartbreaking to go through...grieving is a process with no time limit. Allow yourself to grieve and know you did the best you could...that is all any of us can do. No one can take that away from us, no one can judge us for the choices we made.

Many Blessings and Hugs to you!!
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About 5 years after my father died, my grandmother was deep in dementia (only recognized me, no one else), had serious heart disease, and had a heart attack - at 82. My mthr chose to pursue aggressive treatment for her mother. After 6 months, 2 pacemakers, and me, 12 years old, being the only one who could feed her by mouth and mthr refusing a feeding tube, my grandmother finally died.

Mthr still says - 34 years later - the doctors killed her mother, which is a totally ridiculous statement. It was her time, but sometimes people don't want to face reality and go find someone else to blame. I think that happens a lot when people die in hospice, in hospitals, and under care. We don't like being confronted with mortality. If you think you might need hospice for your loved one's care, read Byock's Dying Well (book) which explains the processes.
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Hospice did not rush my mothers death. Hospice was a blessing for our family and the medications they used were a mercy. I can't imagine not medicating my mom for the extreme pain she endured because of the growing tumors. I can't imagine sitting on my hands and doing nothing through the terminal agitation. My mom did not want to suffer and made that very clear to me. I hope when my time comes my family will keep me comfortable too.
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I am a widow. My husband had cancer.............and the pain was unbelievable. Bill's cancer caused his entire abdominal wall to thicken. A surgeon at the cancer center (UPMC - Hillman) told me, "pray for him to die quickly because his abdominal wall is rapidly thickening - like a vice - tightening more and more around his abdomen as each hour passes". My husband lived another six weeks. Bill was unable to metabolize most pain meds as his digestive system was so compromised. He had a port and pain pump, NG tube, IV's etc etc. We came home with hospice for 10 days but could never get control of his runaway pain. There is no sleep or rest when in that much pain. After ten days, we went to the in-house hospice facility and I lived with him there for his remaining 12 days. I must tell you that hospice helped me to help my husband. They were there to give me a break to get 30 minutes of sleep. They were there to bring me a cup of coffee. They were there for me "to talk." Yes, Bill died and although tons of drugs and combos were tried, his pain went on and on. But I was with helpers. And they did their best to help him. And yes, they helped me. We will all die. Hospice is about comfort for both the patient AND the caregiver. I really appreciate hospice and hope that when it is my time, my family will see to my comfort. Why make someone linger a few days or weeks longer when they are suffering? I choose comfort every time. We must all be ready to meet our Maker. It's inevitable. Hospice helped Bill and I both as I walked beside him on his way home.
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Wow, dogabone, you are way, way out of line here. This is a forum to discuss ANYTHING related to caring for elders. There are no taboo topics.

And you obviously are confusing who said what in this thread. Why bother to keep track of that when you can just indiscriminately throw out accusations?
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Dogabone.. I asked the question because my brother accused me of putting dad in hospice and letting the staff over medicate him so he would die quicker. I then did a little research on that subject on the internet and found that some people believe that like he does. I am a member of this group so where better for me to get input of all kinds on this subject. It has informed and enlightened me as I read the responses. When I want an answer to something I ask. That is all it was.. a question. No blame, nothing. The staff treated dad like he was their own. For that I will be eternally grateful. I was his only caregiver for 4 yrs and finally I had someone to share the load with me and they did. Overall, the experience was very peaceful for me and hopefully for my dad too. I have informed my son that hospice is where I want to be when my time to leave this earth nears.
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Rosie I am so sorry for your loss, it is clearly very recent and painful to talk about. People with liver cancer typically fall into a coma before they die and it is important to continue with medications so even though they are unresponsive they remain pain free and any anxiety is relieved. Ativan and Morphine are the drugs of choice at the end of life especially in the home. The volume of liquid morphine is very small and can be absorbed in the mouth by slowly dripping it in. There is a very good blood supply to the mouth so it continues to be more effective than an IV or injection when the blood supply is shutting down along with other life preserving systems. very often the patient's pain will dramatically increase and it is quite a struggle to control it . Basically if the patient is in severe pain it is necessary to give the medication until the patient is comfortable. I have sat with many patients and administered the morphine until they were comfortable and sometimes unresponsive. At that point I would reduce the dose but continue on a 2-4 hour schedule and instruct the caregiver to continue. Often the patient and their family were pleading for the pain to be relieved. Did I hasten anyone's death? I don't know the answer to that but never did I set out to end their life. That's God's work. Many people will tell you that when you go on hospice they give you morphine and you die. This may appear to be true because many people wait far too long before calling hospice and may even die during admission before hospice has given them anything. others will pass that night or within a few days. We always liked to have the drugs in the house in case of need. We would tell the caregiver not to touch them but call for a nurse first and she would visit and assess the patient. But I digress but wanted to share what happens behind the scenes so to speak. Actually it is more beneficial to hospice if the patient continues to live, When they die we don't save anything and loose the Medicaid payment which is paid daily. so if some one dies after midnight we get paid for that day.
I have no experience with a for profit hospice it could be more beneficial by saving supplies and nurses time if the patient died quickly. I can not comment on that
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Dogabone, respectfully, you are way off the mark, no where did I blame hospice for my sister's death. Read my post again, especially this paragraph...

Here's what I wanted to say: She knew she was dying and wanted to go peacefully. I feel that I was able to honor her wishes by keeping her on the morphine. The nurse told me that her form of cancer is one of the most painful types because the tumor pressed on the nerves to her legs.

The reason it took the hospice staff three hours to get her settled was 1st...the paramedics could not get the gurney down the hall and into her room and had to put her in a sitting sling, very hard when someone has colorectal cancer. 2nd...we were in the middle of a blizzard and the facility was on the other side of town, about 10 miles away. It was a dangerous and bumpy ride. 3, It was very early in the morning.

The hospice people wanted to get her pain under control before they allowed us to see her. They put the morphine pump in once she got there; they may have had to give her some other pain meds too and allowed them time to work. They did NOT WANT one of our last memories of my sister to see her in incredible pain. When we were allowed in to see her, she was resting peacefully in bed with a robe on and her hair combed.

The reason I called the emergency number in the middle of the night was because I didn't think the meds I was giving her by mouth were taking care of her pain. I had promised to let her go without pain...that's why I didn't want the hospice facility to cut down on the morphine just so she would be able to MAYBE open her eyes and respond to us. I would never want someone to be in the position I was in, having to decide what is best for my sister in her final hours, but that it what we do when we care for someone. Instead of "blaming" hospice for my sister's death, they allowed her last days to be comfortable and without pain. I'm sure you want the same thing for your loved ones.

Please re-read everyone's posts....we all have the right to ask any question on this site without feeling attacked by someone else's opinion.
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What a topic for someone to start, (Did Hospice rush your loved ones death?)
The OP of this thread should be tared and feathered for making this statement "Topic".,(Did Hospice rush your loved ones death?)
Ya right sure!...Blame it on the helpful Hospice for your loved one's death?
Where was you when this was going on? If so, Why didn't you prevent it?
(She was in so much pain from the ambulance ride that it took hospice about 3 hours to get her settled) In Pain and you blame hospice for the pain? Come -on!
Your only allowed so much morphine for pain by Law. And your Loved one I'm sure was told to fill out a Living Will.
I must say How dare you attempt to throw blame on hospice. That's uncalled for without proof of some type of abuse from hospice of cause. If you seen something and didn't prevent that's your fault not hospice. Sounds very harsh what I'm saying to you. But,your accusing hospice for blame of death is wrong without proof of such claim. Knowone can control all pain to none without a result. There's no cure for cancer and no cure for the pain to none. I understand your sadness watching the pain of a loved one. No excuse to throw blame to others if you your self didn't attempt to prevent. Sounds like you your self needs to accept some blame before pointing to others. Hospice is the best in that time of need.
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Rosie, please accept my condolences on the passing of your dad. I have a hospice story to tell as well...

My 42 year old sister was diagnosed with Stage IV colorectal cancer in late August, 2007. She had surgery in September and had chemo and radiation, but neither did any good. She was able to return to part time work for a couple of months, but had to stop working because she could barely walk. Two days after she stopped working, she could no longer walk without a walker. Over the next week she stopped eating and became unresponsive. I called the emergency number and she was moved to the hospice facility. She was in so much pain from the ambulance ride that it took hospice about 3 hours to get her settled so we could see her. She was on a morphine pump but completely out of it. She did respond once when my other sister came in, but wasn't making any sense.

I had promised her that I would not let her be in pain. I knew the cancer had spread to her liver and lungs and probably her brain, but I didn't know about the brain for sure. She passed away after eight days. I don't know how much she could hear us, but I kept telling her it was OK to go and to go in peace.

Here's what I wanted to say: She knew she was dying and wanted to go peacefully. I feel that I was able to honor her wishes by keeping her on the morphine. The nurse told me that her form of cancer is one of the most painful types because the tumor pressed on the nerves to her legs.

Secondly, I have decided for myself that if I am ever diagnosed with the same kind of cancer (I have a high risk not only due to heredity but also because I have had ulcerative colitis since 1983) that I will only accept palliative care. I too want to go quickly and with as little pain as possible.

My heart goes out to you, Suzy, and I pray that you will be given peace in knowing that you loved your mother and she loved you. Peace to all who have been in our situation.
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Yes, I feel my mother's death was rushed and I wished I had studied about the medications (morphine and Ativan) before I allowed them to give it to her. Allow me to tell my story briefly. In February of 2012 my mother was diagnosed with a rare blood cancer called Mylo-proliferative Disorder. On September 18. 2012 my mother had a stroke and in the moment she had the stroke she fell in her living room beside her easy chair she had just been reading at. On May 27, 2013 my mother passed away after hospice had been there only 2 weeks. I never knew what a difficult time I would have losing my mother but the way she went haunts me and I am just not getting past grieving. As I write this tears are flowing and I feel I can't catch my breath. Regardless of my mom's stoke she was sharp as a tack until the day following the beginning of the administering morphine and Ativan. My mom had a great appetite, she loved ice cream we used to eat together in the evenings, I remember the day after the administration of the drugs began, my mom said to me; "Suzy, stay close to Jesus". When I have visions of my mother the last 2 weeks of her life I feel so guilty that she died the way she did because I allowed them to give her the drugs, I didn't know that the combination would take her so fast, even she told me before she went into the drug induced coma, Suzy, they are taking me down fast so my medical bills don't grow. I brushed it off as oh mom, they are really helping you to make you comfortable and pain free. She knew, she knew they were killing her. They gave her morphine and Ativan around the clock when the nurses weren't there, they left instructions for me that gave the amounts and times to be given. The meds upset my mom's stomach at first we gave her food with the drugs, and later when there was no body response at all her natural reflex's would try to cough up the meds but she was too far into it. 3 days before my mother passed she went into a coma. On the day she passed I was in the next room with a baby monitor I had beside my bed, I had moved back home to take care of my mom after her stroke, I heard her over the baby monitor stop breathing, I ran to her side and took her pulse, she had stopped breathing but her heart was still beating, I cried out to God "please don't do this, I was afraid she had another stoke and she was going to remain like this, so I wailed to God 'if you want her take her but don't do this'. A few moments later she was gone. For the days and months that have followed I wanted to know what happened to my mother, did she have a stroke?, did she have a massive heart attack? No, she stopped breathing because of the morphine and Ativan combination they use it to give comfort they say but it is these two prescription drugs when combined together become lethal, they take your breath away. My mom came from a family of 9 children, all her siblings lived to be in their late 90's, my mom passed shortly after her 80th birthday. She was the most graceful woman I have ever known. Mom, I am so sorry, I didn't know!
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liquid morphine and ativan definately knocked my mother out and stopped her heart BUT the dying process was already in motion. these meds are given when the patient reaches a state of agitation. hospiss nurse told us they did not want mom to return to consciousness. death was expedited. i suspect that since time began mankind has brought comfort meds to their dying loved ones. you feel inclined to free them from their pain. ive killed several ailing animals in my lifetime and felt justified in doing so. there was no low dose with my mother. it was a full dropper of both liquids every 30 minutes untill respiratory distress killed her. still better than being aware as multiple organs / systems are shutting down.
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My condolances to you. My dad is on hospice for cancer, but I take care of him at home. When I get a respite, and he goes into the hospice facility, he is definately more drugged. It is very noticable. (Atavan, and Seroquel). When I go to see him, he doesn't even know I'm there. It's terrible. When he's at home, he rarely if ever needs his Atavan. They always tell me how much they love my dad, etc. But it is so noticable he is over medicated when he's in their care.
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No, I don't feel that hospice brought death on any faster. It made the final weeks more comfortable for my husband, and less stressful for me. The hospice nurse was surprised when I called to say he died -- all of us were thinking he had a few more weeks. He was not in pain and so not on morphine at all. He ate breakfast that morning. But, as Shakespeare puts it, "Death, a necessary end, will come when it will come."

In the letter explaining the autopsy results my husband's doctor said, "I am frankly amazed that he survived as long as he did despite the burden of very severe Lewy body disease and atherosclerosis."

I am sorry for the loss of your dear father. There is no precise way of knowing whether he would have gone a few days sooner or later without hospice care. You can feel confident that you did what you considered right. That is all any of us can do.
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rosie123, I have a feeling that the toxins in his blood just climbed to a level where he couldn't carry on. If the liver is not working, the ammonia and other metabolites will continue to build in the blood. The lungs can handle some of it, but not enough. The main thing I am sorry to read is that you weren't able to have the last days talking with him at least a little. Hospice was giving your father a low dose of morphine, which might have built up some in his body, but it did keep him from suffering.

I am so sorry that your father is gone. I am glad that you had hospice with you to help you through it. They may have hastened his death slightly by trying to keep him comfortable, but it would probably been by very little. If his liver was failing, he wouldn't have handled food well. I have the feeling that they made it as easy on him as they could. I hope that God is with you as you mourn his loss. One day you'll be able to tell him the extra things you wanted to say. I just hope that day isn't anytime soon.
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