My 93-year-old grandmother who has all timers and dementia has spent the last seven years of her life in a nursing home. My mother and her sister take turns visiting my grandmother daily. Other family members visit my grandmother as well. I visit my grandmother every other Sunday with my mom. My grandma's health has been diminishing because of her loss of appetite. She's always been a little bit chubby but she has been losing weight drastically because of her loss of appetite. My mom generally feeds her fresh fruit Jell-O and thickening liquids that the nursing home provides. We've all discussed that my grandmother probably gets no other nutrition besides when someone comes to visit and spoonfeeds for lunch or dinner.
A few weeks ago a hospice representative approach my mother and told my mother that their services would provide comfort for the family and my grandma as my grandmother's health continues to deteriorate.
Last week when I went to visit my grandmother I noticed that she had a brand-new chair that seeded her a lot better and she seemed more comfortable.
today when I arrived I thought my grandma was dead. I've never seen her look so poor and not in control whatsoever of her body functions.
We proceeded to the nurses station and found out that hospice has been administering morphine since Friday at midnight every six hours but the nursing staff could administer more every two hours if they felt my grandma was in pain. I asked the head nurse how has this happened that the family has not consented to morphine yet my grandmother has been given morphine for the past 48 hours... The head nurse said that hospice is supposed to contact the family to let them know but in order to stop giving her morphine they would have to have a doctors order faxed to them immediately... Where they would have no choice but to give her the dosage. I am mediately called hospice and left a message on their Emergency number. My mother said by the time she got home hospice had already called she return your phone call and they agreed they would call the nursing home and tell them to stop. This evening around 630 we were called by the nursing home letting us know my grandma's blood pressure was 74 and they said she may not have much time left to get to the nursing home immediately. Grandma was itching her skin and hair... The majority of the time she seemed disoriented and confused and still highly medicated. Her mouth was wide open and it looked like she desperately needed water or something moist to quench her thirst. A hospice care worker was there as well and said she would be willing to meet with me in the hall to discuss my grandma's condition. I told her I was not interested in speaking to her about my grandmother's condition and they have already caused enough problems. Miscommunication could be detrimental to my grandma's condition... And no one in the family had consented to my grandmother given morphine.
My question is do you think my grandmother will survive after having morphine in her system for more than 48 hours? The nursing home also told us that hospice had change the doses of some of her medicines and in fact she was placed on another medicine for anxiety; one that is not recommended for Alzheimer's and dementia patients- we were told the drug makes patient very lethargic.
Seroquel 25 mg -- is the drug and dosage.
My grandmother hasn't had food or liquids for several days now. I'm actually ticked that hospice could be so negligence and not inform the family about the morphine and we had to find out through the nursing staff at the hospital.
The nursing staff knows my grandmother for seven years -- it's not like no one came to visit her-- family was constantly surrounding her-- now hospice has come in and in within one weekend has caused her to be incoherent, non-responsive in a coma like state.
The hospital that discharged her to hospice care thought my mother might not live out the week. That was 18 months ago. She's still enjoying bingo. Hospice thought my husband had at least several weeks left when he died. All anybody can do is give a best-guess.
I think you will find this article about morphine use by hospice very enlightening: http://www.hospicenet.org/html/pain_myths.html
I had a feeling the paperwork probably stated something to the fact about administering meds based on granny's conditions and changes etc.
I guess my main question was the one I asked already ... Will she survive after having 48 hours worth of morphine pumped in her?
But like on person said it's impossible to answer unless you look at her medical charts, etc.
Thank you for your time!
My husband died on hospice in our home. They gave me the drug kit, explained what each thing was for, and I was in charge of what to give when.
When my mother went on hospice in the nursing home, we understood that Hospice, rather than the NH, would be in charge of what drugs she would be given and when. That is kind of the point in bringing them in. Their goal is to keep the patient comfortable and pain-free. They did a great job. Mother graduated out of that program in a few months. That was a year ago. She is doing well. When her time comes, I would certainly have her back on hospice care.
It is always hard to say how much of what you are seeing, if any, is due to the drugs, and how much, if any, it might be worse without the drugs. Hospice has A LOT of experience with the dying. That's why they insist on that comfortable chair immediately, and demand and get different mattress pads or beds. And it is why they make the drug decisions they make. They are all about comfort care.
Remember, hospice is for persons expected to die within the next 6 months or so. People who are actively dying don't look and behave like they did before they were actively dying.
You say "My grandma's health has been diminishing because of her loss of appetite" but it is probably more true that her appetite has been diminishing because of increasing and accelerating loss of health. People who are on the last leg of their journey are often not interested in eating. And at the very end, eating when their body can no longer process food may make them suffer.
It is so very hard to see our loved ones' health decline before our very eyes. My heart goes out to all of you.
Not all hospices live up to their mission. Maybe you got a bad one. But I think it is very likely that you had/have a misunderstanding of what hospice was going to do. It can be extremely stressful to see a loved one in the final stages of life. I suspect that is really what is so upsetting to you. And it would be upsetting whether there was any morphine involved or not.
Who is in charge of medical decisions for your grandmother? That person can cancel the hospice program at any time. Personally, I think that would be a mistake, but it is perfectly possible to do it.
The rep also said they had volunteers that would come visit my grandma, my mom said she assumed they were visiting her... That's why my mom said she signed my granny up for hospice visits.
Yes granny has been in the nursing home for 7 years... Everyone there seems to like her because she's a character-- always happy go lucky and waiving and laughing holding on to her dolls which she calls her babies, etc.
She's been on the thickening liquids for more than a year for sure.
Food wise she would eat only if we feed her or if someone else did.
There must be a complete misunderstanding on your part. Hospice is usually reserved for end of life care so why did you call hospice? I know how hard it is to make decisions like this but perhaps as Jessie said maybe its time to let grandmother go peacefully and that sometimes involves administering morphine.
Many people don't even bother to read the medical consents before signing.
As to your question of whether your grandmother will survive after morphine administration, that really can't be answered by anyone here who doesn't have access to your grandmother's specific chart to know what else was administered, what other conditions she might have, what the general state of her health was, etc.
I'm confused though...you wrote that you learned "through the nursing staff at the hospital" that hospice was administering the morphine. What role is the hospital playing, or is your GM in a hospice wing at a hospital?
It must be very frustrating for you to be dealing with this unresolved issue. I would sit down very quickly and have a discussion with hospice, even if you don't have confidence in them, to get the information you seek, especially the issue of what consents were granted when admission papers were signed.
I'm sorry to learn this has been so upsetting to you.