When is hospice euthanasia?

Thanks for getting back to me!  Sure is an eye-opener...Thanks for going after them and I hope you can get some resolution here (and maybe scare them into cleaning up their fraud).  Just cannot take anything on trust these days.

OhSusannah-My husband started being given all that Morphine two day's after he was admitted to the Hospital. He stopped eating, walking, talking and drinking. All he did was sleep. The Palliative care Doctor stated it was to improve his quality of life, to help him. What quality of life is there when all a person does is sleep? He walked into that hospital and never walked again!

rovana-They admitted they had NO consent forms for either. CMS questioned them also when they found out there were NO consent forms signed. They told CMS my husband wasn't enrolled in Hospice/Palliative care. Legally, he wasn't. Illegally, he was. I sent all documentation to CMS proving he WAS put on Hospice/Palliative care. They told me they were never billed for Hospice, so I sent them all the bill's they paid for the Hospice/Palliative care Doctor and Nurse Practitioner. That money was taken back and I'm still fighting the Medicare fraud practiced by the Hospital. Hospice is paid at a lower rate and the Hospital got away with billing for Original Medicare. If they had billed under Hospice without consent forms, then MAYBE they would have been in trouble.They were paid for FULL services/treatment and my husband was never treated for anything. All he got was overdosed with Morphine and if I didn't get his record's I wouldn't have known that or anything else, including SEPSIS that was left untreated. As for the DNR, CMS is doing NOTHING and the NH Medical Board claims it was a case of MISCOMMUNICATION. Does MISCOMMUNICATION give anyone the right to Murder someone?

With any human situation there are going to be good competent people involved, incompetent but well-meaning people on the scene, and just plain malevolent people too. To me it makes sense to choose comfort care only when your situation is not going to be significantly helped by further treatment. I don't see the point in "fighting to the last ditch" when sooner or later death is going to have the last word.
But I don't understand why hospitals, etc. would want to kill someone for money reasons.  After all they get paid for patients in the beds and not corpses.  Would make more sense to indulge in last ditch treatment on a money basis.  And is there a question here, pissed off wife, that no DNR or hospice papers were signed? Did you ask to see the papers they claimed they had?  Did a civil attorney petition on your behalf?

As for drugs, to control pain etc.; of course there are downsides but you have to look at balancing good effects vs. bad effects and find a balance. A dear friend had back/spinal issues as well as CHF. The painkillers were sure not "good" for her body in a general sense, but without them she would probably have killed herself.  So often, in this life, you are stuck choosing the "least bad".

It is interesting that when people talk about a too high dose of morphine, they always talk in terms of pain tolerance.

Yes. It is true. One does develop a tolerance to morphine and the user needs more and more to quell the pain.

Still, the drug is doing irreparable damage to the kidneys and liver. It is toxic.

I took my grandfather out of a facility that was overdosing him on pain meds, weaned him off and he lived another happy five years. There are natural ways to relieve pain. If people research these methods, they may be surprised.

Also, when being weaned off of morphine or opiates, it causes a withdrawal syndrome that is very very very painful and anxiety inducing Thus weaning is like a catch 22. The pain levels seem to go up, due to withdrawal symptoms, But once the body adjusts again, the pain will subside.

Of course it is much easier to simply give a prescription pain med rather than seeking alternative methods, particularly when one witnesses the withdrawal symptoms.

Here is a link to an National Institute of health (NIH) abstract discussing the toxicity of pain meds.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5297852/

Here is another NIH link with a portion of the abstract included in parenthises. The word hepatic is a medical term for the liver. The word renal is a term of the kidney.

https://www.ncbi.nlm.nih.gov/pubmed/15886461

( "Our findings pointed out the risk of increased lipid peroxidation, hepatic and renal damage due to long term use of opioids, especially morphine. Although opioids are reported to be effective in pain management, their toxic effects should be kept in mind during chronic usage." )

Morphine, like all opiates and opioids, causes tolerance to develop when it's taken regularly over a period of time. That's why it's not possible to say that a certain dose is too high or not for a particular patient unless other factors are known. 225 milligrams of morphine given as a daily dose may not be high at all for a patient who has been using the drug for many months or more. The patient would likely start off at about five to ten milligrams per dose, but as time goes on, the body becomes used to the drug. More and more is required to continue to provide adequate pain relief. Tolerance is a normal occurrence that happens to anyone who takes an opiate or opioid regularly. It's not the same as addiction; it's just the way the brain responds to the regular presence of an opioid drug. Oral morphine tablets are supplied at different dosage levels ranging from 5 milligrams on up to 200 milligrams per tablet. It's very possible for someone with a very high opioid tolerance to safely take 200 milligrams of morphine as a daily, or even a single, dose. This would be likely be in a time-released preparation intended to be administered twice a day.

On the other hand, someone who has never taken an opioid before, or has used them only rarely in the past, could never, ever safely take anything close to 225 milligrams of morphine in a single day. Everyone is different, of course, but as a general guide, a patient just starting morphine therapy for pain would probably receive about five to fifteen milligrams as an initial starting dose. Factors such as pain level, age, sex and size of the patient could affect the dose. Over time, with regular daily use, the patient will require periodic upward dosage adjustments in order to keep getting adequate pain relief.

Pissedoffwife, I hope you find peace somehow with the death of your husband. My experience so far with hospice care for my friend with heart failure has been a positive one. His pain is adequately controlled with moderate, although increasing, doses of oxycodone. Lorazepam eases his anxiety, and temazepam allows him adequate sleep at night. Tolerance will affect the dosages of all these medications eventually. This will also be true should he need morphine to help ease the dyspnea that is sure to come.

May all the caregivers here find the strength they need to care for their loved ones. It's sure not easy.

In terms of your request on hospice i would suggest you check the medical guidelines of the 1997 passage by the supreme court for palliative sedation. This procedure is only to be used when the patients pain is not controlled by other means, they have 3-4 days to live, not more than 14 days to live, and have stopped eating and drinking. There are many articles both in medical journals and newspapers discussing hospice care and their usage of this palliative sedation and what the medical community thinks of this procedure. It is highly debatable as usage has an effect on death.

Heather10 He was my husband of almost 43 years.

I just Googled "hospice hasten death" and there are websites but none of those websites are medical websites, such as the National Institute of Health, or the Mayo Clinic. They are website created by individuals who were upset that their love one had passed.

When death occurs, one has a real need to blame someone, that is quite normal. Yes, the emotions are very real. I would hate to find out my family was spending so much time regarding my death not to pay attention to anything I had done in life.

When it comes to the Internet, one can find anti websites for everything and anyone. There are still websites that claim no one dies from smoking cigarettes, that smoking health issues are a hoax.

There are websites that claim the world is flat.

it is best to concentrate on websites from highly accredited medical facilities, who have done decades of research on any medical subject matter.

Oh, regarding the recent new report about a doctor who overdosed his patients. Does that mean every doctor does that? What percentage would that be? 100% or less than 1%. It would be the latter.

Pissed off Wife:

I am sorry to hear about the negligent care of your father.

You are right SOME hospitals or hospice care facilities do hasten death for their own convenience. Just google it.

Perhaps people need to stay in denial to comfort themselves.

Can you talk to an attorney about filing a civil suit. A civil case is easier to win than a criminal case. Most attorneys give a free initial consult.

My grandfather was given weeks to live in a hospice. I took him to my home and he lived more than five relatively happy years.

Also just recently here are links to a high profile case about a doctor that was prescribing overdoses of fentanyl and killing patients without permission from family members.

https://www.nbcnews.com/news/us-news/families-sue-doctor-accused-ordering-fatal-doses-pain-medications-dying-n959476

https://www.dispatch.com/news/20190115/second-lawsuit-filed-alleging-deadly-dosage-of-fentanyl-by-mount-carmel-doctor

Frequentflyer-Evidently you're not in CORRUPT NH where Hospice is running rampant. No-one consented or signed anything for Hospice and No-one consented to oor signed ANYTHING for a DNR. It all boils down to NEGLIGENT HOMICIDE and Medicare fraud. You have no idea of how Hospice and the NH hospitals work in Murdering patients. In this Nashua hospital you have No say.
Illegal? You're damn right it is! Oh and by the way, do you consider 225 mgs of Morphine daily to be too much? I do. Thats an overdose!

pissedofffwife, please note the time table to passing is the same whether Hospice is used or not.

As for the reason why one isn't given food or water is because the stomach is no longer digesting, thus food/water would just sit in the stomach causing a lot of pain. This would happen with or without Hospice.

A person isn't placed on Hospice without a doctor ordering same. Who in the family signed the paperwork that is required by Hospice?

When it comes to morphine, a Hospice patient gets 5 to 15 mg, no different then the amount that a surgical patient would need for the pain. It would take 200 mg to cause death. Morphine is a highly regulated medicine, thus every mg is accounted for.

DNR is not given to a patient if the patient or whomever is representing the patient [Power of Attorney] had signed the paperwork. Someone had to have signed the DNR paperwork.

Most Hospice associations are non-profit. And many of the workers are volunteers.

I am sorry for your lost, it will be coming up to two years, correct? Could you tell us why your husband was in the hospital?

freqflyer-Yes I have. I was told I can't file charges against them. That the State has to. Nobody seems to care about Medical Murder's. For some reason they are letting them get away with Murder. Probably Money.

pissedoffwife, have you contacted the police?

Hospice is ILLEGAL Euthanasia when the patient first off refuses Hospice and is UN-KNOWINGLY forced onto it anyway without ANY Consent. Second, the patient is denied treatment for illnesses found through lab work, but never told. Third, the patient is denied food and hydration and overdosed with morphine. Lastly, offered a morphine drip to hasten his death, which he is responsive enough to REFUSE along with his family. He's been denied ALL lifesaving treatment even though he adamantly states he wants treatment and does NOT want to die. Last but not least, ILLEGAL DNR takes place. I'm talking about my 66 year old husband, ILLEGALLY Medically Murdered. His name is William and he will NOT EVER be forgotten and the Murderers will NEVER here the end of me!!!

My father returned home after a couple weeks in the hospital with hospice care. The help they provided was wonderful and the emotional help was amazing. He gained his strength back and probably could have gone back to home health but he was very comfortable with the staff especially the woman who came to shower him three times a week. Two years later he was still on hospice care when he began his journey. Every situation is different but he was restless, agitated, and seemed uncomfortable. Hospice advised us to begin administering the morphine as we felt was necessary. He passed very peacefully the following day. Hospice offered us so much emotional help and an understanding of what to expect when a patient begins their journey. My advice would be to make sure all family members are on board and understand exactly what hospice does. One member got angry with me and told me I should just take him to the vet and have him injected. Hospice is a wonderful organization and they are there to guide you.

THANK YOU DR HOSPICE--
for your well thought out and professional statement.

I'd hope that your comment would shut down the pointless round and round that the subject of euthanasia always brings. People just argue and no one really "listens".

Having 3 members of my family being aided out of life by the kind and compassionate use of Hospice, I will always be grateful.

A friend is entering Hospice care this week after a 10 year battle with multiple health issues. She's ready and her family is ready, not saying it's going to be perfect or wonderful--but she's done with the suffering.

I, for one, am pro-hospice. I plan to take advantage of it when my time is here.

I have only one experience with hospice, and it was murder.  My mother's death certificate says cancer, but she died of malnutrition, dehydration, and overdose of Morphine/Ativan combination... be very careful about who gets your power of attorney...  Her cancer was just a convenient name to give to a woman who had no money and no insurance and a daughter who had no desire to fight for her right to fair treatment.

I promised myself at an early age to graduate medical school and endeavor in further specialties, and I find myself in the blink of an eye a retired neurosurgeon. Maybe not that fast. I practiced as a neurosurgeon in the western US and now have to focus on my health and how I will receive care in my final days. I am alone with no children and my wife has passed away a decade ago. I have friends, and people who have become my family. But, I will research and decide the details for myself while I feel strong. I couldn’t put my friends through the daily back and forth and sometimes confusion of what is best. This is my life and I will end my medical career with myself as the patient. And enough of my boring details.

You posed the question “When is hospice euthanasia?” I can answer that easily with a single word, never. I say this with clear intent to highlight key distinctions and even basic definitions of these words.
What you really mean to ask by this is whether hospice care has mutated from the intent of care focused on patient’s concerns and needs and now can be so defined by a single word that evokes immediate shock and divides people instantly across many lines, that word being Euthanasia. Euthanasia by definition is a single specific act or direct process that brings about the humane death of a patient who finalized the decision over much time and information. It is a single moment.

Hospice is not a single moment of pre determined and mutually agreed upon means to bring death. I know there will be those with experiences they say reach that level, but just the initial conversations alone you learn of a series of services and interactions that are to take place over an unknown, but generally understood time frame.

Lets say you believe hospice literally performed a single act that brought intended death. By definition, the patient would not have consented and made an informed clear decision indicating his active participation and self intent to die. Words have meaning. And these words convey unique definitions.
Definitions aside to satisfy my need to answer the question as it was posed initially, I do understand what the question was really seeking to answer. Are they just playin’ nice and smiling with their brochures in a ruse to distract us from their ultimate goal of a quick death of Uncle Ed?
By by the time we bring a loved one to hospice we are adults. We have experienced many things, developed understandings and knowledge that only a lifetime of experience can provide. Yet, most people choose ignorance in new situations, because there is comfort in our ignorance. And it requires less of us and more of them.
Of course there here have been experiences between people, families and staff that have measured on the spectrum from ideal clear to Aunt Elda being convinced Uncle Ed was simply euthanized. I know how people interact. I know how people hear things and then twist them round and round. I know I can experience something literally next to another who witnesses all I have and yet gives an account of our shared experience in complete contrast to mine. People are wonderfully silly creatures.
So, inform and educate yourselves with decisions regarding the life and care of the final days of your loved ones IN ADVANCE of the day you ever walk through any doors or shake any hand.
I am here now beginning to become an expert in all things hospice long before I ever require that service. We know how to seek information these days, and even seek follow up resources on any topic known to man.
It is to me shocking that people choose not make time beforehand to research and freely and unencumbered know everything you need to know in preparation of the final days your sweet mother will be on earth.
People point fingers, blame, and often much prefer this path. Americans love actors and I imagine many fancy themselves on screen.

may you all persist in peace and prosperity

Novallentjsmom

Thank you, Novallentjsmom.

I agree.

Yes, it was the spiritual guidance you and my friend and the dying person all needed from a supposedly experienced and supposedly kind and caring hospice work.

After all, guidance is all they can offer, and it is for their guidance that their services are requested.

Just like you, my friend said her mother's passing was very traumatic for her to experience all alone.

Yes, the hospice agency should be held accountable for not having someone show up.

Heather10:

thank you. It makes me so sad to hear that this happened to your friend. It shouldn’t happen ever.

I wish they could be held accountable for not showing up at all. I feel like many people say to me “well they couldn’t have stopped him from dying” but that’s not what was needed. Guidance comfort and maybe explanations about what I was seeing would have been nice. Or taking care of him spiritually when he was still alive. I know I will harbor this anger forever. It’s sad.

Novallentjsmom:

I am so sorry to hear your story. It is a common one, sadly.

I have a friend who contacted her assigned hospice workers because she felt her mother was about to die.

She was an only child and was alone with the mother. She has no medical training and was beside herself about what to do and what to expect.

The hospice nurse had not shown up that night and when called she said she could not come because she had unexpected family issues to tend to. The agency had no back up to send.

The woman died within hours. This woman is also angry and the treatment she received.

My mother passed away in May 2018. Our experience with hospice could not have been better. (It was through the Visiting Nurse Service of NY.) She was at home and died around 8-9 weeks after we signed her up, following a 4-year odyssey of breast cancer, a broken vertebra, and then a massive stroke which left her bedridden and incontinent and with 24/7 care at home.

In her case, the hospice staff were very conservative with medications. They gave her a few tiny doses of morphine when she was having trouble breathing, but no way was it even close to euthanasia. I'm sure hospice providers vary considerably. (Personally, I want euthanasia if I get to the point where I have no quality of life. Bring it on!)

My father passed away in January after being placed on hospice care 2 months prior in our home. The hospice never sent a priest out to give him the anointing of the sick like they told my dad they would. I never saw a social worker and we saw a nurse occasionally unless I called for something. They did come clean him every other day though.

My dad had a mini stroke in November and after was on Home health care for physical therapy, a nurse and occupational therapy. They were all able to get him up walking talking he seemed fine. The doctor came in a week later and said that since he refuses the hospital she wanted to put him on in home hospice care and we could leave it at any time. Since my brother had such a great Experience with the hospice he had before he passed many years prior we thought it would be a good idea. My dad refused the hospital and usually the paramedics wouldn’t take him because he could answer all of their cognitive questions even when he had a mini stroke.

My dad passed January 14,2018 and he woke up that morning feeling sick and vomiting. I called the 24 hr emergency line 6 times between 7:45 am and 2:34 pm when he passed and a nurse never showed up. We were told over the phone only to give him Ativan and morphine which he refused saying he wasn’t in any pain he wasn’t taking that. They never told us why we should give him that nor that he was actively dying and I was never given the signs of end of life.

My fathers passing was very traumatic. He was sitting up and went unconscious but still had a pulse. As soon as he went unconscious brown fluid poured out of his mouth and nose continuously. My mother, my 26 year old daughter and I were all yelling his name and freaking out. I finally sat next to him grabbed his hand and said daddy with tears pouring down my face. At this point the fluid stopped as did his heartbeat and his head laid over on my shoulder. The nurse arrived 5 minutes after he passed. Hospice failed my dad and they failed our family. They weren’t there when we needed them most. If I would have only known he was dying I would have laid with him and comforted him, right before all this happened I was upstairs making him his favorite banana pudding thinking it would make him feel better.

I still attend grief counseling but my grief will never get better better because I am so angry about that day and the events that took place. No matter how much I try that anger won’t leave.

I'm so sorry to hear about so many horrible, sad and frustrating experiences with hospice. I was near tears at so many of your posts. it's emotional enough trying to get the best care for your loved one but to have an unresponsive, uncommunicative or overmedicating hospice staff is unconscionable. I didn't know much about hospice when we put my mom into their care. She was in a nice assisted living facility but fell a couple of times, complained about constipation, etc. and after 5 trips to the ER in one month, with one 5 day hospital stay, for a relatively minor complaint, having a nurse come to her instead of the stress on everyone, transporting her to the ER and waiting for hours... seemed the best for everyone. Every time anyone came to see her - nurse, aide, chaplain, social worker, I would get a phone call. They'd call before they saw her and if there were any concerns I had, they'd call after the visit to tell me about her condition. I saw her 4-5 days/week also and she had a personal daytime caregiver. She would refuse meds if she didn't want them - and the AL would call me every time she did. They never forced drugs on her and she knew what she was taking. When she was in pain, she wanted the pain meds. When she wasn't, she'd refuse them. I don't feel that the meds hastened her death. The meds definitely made her more comfortable. She was in constant pain before hospice and couldn't get comfortable, couldn't sleep, etc. When she started requesting the pain meds, it made her so much more pleasant. She enjoyed eating, she enjoyed seeing people. She wasn't getting physically better but she felt better.

The AL told us that some hospice companies were better than others. We were happy with the one we went with. Sometimes I felt they communicated too often but I was always glad to get the updates. If you have any concerns or bad feelings about the hospice company you're using, switch! My mom had COPD, CHF and PAD. She was maintaining, eating, etc but she became less mobile because of her PAD - her legs wouldn't support her any longer. At the end of COPD, carbon monoxide builds up in the brain which causes the sleep/lack of consciousness. When she got to the phase, she only lived 2-3 days. The hospice nurses called me when they were afraid she would live the night. No meds had been administered. Her O2 was on max - her body simply couldn't sustain life any longer. It was peaceful - I was with her - watching each labored breath until there were no more breaths. I think her brain stopped functioning hours before her breathing stopped because of the CO. I'm glad hospice was there for us - they made her more comfortable and were very attentive.
--Suzanne

Carla B

Actually, my friend was determined by all qualified medical professionals to be unlikely to have more than a year to live and that treatments were not working well. That is how she was admitted to palliative/hospice care.

Apparently the doctors were wrong about how long she could survive.

With rehabilitative care she is still going strong, although her illness is not curable.

She is not the type of lady that likes to be sedated. So she is willing to put up with some pain to avoid it.

She takes advantage of meditation, acupuncture, massage and other techniques to relieve pain.

Thank you for the Kudos and sending some back to you, too.

Here is a link with some information about who is accepted into hospice.

http://palliativedoctors.org/hospice/care

From the link: [ "What is Hospice Care?

There may come a time when efforts to cure or slow an illness are not working and may be more harmful than helpful. If that time comes, you should know that there's a type of palliative care—called hospice—that can help ensure your final months of life are as good and fulfilling as they can be for you and your loved ones.

Hospice is not about giving up. It's about giving you comfort, control, dignity, and quality of life.

Eligibility

Insurers, Medicare, and Medicaid will generally provide coverage for hospice care if your doctors determine you ( likely) have 6 months (a year in some cases) or less to live if your illness follows its normal course.

Heather - the account you shared about your friend is shocking! I'm appalled that any family would place their loved one in hospice unnecessarily and that hospice would accept a person who did not appear to be terminally ill. Kudos to you for putting a stop to the craziness and getting your friend out of there. I'm glad she is doing well.

CarlaCB wrote:

["Heather - I'm thinking about what happened to my mother in hospice. Her immobility was not caused by her pain medication. Her immobility was one of the first signs that she was dying. She came home from the hospital bedridden. I tried to get her up only once - she could not stand up even with me holding her up. She couldn't use the bedside commode even with help. She couldn't turn or lift herself either. Even using the bedpan was too much - she had to be catheterized."]

Carla CB:

In your case your mother was already immobile and could not even stand.

I am talking about people who are mobile, I am talking about people who are still walking and mentally alert, and who request NOT to be drugged who may not even be in much pain, but are given sleep medications. Or, who are at tolerable levels of pain and specifically request NOT to have pain meds.

The person I am caring for called me, desperate and in a panic, requesting that I take over of medical and financial POA, after her children put her in a hospice facility that was drugging her to induce sleep. She pretended to swallow the pills, so she could avoid them and stay alert.

She then contacted me. Her children were all fighting over who gets what, etc., according to her, and she did not trust them. She felt the children wanted to hasten her decline. Whether or not this is true, is not for me to decide. The children may have had good intentions, but were simply naive.

However, she clearly did not want to sleep all the time. That is why she called me.

I moved her out of hospice and into a rehab facility. That was four years ago. She is does not have dementia and walks fine.

There are some wonderful hospice facilities, but some that are not so wonderful.

Some simply obey the requests of the medical POA, particularly if a patient is difficult. Others will not and will suggest that a patient be put in rehab, if that is a better option.

The key is to be aware that some of the not so good facilities will do what is best for them and not the patient.

That is why the courts are filled with neglect lawsuits regarding such facilities. If one simply goes down to their local court house they will be able to read the horror stories.

Also many times, the workers at the not so good facilities will clean a patient up when they know the patterns of the family visits but if a hidden camera is used, the patient is not attended to at other times.

In your case, you mother was obviously declining rapidly. You and your family were there attending to her, too. So you were obviously very ALERT TO HER NEEDS.

Your mother was lucky to have you.

I’m so sorry for your loss MadGdaughter. I am glad you finally got answers. Our family experience was a little like yours, we knew MIL was dying but we didn’t know it would be so soon because nothing was communicated to us by the family member in charge, the person who was primarily taking care of her. The night before she died, I asked him if the nurse had given an indication of how much time she had left and he said no. I found out shortly after she passed that the nurse had told told him she wouldn’t make it through the weekend. We had a problem with lack of communication amongst each other and information being withheld. We knew her heart could give out at any time but we expected/hoped that when the end was near, we would be informed and allowed to say goodbye. But like I said, there was communication issues and when she was in her final days, that information wasn’t shared so we were all blindsided when she died. At a time like this, communication is so important.

Hi everyone. My grandmother passed away 6 days after going on hospice. I was clearly very upset and confused when I found this forum and posted. For my tone I apologize. I’ve done a lot of thinking/studying on this subject. I’m thankful my grandmother (I’m told) wasn’t in pain or distress. That is a blessing. I do now realize that all my family members were shocked. No one knew she was days away from dying. When I walked into the scene I believe her children were just realizing their mother would not wake up. She went into a deep sleep as soon as hospice came in and did their thing. She had been talking and there was shock that she would not be waking up. My big issue with this: the family should be very clear about what’s going to happen as soon as hospice walks in. My understanding is that wasn’t made clear. The hospice nurses were wonderful and brought great comfort to my family. I’m in my 30’s and have a lot to learn about this process. It’s unnerving to watch a loved one’s body shut down but I feel knowing more about this inevitability for all of us brings a little comfort to a mysterious life event. I appreciate all of your wisdom as caregivers and will continue monitoring these topics. By the time (hopefully a long time from now) that my parents health declines I will hopefully be more prepared mentally and emotionally to give the support needed.