Mom, who is 93, diagnosed with advanced congestive heart failure, and on morphine and halidol, has been like this for about two weeks. She signals wanting small amount of hand fed pureed food and water and ingests, but it’s not enough for nourishment. Coughing and chest fluid are now under control. Doctor said bowels are fine. But she cannot move, is like she is trapped in her body, but appears to be in no pain until moved for changing. Too weak to talk. Sleeps on and off. So heartbreaking, sister and I are there every day. Hospice team says this is normal - is it? If not, what should we do?
So sorry for everyone’s losses.
An increase in foods would likely lead to at least some of it going into her airway. This could lead to aspiration pneumonia and a quick death. If, however, she indicates she wants food for slightly thickened water, cool gelatin, you can try small amounts if her head is raised and she is awake enough to cooperate and have a good swallow.
Your mother is dying and I encourage you and sis to talk with the hospice nurse and social worker about what to expect. As her organs fail (which may come quickly due to her very weak heart pump) she will become confused as toxins build in the body that heart and lungs and kidneys cannot address. She will become confused when this happens. She may begin to indicate she wants things. To get up, to eat, to drink. She may pick at things, hallucinate. This is expected and it is why there's mercy in drugs to keep her VERY SEDATED.
Nurse Julie on youtube is a hospice specialist and can help you understand what you are seeing/will see as well. My heart out to you. This is a very difficult time to stand witness to one you love.
I'm very sorry you're going through this, my friend. I admire your strength and courage, and pray that God comes quickly to take your dear mother Home. I wish you peace and acceptance along the way. Remember to breathe.
I'm surprised hospice hasn't spoken more about this, but I'm sure they would if you ask questions. They should be able to tell you practically everything you ask about the situation at hand.
May you have comfort and peace.
Don't worry about the morphine and haldol or ativan. These are keeping her comfortable, as their organs shut down it is painful. Just be there. Share good memories. Tell her you love her. It's all you can do. The breathing sounds awful but I'm told it isn't putting them into distress, it is just hard for us to hear.
Yes, it’s so distressing feeling totally helpless at a loved one’s bedside. I appreciate you mentioning moving legs can be a sign of pain. I didn’t realize that and although she is normally still, she did that today. Thankfully, my sister and I had already spoken to the hospice nurse and arranged for more morphine because she was showing distress when the tech attended to her so you mentioning the legs moving as an additional sign of pain was really helpful and confirmed that we did the right thing in requesting that she be more medicated. I also appreciate you confirming the morphine, halidol and ativan. It’s such a worry not knowing if they are using the meds that would make her the most comfortable, she is on all three now. The information you offered is really helpful. Thanks again.
Visit her, talk to her about happy times. Your goal is to allow her to pass on her terms. When you leave your visit be content that she is in no distress
If you feel that you need clearer explanations, ask the hospice team. In my experience hospice has always been kind and very forthcoming to explain what's going on. Be grateful that mom's team is making sure she has little or no pain. You might wish to take part in grief counseling, which they will offer to you at no charge.
My condolences to you and sister.
As a hospice trained CNA, I knew it was the most compassionate loving and comfortable way for her to pass although it was very difficult for us to not be able to be there. What your mother is experiencing is normal... My best to you.
It was actually two sisters and myself, all in our seventies except for one sister who is in her late sixties, who had been taking shifts monitoring Mom’s care and feeding her small amounts of pureed comfort food and fluids from morning until after the assisted living facility closed.
The whole time my sister with the morning to early afternoon shift was there no one advised her that there was a covid outbreak - even though a quarantine notice should have been posted at the entry door, administration failed to post any signage.
And when I entered the building to relieve my first sister to start my afternoon to early evening shift of monitoring Mom’s care and feeding her the pureed comfort food and giving her fluids, there was still no sign posted by administration to warn visitors of the covid outbreak and no employees bothered to alert me to it (I have an iv contrast allergy so my doctor advised me not to get vaccinated per CDC guidelines, which I made the facility aware of, and always wore a KN95 mask).
It wasn’t until my youngest sister, who is in her late sixties, arrived a couple of hours before closing to finish our monitoring and feeding shifts for the day that she was told that there was a significant outbreak of covid in the building as a result of the Christmas party administration chose to hold with outsiders in attendance with no measures taken to protect their most vulnerable - assisted living hospice patients like our Mom who are self-paying $12,000 a month.
When I asked if any employees tested positive out of concern for our mother’s welfare as well as that of myself and two younger sisters (all three of us have serious health issues and are high risk), I was told that only a number of patients tested positive and were symptomatic for covid.
As a result of holding this Christmas party, despite the clear risks to their own high-paying patients, my sister who did the morning to early afternoon shift became seriously ill with covid and was denied paxlovid because of the heart meds she has to be on. And due to my several hour daily exposure in the facility to provide care to our dying mother and my exposure to my sister who didn’t know she had been infected because of their negligence in alerting visiting family members and patients that there was a significant covid outbreak in the building, I also had to go into quarantine.
Although we hoped that the paid assisted living facility and hospice personnel would provide our mother with the level of care that we were providing and we could resume her care after our required quarantine periods were over, our Mom died all alone two days later.
When our younger sister who was there for the latest shift questioned the aide working for the assisted living facility who was directly responsible for her care, the last time our Mom had received her comfort food and water, she actually said that they had been too busy trying to contain the outbreak so she didn’t know. Again, this was the aide working her shift in which she was directly responsible for our Mom’s care.
Her funeral was yesterday, Dec. 22, 2025 and had to be delayed because my sister had to recuperate from covid and we had to finish our quarantines.
Because of this facility prioritizing a Christmas party - and, to be clear, I am a devout Christian - over protecting the most vulnerable, my sisters and I were denied the opportunity to be with our Mom on the last two days of her life, our Mom died all alone and we worry she felt abandoned as she lay dying.
There were more issues too so I have nothing good to say about hospice.
BUT if she is aspirating any of what is offered then that should stop.
You can provide a swab for moisture for the lips, mouth, gums.
ANY liquid should be thickened.
Her body is shutting down so it will not use nutrients (food/fluids) like you or I do.
She also will not have the hunger or thirst like you or I know it.
If she is given food or fluids that her body can not process the food can accumulate in her stomach possibly causing pain or discomfort. Fluids that are not processed can seep into tissues causing discomfort. the kidneys stop processing.
Your Hospice Team is right this is normal.
It is more difficult for you and the family than it is for your mom.
Be with her, hold her hand, talk to her, tell her that you will be alright. Thank her for being the kind of mom that others wish they had.
By the way when she is sleeping..she may not be sleeping. It takes muscles to hold the eyes open, muscle strength that she may not have. so while her eyes are closed she may still be aware of what you are saying so you can talk to her.
I just saw your response to another post....
I am sorry for your loss.
My sister who did the morning to early afternoon shift of monitoring and caring for our mom while I did the afternoon to evening shift contracted covid from the outbreak in the building.
As a result, neither of us could be with our mom during the last two days of her life due to required quarantines and she passed alone, with us being denied the ability to comfort her in her final hours.
Also, we encountered another issue with this assisted living facility that is of concern as well. The day before Thanksgiving, one of the higher level nurses stopped into mom’s room to announce to me that despite our mom wanting to continue being on small amounts of comfort food and fluids, this “medical professional” callously told me in front of my mom as she was laying in her bed fully aware that she was giving a nothing by mouth order from now on.
Since my mom would tell me she was hungry and wanted to stay on her small amounts of comfort food and fluids, I told this to this nurse and she replied that what my mother and I wanted didn’t matter as she had already issued the new order so no more meals or fluids would be delivered to her room.
When I tried to explain to her how her aide said she was still having bowel movements, she insisted that my mother was constipated and her bowel was no linger functioning - without even doing an exam, feeling her abdomen or listening for bowel sounds with a stethoscope.
Of course, I knew what she was proposing - cruelly starving and dehydrating my mom until she passed. She puffed her chest out telling me, her daughter in her seventies, that it was her call and that she had been a hospice nurse for many years before working at the assisted living facility, like that should override compassion and common sense.
Knowing that I wouldn’t be able to discuss this matter with someone who refused to hear me, I waited until this so-called experienced “nurse” left the room and phoned for my mom’s doctor to come to my mom’s room to examine her on an emergency basis.
A few minutes later, her doctor arrived and I advised her of my interaction with this nurse who told me that she had already issued the nothing by mouth order.
When her doctor took the time to actually examine my mom, unlike this nurse, she said my mother’s bowels were working fine, she was not constipated and she would be cancelling the nurses’s nothing by mouth order immediately.
You mentioning how my mom could be awake and aware even if her eyes were closed really hit home because I thought everyone knew that and that’s why it is so important to watch what is said in a patient’s presence.
Surely this nurse knows this so these are matters that may need to be pursued with her employer. We also learned that our mom’s respiratory rate hours before she passed was 44, which could be a sign of distress and right now we have no way of knowing how long she suffered unmonitored with that excessive respiratory rate. Until we get her records we are left with a lot of questions about her care during the two days we were in that required quarantine until she passed.
Thank you for your update on your mother's passing. She had a good long life. I hope you will soon be able to celebrate good memories of that life. My sincere condolences on your family's loss.
I am sorry that some of your family got covid after an exposure. Recently two in-laws in their 90s came down with it, and though ill as with a "bad cold" by symptom they are well again. In fact, many are now accepting that this virus will be and is with us for the duration at this point, and are not even testing when they get symptoms. We are seeing few deaths due to covid at this point, I do believe. Certainly it is never pleasant to get sick, as I can attest with my partner down the few weeks before Christmas with "something" cold-flu related. We didn't test for covid.
I want to hope that your new year will be a good one. I hope you will be able to let loose of anger soon. As you will know the Forum does reflect a whole lot on the inadequacies of care facilities, and of their, and our own inability to get it perfect. Often in grieving, counselors tell us who work with grief therapy, there is a tendency for us to want to BLAME. People blame most of all caregivers, doctors, nurses, facilities, blame other family members, blame gods, blame even themselves. It seems a way for us to hold off the awful finality of loss and the darkness of mourning. But at some point it can become destructive to us; I hope if you feel you could benefit from a few grief counseling sessions that you will seek it out. Hospice can provide you will information and access.
Again, I am so sorry for your loss of your Mom. And hope she was at peace and felt surrounded by your love at the end.
Know though, when the body starts to shut down, no more food or drink should be given. The body can no longer process it.
Mom’s comfort food feeding of small amounts of food and fluids was their job, as was her monitoring, since our mom was considered a hospice patient at the highest level of care. In fact, we were self paying $12,000 monthly for that highest level of care, and we advised them that their staff would need to take over that care until they were notified we could resume providing it.
They agreed and had also confirmed that this was the facility’s and hospice’s responsibility at her care level. To be sure, I even asked if we should be moving our mom to a nursing facility when she started to decline and was told that their facility was capable of providing the end of life care as well as the intermediate level of care our mom needed.
When my younger sister, who is in her late sixties and didn’t have the all-day exposure like my other sister and I, arrived after work to monitor her care on the second of the two days into our required quarantine, she found our mom in obvious distress with a respiratory rate of 44 and food resembling mashed potatoes sitting in her mouth.
Our mom was not supposed to be comfort fed unless she was awake and aware and either requested food herself - she would say the word hungry - or signaled her hunger by opening her mouth to receive the spoon feeding of small amounts of comfort food and fluids on the tip of a spoon. You don’t need to be a “medical professional” of course to know this, just a hint of common sense.
My sister asked the aide - who was changing our mom when she walked in and found her with the respiratory rate of 44, as determined by the aide, and the food in her mouth, which the aide did remove - when our mom was last fed and checked on. That aide, who had been responsible for our mom’s care since 3 pm that day - it was now 7 pm - said she and the other staff members had been too busy trying to contain the covid outbreak, which the facility’s administration had themselves caused. In other words, trying to contain the outbreak had been given higher priority than patient care and apparently no additional staff had been called in to help, or temps hired to ensure the most vulnerable were receiving the level of care they were self paying for.
While I was home in quarantine after my exposure, and after learning how ill with covid my sister had become, I called and insisted that they test our mom for covid even though they told me she was showing no symptoms because she had been exposed to my sister who was by now extremely ill with covid because they held that party, which none of us attended.
I was called back and told mom, who was on oxygen, tested negative for covid.
Then, at a little after midnight that night, the assisted living facility called to tell my sister, who was seriously ill with covid from their outbreak and who was the family contact, that they had entered our mom’s room and found her dead.
An hour later, hospice called, confirmed her death and said they were moving her body shortly to the funeral home that had been called by them.
Right now, we have no way of knowing how long our mom laid there helplessly neglected with a respiratory rate of 44 bpm evidencing clear distress before my other sister got there after work at 7 pm that day, how aware mom was and the amount of suffering she endured.
They say the five stages of grief are consecutive, but they often run concurrent. There is the shock of the loss, anger at the circumstances around why it happened now, wondering if the outcome would have been delayed had it not been for this party, feeling depressed about not being there. I lost my dad in 2023 and still cycle through these sometimes, but there is at the end a sense of acceptance, a sense that everyone involved did their best, and it was just his time.