Did Hospice rush your loved ones death?

I don't feel like she was bad-mouthing hospice...she was simply asking if they could have been wrong----and, anyone human can be wrong sometime. But, she went by the best advice she felt she had at the time, so I don't think she should feel guilty in any way. She did what she felt was best at the time for her loved one....and no one can do more than that.

Dogabone, this isn't your loved one. And though hospice is a good thing, it is NOT perfect and can make mistakes like everyone else. Can we indeed hasten the death? Absolutely. Every business in healthcare is under-staffed and under-paid and only has so much time. Plus, the staff, at times, go by the textbook answers to which they have been trained---but like every medication, different people have different reactions to them, at times---so mistakes can be made. Lay off Dogabone. She has a right to voice her concern.

Losing a loved one is never easy. I have witnessed death without hospice and with hospice when severe pain is involved. Hospice gets my vote every time. We would all love for death to come gently in the night during sleep but that is seldom the case. You have to take comfort in knowing you did the best you could.

The ones second guessing you have not walked in your shoes or shouldered the responsibility. Do not allow their words to linger on your mind or heart! God bless!

I, too, have been haunted by the hospice care for my mom who died in April. She went into a regular hospital with a simple urinary tract infection but, due to toxic amounts of Digoxin given to her, she had a massive stroke and then her kidneys began shutting down and fluid built up in her lungs. She required heavy oxygen. The hospital could no longer do much for her as she had signed a DNR. She was then referred to hospice. She wasn't able to speak well but upon arriving at hospice by ambulance, she kept saying "home, home". I knew she wanted to go home but the AL facility where she lived would not let her undergo hospice there (could have no tubes). She was eating, drinking and able to understand and converse a little when she entered hospice but the heavy medication soon began. She only lasted five days. My sister feels I, as her POA, should have moved her back to a regular hospital but I felt I should honor mom's wishes. My last memory of her is of her dead body, mouth and one eye open. I see this every night in my dreams. No, I would not do hospice again. I would leave her in the hospital until everything possible was done. Then, turn off the respirator, in it came to that.

My daughter was on Hospice, and I knew full well she was no longer going to receive anything that would help her Leukemia. She lasted a month. I could not have done this without the Morphine. It made it easier for her to breathe, it made her more relaxed and less anxious. The last day we needed Haldol too, because those last few hours are not pretty.

2Smart, thank you for sharing a frank, insightful and informative look at the corporate aspect of hospice "care". Your experience with hidden clauses in documentation is very helpful; hospitals shove consent forms in front of patients, with nonmedical staff often saying "it's just the consent", without the basic common courtesy of allowing patients to read, then become annoyed with they're told I won't sign until I've read everything.

I am sorry that your hospice experience was so regimented and drug oriented, but it doesn't surprise me, and I'm appreciative of the time you took to provide this caution.

Veronica91 thank you for your well thought-out response. My mom’s case was so complex I was striving for brevity in answering the question whether I thought hospice rushed my mom’s demise. She was medically fragile with multiple health problems: CHF, seizure disorder, diabetes, and anemia. She had been on death’s doorstep many times before and we, her daughters, pulled her back each time because we learned early on that she had to have an advocate there at the hospital by her side every time she landed there. She turned 86 on July 4th and we knew we were on borrowed time with her, time we had bought by being vigilant with her care and multiple medications. We did so because she was vitally engaged in life: loving, fun, alert, and highly interactive. For all her infirmities, she never had pain. None.

Her three daughters who made the hospice decision jointly felt like we knew what hospice care would be, as my oldest sister pioneered the field, working as a hospice RN in the ‘80s. I greatly admired her dedication to the field and what it was doing. The emphasis back then seemed to be more about dying with dignity and avoiding “heroic measures” and less about medicating the dying into senselessness.

The hospital that had saved mom’s life many times is supposedly a non-profit. It used to be a Presbyterian hospital with a great reputation. They are now part of a conglomerate that offers hospice care and somehow manages to claim non-profit status, but I know what corporate smells like when I smell it. I agree that those in the trenches don’t profit like shareholders but virtually every single hospice employee I met was robotic and determined to drug my mom. Relentlessly determined. She never complained of pain. Not once. When I told the nurses she was not in pain they never wavered from their insistence that they needed to manage her pain. When asked, they could not support their claim she was in pain and never even tried to. I know corporate programming when I see it.

And I know bottom line concerns when I see them. No medical facility anywhere is so sufficiently staffed that a paid employee could sit by my mom’s side and spoon feed her the water she needed to stay hydrated after all the Lasix she was given. It is much more expedient to keep dying patients so drugged they can’t ask or cry out for water. They are going to die a lot sooner if they are not given water. That’s just a fact.

I was by mom’s side 24/7 to respond to her every need, so there was no need to keep her drugged to relieve staff responsibilities. She was not crying out or fitful. The only motivation that the conglomerate nurses could possibly have had to force opiates on her was to expedite her dying, and the only reason for that has to be financial. I’m sorry, but it’s time the public wakes up to the fact that medicine – and now dying – is big business. With hospice care, sure, the facilities, conglomerates, and pharmaceutical companies make more money the longer the patient stays alive…but who is picking up the tab? That’s who is calling the shots.

Instead of keeping mom at the conglomerate hospital with the nice room, we returned my mom to her nursing home where she was beloved and well cared for. Because of the 4th of July holiday we were never given hospice papers to sign at the hospital, although we verbally agreed to use the hospice program offered by the hospital’s conglomerate who would “manage” her hospice care at the nursing home. I did not understand that I was agreeing to have ALL of my mom's medical decisions made by a nurse who was not on-site and that no other nurse or doctor could evaluate her for non-hospice care. We will never know what caused the swelling in my mom’s jaw. The hospice nurse never looked in her mouth or palpated her neck. She only offered opiates or Ativan.

Morphine is a poison that destroys lives across the planet every day. Just because the dying can’t articulate what it is doing to them doesn’t mean that they want it. I think in many cases it is given because it is easier on the living…and easier on the bottom line. I'm not saying it shouldn't be administered to those in pain and those who ask for it, but I am saying that there needs to be much more public dialogue about this so families in my position can make more informed decisions.

My mother went on hospice, in a nursing home, in April of this year. She was discharged from hospice care in July, because she had improved so much that she was no longer considered likely to die in the next few months.

The NH took good care of her. Hospice added another layer of attention and special care. Her 4 daughters made 10 to 12 visits each week, on all shifts.

I believe that every bit of care and attention contributed to her quality of life. As it turned out, I think it all contributed to the length of her life, also. Hospice care certainly did not shorten her life.

MIL just passed this morning and I was asking the opposite question. It was obvious she would not get better from the stroke and heart attack she had a week ago. It was an exhausting week for everybody. MIL had advance directives of no heroics, tube feeding, etc. She died on her terms and my ex had the courage to carry them out. It seemed to take so long, I wondered why can't they do something to speed this up.

It's hard for me to relate to your concerns because of my own thoughts and plans for ME near the end. I'll take your dad's recipe, frankly.

It's been my experience that, when pain relief has been prescribed by mom's doctor, it's liberally offered: "Are you in any pain?" Here comes a pain pill. Perhaps it was the same with your dad.

You said it all to your dad, yes? He's in a better place, yes? Let it go is my advice to you. Hospice workers are caring and compassionate people. Your dad died peacefully. That you weren't able to say a final goodbye, in the scheme of things, means little. He knew you loved him. He knew he was dying. (Even if he DIDN'T know, he STILL knew.)

One's body does the best with what it has. It's a remarkable machine. Even when death is inevitable, one's body will fight-fight-fight. One minute he was able to handle the toxins his liver couldn't metabolize, the very next minute his body was on overload. Day. Night.

Your dad wasn't eating BEFORE he went into hospice. His body was giving up the fight. Again, he went peacefully and pain-free. Be thankful and let it go.

Dear tosmartolate I can only offer you comfort for the loss of your beloved mother. You and she had a horrible experience with the hospice your mother was admitted to.
As you conclude "follow the money".
I am assuming that this hospice was "for profit" Their one objective is to make money and if this is sucessful their top executives recieve the same over inflated pay checks and bonuses that executes in welknown major corporations enjoy. Horrible, sad and any other way you care to describe it but true. There they sit in the luxury of their top floor office overlooking the beautiful ocean planning their next corporate trip to a warmer climate next January. While the top brass enjoys the perks of sucess the worker bees (nurse) are not exceptionally well paid and may have an excessive patient load which may delay their visits.
All that being said, they are able to attract many patients with the facilities they are able to offer. Most people are unaware what hospice means and at the time they consider it they are dealing with a loved one's approaching death so are unable to do the necessary research.
All the medications you describe are commonly used in hospice care and for very good reasons. You do not share what your mother was dying from and why her jaw swelled so suddenly. However she was in a facility within a hospital and her regular care was being administered by nurses in the facility. Such an emergent condition would appear to merit faster action and not waiting six hours for the arrival of a hospice nurse. In her defense a hospice nurse has to triage her calls and a patient with acess to care within a facility would not be as urgent as a man who has become unmaneable and is beating up his 89 year old wife.
I can not say whether the intention was to speed your mother's death or not and am very sorry you feel so badly about the treatment your mother recieved. As with everyone else nurses also have their personal views on subjects and the nurse you spoke to may have had strong objections to certain treatments and had previous bad experiences with the practices of this particular hospice.
Finally in closing there is a very big difference between a for profit or not for profit hospice. For profit is a business just like any other and may be good or bad. A not for profit is a registered charity and must follow the rules just as any other not for profit. As most of the patients are Medicare or Medicaid the hospice has to follow the regulations set out by these two entities. The level of renumeration provided by a not for profit is far lower at all levels therefor the nurses etc attracted to this work are most interested in providing the kind of loving care they would want for their own loved one.
As a RN who spent the last ten years of a long career in nursing as a hospice nurse I can only say how sorry I am that you are so distressed by the way your mother's life ended. Try and take comfort in the fact that she had her loving family at her side and was ready to meet the Lord. Blessings

I have to say yes, I believe hospice rushed my mother's death three weeks ago. And I believe the hospital she was in rushed my sisters and I into thinking she was ready for hospice by administering morphine which took her from a critically ill but alert patient to a living corpse overnight. The only good thing I have to say about hospice is that it empowered me to reject the morphine and later the dilaudid the hospice nurses relentlessly and robotically tried to force on her. And I do mean relentlessly.

It also gave me a wonderful room in the hospital’s palliative care unit in the where I could access unlimited little pots of thickened water. After we moved into this room I sat by my mother’s side and patiently spoon fed her thickened fluids for four or five hours until she finally became rehydrated. With water and without morphine she came back to life. She ate small amounts of food and answered questions appropriately. Because she was in a state of pharmaceutically induced encephalopathy she could not fully track conversations but she didn’t look like a corpse any more. She also stopped moaning once she was rehydrated and the morphine was discontinued.

Nothing any doctor, any nurse, any professional anywhere can tell me will ever persuade me that it is humanitarian to give morphine instead of water to a patient who can still swallow. It was clear that the minute I signed the hospice papers that I reduced my mom to “living corpse” status. The change shocked me. I was told that we could have anything needed for comfort but when her jaw began to horribly swell, completely disfiguring her lovely face, it was over six hours before the hospice nurse came. The staff nurses told me they could do nothing but give her morphine, dilaudid, and Ativan – which she emphatically rejected. It was the worst night of my life. The only thing that prevented me from withdrawing her from hospice was my mom herself, who by then had the seen a beautiful destination and did not want anything delaying her arrival there. Including morphine, dilaudid, and Ativan. She wanted to meet her maker undrugged and I was determined to keep her undrugged. But what a battle it was.

Later a non-hospice staff nurse at the nursing home validated my Herculean efforts to honor my mother’s wishes by confiding that morphine causes patients to have “bad dreams” and moan and toss. When I told another staff nurse that I believed that the hospice nurse deliberately delayed arriving because they wanted my mom to die ASAP she said it was true – she had seen it before.

This is a long entry and I take the time to write it because this is a strange new world we live and die in. I cannot speak for patients who are in agonizing pain, but for patients like my mom, and suzy05’s, who are not in pain, there is no justification for morphine or other opiates. If I had it to do over again I would never sign hospice papers for my mom. There is a distinction between not taking heroic measures to prevent death and expediting it with sanctioned drugs. Anyone who thinks that hospice care isn’t being guided by corporate principles needs to follow the money.

Pam that is a wonderful story I had wondered if you all made it to the Outer Banks. your daughter was very blessed to have such a wonderful mother.

Pam, thanks for telling your daughter's story. Hospice is a blessing.

Pam, I am so glad that the inevitable was made as comfortable as it could be for your daughter and for those who loved her.

My Mama has benefitted from Hospice as well. as have I. we have had a few miscommunications along the way, but both sides (them and me) were open about all of it and have continued smooth sailing. Our Hospice immediately got everything we might need so it would be on hand but thus far, none of it has been necessary, other than a couple of times when she first came home and she appeared to be grimacing and a tad and I do mean tad of morphine was given and that seemed to work very well for her comfort level. My Mama is, at present, doing very very well. She has even begun to communicate with us like she used to do. Today has been excellent and Mama is so happy. I am so thankful. I don't know what our future holds...well, I know we are all leaving this earth one way or other, but, Mama is really doing well under the watchful eye of Hospice....they have instructed me on different things available in the event they become necessary but Mama has never taken medicine and so I do not give it unless absolutely needed. Our nurse said that she is amazed at how well Mama is doing....we all are...and I am so very thankful to have them... When my Daddy passed, some 18 years ago, we had home health, but never actually were "signed into" hospice. nonetheless, he passed at home, very quietly surrounded by his family....I wish we had the morphine back then, it might have been more comfortable, but he went very quickly and seemed to have drifted into a more comatose state and did not indicate discomfort. My heart goes out to each of you on this thread. Losing our loved ones is a painful process, even talking about it can bring back so much emotion and pain...It's good we can be here for one another.

Shortly before her death, my 103 grandmother came home after a quick succession of hospitalizations, contracted C-diff along the way, and it all took her down from an otherwise physically healthy centenarian... to losing 30 lbs in under 2 months, and all the things then that start to happen when the body can no longer sustain itself and is demising.

My only real input here is that - NO, the hospice nurses didn't rush my grandmother's death at all. I was able to take her home for the last 2 weeks of her life, and largely tended to her day and night by myself, her hospice pain meds were never used, and she passed during the night... that morning, hospice was called in to the house, and the nurse remarked she was very surprised my grandmother passed as quickly as she did.

So, no... not rushed, not meddled with, not anything. Hospice was on hand, but no one ever administered meds or "interfered" in any way. That was my experience.

(((((((Pam))))) - that is about as good as a very difficult time gets. My son went very peacefully under totally different circumstances, but it was a comfort.

I am so very sorry for your loss, Betty3.

Hospice made it possible for us to get our daughter to the Outer Banks NC for her last wish. She had Acute Myelogenous Leukemia that a stem cell transplant could not repair. She had Compazine and Morphine which we carefully gave as needed. Those drugs made it possible for her to enjoy the OBX for six full days. Those drugs made it possible to transport her in a bed in a rented RV in complete comfort, no anxiety. The last day of her life she was alert and talking with family all day. In the afternoon she was disoriented so we added a dose of Haldol. Her urine bag was the color of coffee. When evening rolled around, another dose of Haldol, another 10mg of Morphine. Her girlfriends got in bed with her, one on either side and she fell asleep. Her BP had slowly dropped to 70/40, O2 fell to 91% and heart rate increased to 130. She was not agitated, she was not uncomfortable, just asleep. Just after 2 AM she took her last breath, still asleep, still relaxed and peaceful. It was as beautiful a passing as anyone could have.

Don't do hospice................!!!. in my case my dad entered the hospital with pneumonia on a Monday June 9th talking, eating, knowing all the grandchildren included myself, his daughter, and knew his first name middle name even his conformation name, his birthday, also and the Fighting Irish fight song. On the next day, June 10Th, he had a bronchoscope which he did well. He seemed much better Wednesday June 11. My sister stated to my brother and I to see if dad was a candidate for hospice so the 3 of us meet at the hospital. I stated I wanted to see the order for hospice from the doctor and have a meeting. On Thursday June 12 Hospice was called in I had no idea. Dad came home Saturday (after being pneumonia free) June 14, very tired but was drug up from the morphine and other drugs, it was said the drugs were for pain. I did get hospice to lower the dose. It was a small amount. I asked Daddy, are you in pain, he said no. I asked him if he knew who I was again and he did know my name, first, middle, madden name, and last name and of course who he was, and his birthday. Dad didn’t have food, and only a swab of water. He could swallow so why oh why could dad not come home with IV’s? I was told he would aspirate which is not true, IV’s would not put liquid into your lungs. Dad had gone to the doctor 3 week prior and was told his heart is good like a high school student. By starving a person and not giving fluid your body will shut down it was so sad to see dad in this state. Dad lasted for 8 days. He passed on father’s day. Hospice told me to get grieving counseling!!!!!!!!!!!!! He should have never starved to death. So Please, please don’t place a family member on hospice unless they are truly terminal – less than 24 hours.

Rosie, High ammonia levels lead to coma and death. The person might seem fine one day and the next day be in a coma. I am so sorry about your brother accusing you. That's really unfortunate, but please try to forgive him because it is his grief talking. Clearly your brother is in the bargaining stage of the process - "If only my sister had not put dad on hospice, dad would have lived longer." Normally, this phase of grief is followed by depression and then acceptance. Please try to have patience with your brother as he works through this. Of course, you are grieving as well and you are also questioning. "Could I have done anything different? Is this my fault?" So you are bargaining as well. It is very important that you and your brother not allow your father's death to tear you apart as family. Your dad would not want that. I do think that your dad was clearly on the way to liver failure before he left the hospital and I truly believe that nothing hospice did rushed his death. Perhaps this will make things easier for you and your brother: Psalms 139:16: "Your eyes saw my unformed body; all the days ordained for me were written in Your book before one of them came to be." What this means is that your father's entire life, including the day he would die was preprogrammed for him before he was even conceived. Remarkably, modern science has proven that as biological beings, our cells are preprogrammed from the moment of conception to do specific things throughout our lives, including dying. So this ancient thought on life, is, in fact, proven by science to be true. You father died on the day and at the time he was meant to die and there was nothing either of you or anyone else could have done to change that.

The death of a parent shakes the very foundation of our lives. It is natural for both you and your brother to feel vulnerable, alone and out of control at this time. No one wants to lose their parents, even if our parent was far from perfect. But that is not how life was designed. We are meant to spend half of our lives with our parents and half of our lives without them. As you work through the grief process you will come to realize that this loss has been profound, but that your father left you strong enough to face the future. And through this loss, you experience one of the defining moments in life. I want to recommend that you get this book for both you and your brother:

amazon/Losing-Your-Parents-Finding-Yourself/dp/078688651X/ref=sr_1_2?ie=UTF8&qid=1389030744&sr=8-2&keywords=on+losing+your+parents

Please, don't take on guilt that is not yours and don't let this turn you and your brother against each other no matter what. You are both part of your father and you are meant to share that bond for the rest of your lives. Be patient with each other. You both are sharing a defining moment in life. It's a difficult transition, but you can get through it together and most of all, grow in ways you never thought possible.

Redhead. You did all you could. Hopefully they will be keeping an eye on that hospice in the future

Veronica91 we wrote to Medicare to itemize where the hospice bill was fraudulent. They called my father with the mistaken idea that he wanted something from Medicare. He did not, he just wanted them to know. They mustve been covering their ineptitude becase they never did anything to reclaim what the hospice took.

Once the digestive system shuts down it takes about 24 -36 hours for them to die. It is an incredibly painful way to die. They vomit copious amounts of fecal like fluid. So the only help you can give them is to relieve their pain and anxiety and this requires amounts of medication that will cause unconsciousness. The time table for dyeing was already set before the drugs were even started, they neither hastened nor slowed the process they just made it bearable. Hospice nurses can only give the amount of medication prescribed by the Dr they can't just come in and overdose a patient. The Dr may prescribe a range of doses so the nurse can make small increases without calling the Dr but that is all they can do. They may have the means but if they use it without authority it is a homicide

only hours before my mother died her digestive system had ceased to function. she was somehow aware that she was done for and in fact asked me how she was going to get out of this one. hospice heard no sounds from her digestive system and promptly ordered liquids ativan and morphine. she was dying, they rendered her unconscious to free her from pain. in the state of agitation she was in it would have been cruel to let her death play out naturally. hospice didnt kill her, copd, kidney cancer, and dementia killed her.
its snowing like a mf and id give anything to have her here baking bread today.

Dogabone, I sent you a hug because I see we are both grieving the death of a loved one; a lot of my grief (and my guilt) lies in the fact that my sister did go from alert and talking to nonresponsive in, what it seemed to me, was just a few hours. We shared a house and I was the one caring for her, so I do take a lot of the guilt on myself--even why didn't I go with her to the doctor's appointments over the summer when she wasn't feeling well. If the cancer had been discovered sooner, would there have been a better outcome? I just don't want anyone to think Hospice killed my sister; the cancer did that. Maybe the drugs caused her to pass away a few days earlier, but I hope she wasn't in any pain. Thanks for coming back to this thread and posting; that took courage.

Sorry for jumping the gun on this topic thread.If I may say,you could of rephrased the main topic in a different way other then,Did Hospice rush your loved ones death?This topic you created doesn't go with what your trying to explain.From reading this main topic sounds like your pointing the finger at Hospice.I'm not indiscriminately throwing out accusations?I'm only going by the main topic how it's worded.(Did Hospice rush your loved ones death?)Sound's a little harsh if not pointing the finger at Hospice.But,I get what the OP is trying to explain.
I'm sure some Hospice employees do rush a loved ones death.But,if the family didn't keep a open eye on what that Hospice employee was doing to their loved one.The finger points where?At Hospice the employee or the non open eye of the family?Some people feel better in them self by pointing blame to others to ease their own guilt.But,if you didn't attempt to prevent?Where else does the guilt point other then your self?Sounds harsh but,the truth.
If you say you did all what you could do?So,be it.No need for guilt if you attempted to prevent with a open eye.
I will agree one some things you all stated.
My Father in law was diagnosed with lung cancer.The first day of chemo I drove him and his wife to the doctor.He walked into the doctor's office to his chemo on his own.I waiting out in the car while he was doing his first chemo.His wife was with him during the chemo.2 hours later his wife comes out to the car to me telling me I need to help him to the car.I was shocked what condition he was in after that chemo.He walked in to the doctor's office.I had to carry him out.From that first chemo he never got any better after that.Down hill he went.To this day thinking about it now.That first chemo I feel is what put him down so fast.Before that day of that chemo he was walking,talking,joking.I think that first chemo just woke the cancer up.They say once you crack it open your done for.
I remember when Hospice started coming to help him.I see what you mean by saying Hospice drugs people up to their death.I think it's true in some or most conditions.And yes,I feel Hospice does rush their death.We couldn't talk to the father in law.He was too drugged up.But,I'm sure if he wasn't all drugged up he would of been in alot of pain.But,who really knows how much pain he was in really?He was ok until Hospice and cemo came involved.I feel if he didn't have that chemo.He would of lived a little longer I'm sure of it.From what I seen the Chemo and Hospice put hin down fast.

No need to defend your self.I'm not pointing fingers and sorry for your loss.My last responce was from going by the main topic.
(Did Hospice rush your loved ones death?)
That's a harsh sounding topic to create.And cought me off guard to react on it.
I can't speak for all Hospice employees or all Hospice clients.It varies by employees and clients.I know by my experience of dealing with Hospice I had no problems what so ever.In fact without Hospice our family wouldn't know what to do.My father in law died of lung cancer,My Uncle died of Throut cancer.Hospice was their for both of them and did a amazing job.When my Mother & Father died back in 1992 & 1999 we never heard of Hospice.We had no help.I was 21 yrs old when my Dad died.Both could of used Hospice but,then that option wasn't around for us.Again sorry for your loss.If your family thinks your the cause why your loved one passed so soon because you got Hospice involved?Their thinking wrong.And good for you ,you did so.I sure wouldn't want to be the one to give shots to my parents during thier passing time.I wouldn't want to remember that for the rest of my life.That's why there's Hospice.To do what we can't or don't want to bare to do.
Off the wall example,
When your dog dies.It's not best for you to plant your dog your self.It's best to find someone else to do that for you so they say.But,I planted every dog I had my self.
Dogs are just like your family.I have a 12 yr old black lab not doing good.Loss of eye sight,bad hips.Everyone tells me to put it down.That's the answer for everything they say is put it down.Well,I know my dog.He isn't ready to go yet.I'll know when it's time.Until then,I will enjoy him.If only a dog could talk lol.

The issue here is whether hospice influences the early death of someone under their care. For what it might be worth, some patients have recovered from their illness while in hospice, and went on to live years afterwards. According to an article in Washington Post published December 26th, nearly half of the patients in Alabama got better, and a similarly large percentage of California patients recovered.

Hospice and palliative care may be one of the greatest gifts you can give someone who is terminally ill. Furthermore, hospice is covered by Medicare, and provides services to the surviving family.

What exactly is "over-medication"? Hospice workers know best. Hospice workers are aware that over-medication may give rise to homicide charges, so they generally do not try to "overdose" a patient. We currently have a case in my state, Pennsylvania, where a caretaker daughter, a nurse, was so charged for over medicating her father. At the other end of the spectrum, I recall enjoying a football game with a relative when his wife came in the room, turned off the T.V. and threw his beer down the sink. As she was leaving the room she said "well you told me in your advance medical directive to 'pull the plug' when when your quality of life depended on machines and ingested fluids." Since family members so often miss the mark about what is proper medication, it is a decision best left to experienced hospice workers.

For those families not sure about whether hospice is appropriate, it might be a good idea to have someone review the medical records and offer a second opinion. The authority of N.P.'s under the laws of each state are different, but in some states a Gerontological Nurse Practitioner can be retained to review medical records and have a candid discussion with family members at a reasonable cost or covered through insurance.