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If I may interject a recommended documentary...called " an honest death". It follows a Palliative Doctor(masahiro tanaka) during his months prior to his final breath. It brought to the surface the reality of how when one who was once the healer.. be comes the afflicted. How very much I could identify. As my mother (an RN)for years 'tendered' to the afflicted...and many a tear did she shed when all was done. Then when it was her time to chose such care. .it was I that had to hold her hand...and be there. Anyways the documentary may be shot in a country with different life values...but ultimately (like most of us do...) his wife held on to hope far longer then his body could sustain. The staff at the care facility were so respectful of the families wishes....
If I may interject a recommended documentary...called " an honest death". It follows a Palliative Doctor(masahiro tanaka) during his months prior to his final breath. It brought to the surface the reality of how when one who was once the healer.. be comes the afflicted. How very much I could identify. As my mother (an RN)for years 'tendered' to the afflicted...and many a tear did she shed when all was done. Then when it was her time to chose such care. .it was I that had to hold her hand...and be there. Anyways the documentary may be shot in a country with different life values...but ultimately (like most of us do...) his wife held on to hope far longer then his body could sustain. The staff at the care facility were so respectful of the families wishes....
I would like to see that film. Do you know where it may be available?
My mother had in home hospice for over a month. It was not the same people every time. Some were wonderful, caring and helpful. Some did a good job but they were cold and distant. Some were rude. The worst was beyond rude, They were just a terrible person resentful, hated their job, hated us, we were afraid to leave her alone with mom because we thought she might hurt mom. We finally had to tell her to get out of the house or we were calling the police.
I think it is like pretty much everything. There are good people and bad people.
I have a sort of different perspective on this, as my father was under the care of two hospices -- one in Florida for about two months, the other in New York for less than a week. (I only had a week to observe how the Florida hospice worked when I was visiting, so I suppose "technically" my impressions are of the same time span for each hospice). Both were nonprofit hospices. And this was all home hospice, not in facilities.
First of all, I have to say that my family used home hospice once before, about 25 years ago, so I knew a little of what to expect... but times have changed, and probably stresses on hospice organizations have as well.
Second, I have observed that people who don't have any experience with hospice organizations may not understand the limits of what they can offer, or may not ever have seen the dying process up close and find it distressing to experience for the first time. That said, I had some criticisms of both organizations I dealt with (as well as praise).
The Florida hospice seemed very well organized (not surprising considering how many old people are in retirement communities and die there), in terms of how medicines were delivered, how their late night answering service worked, and the regularity of how they sent people over to check on my dad. But, with one or two exceptions, the staff seemed more distant and impersonal. While my dad liked any and all attention he got from anyone associated with hospice, as a (interim) caregiver for a week, I felt there was no one I could connect to. It was always someone different who was sent by. His case nurse just had cold manner that I was intimidated by. There was always a different CNA sent by for baths. My dad had to get subcu meds for five days in a row and it was always a different person who came out to administer them. It wasn't until late in my dad's situation (when we were working hard to get him moved from FL to NY) that I found a staff member I could connect to on a personal level, his social worker; I was on the phone with her a lot, speaking frankly about my concerns and talking about my dad's wishes. (Even then, sometimes she wasn't available and we got a different social worker - though that's the nature of hospice)
To those who weren't following my saga in the Caregiver forum these last few weeks... one criticism I had of the Florida hospice was that I wondered if they had adequately vetted my dad's home situation down there, before admitting him. Nobody in the home he was in down there, was 100% committed to his care. There was no 24/7 caregiver, just an assortment of friends and neighbors to "check on him" (or an unspoken expectation that I would fly down and be that caregiver, which for family reasons in NY, I could not do). There had been an attitude that my dad would hang out and get "free" home hospice in their house until such time as he was ready to enter a facility. Well, that time never came, because my dad never was honest with himself about how he was progressing. Then he became a burden to the non-committed people he was staying with (I don't say that to condemn them in any way, just that they bit off more than they could chew).
In contrast... the NY hospice we finally got my dad into, has stricter vetting policies about admission to hospice. They want ample evidence up front that someone is committed to 24/7 caregiving in the home and that they have a family support network (or that they are willing to get the person into a facility if it turns out to be too much for the caregiver). I am sure this policy evolved exactly because they wanted to avoid a situation like the one that happened to my dad in FL.
The FL and NY hospices (at least the social workers and admissions people) could not have been more helpful and compassionate about my dad's situation, and they bent over backwards to help solve a difficult situation. My dad had to be discharged from the FL hospice, travel to NY, be without hospice care for one day, and then the NY hospice moved to swiftly admit him. So, no complaints there.
The NY hospice, we only were involved with for six days until my dad passed. It was sort of the opposite of the FL hospice, where I felt the NY staff were nothing but kind and engaged and easy to connect to, but -- whether it was because of my dad's whirlwind situation and rapid progression -- during that week my sister and I, who were doing the caregiving, felt adrift. We were told we'd be called by hospice every day for 7 days... that didn't happen. We were told we'd get an LPN for five days a week... then left alone for 2-3 days until an LPN was able to be scheduled. When the LPN finally showed up, she realized how much we needed help and instruction (because my dad had progressed so far), and the hospice then scheduled her daily. We met his case nurse but we never were told WHAT day of the week she was scheduled to come on weekly visits. Equipment was delivered unannounced at odd and random hours. The late night and weekend answering service was not very good, often putting us on hold. They seemed understaffed. And as for my dad's meds, it seemed like every person we talked to gave us different advice, which was scary. We never felt like we had clear orders for the meds or who we were supposed to listen to - and I was pretty good at making sense of meds, but I wasn't about to randomly change his doses on the fly.
But every single person we met from NY hospice (although my sister didn't like the case nurse's more businesslike manner) seemed kind, experienced, and interested in my dad even though he was not very communicative at this point. We had a house call from the attending physician supplied by the hospice (my dad had no doctor in NY), the aforementioned LPN, and on what turned out to be my dad's last night, we called for a nurse and she was absolutely the right person at the right time, as she recognized my dad was very close to going, and she told us what exactly to expect and how we should handle it. She also came back after he passed and walked us through every consideration with the process of removing him from the apartment, dealing with the funeral home (the funeral home owner showed up for the removal, at 2 a.m., dressed in his suit to talk to us personally), and so on.
My dad's strange situation and quick progression was probably the major factor in why I didn't have 100% satisfactory experiences with the two hospices. I felt like both hospice organizations were doing reasonably well, considering. Some of my other family members felt more like criticizing some aspects of the care. (And there was a flip side to the caring in the NY hospice, as the day after my dad passed, his LPN arrived for his normal visit and she hadn't been told of his passing, so she came in and talked to us, which was nice for a while, until she began a lengthy venting about her own family troubles which was... TMI... and made us wonder if she was stretched too thin or too emotionally affected by hospice work.)
Would my family use home hospice again? Not sure. My mother is not enthusiastic about using it now; she now talks of wanting to go into a nursing home when her time comes (a complete 180 from everything she's said all her life). I don't think there is any perfect home hospice experience.
My mother was not in pain, her heart rate was accelerated due to liquid outside her lungs. A nurse literally begged us to give her morphine to help her rest and help with any anxiety. She stated although she was not in pain it would alleviate some of the pressure her heart and other muscles were having to endure. She mentioned morphine and aspirin were routine treatment for people that have had a heart attack. She even showed us the small amount she was going to give her.
What you describe appears to be heart failure and not a heart attack. The nurse is intentionally trying to lead you to a conclusion and get you to administer the morphine. The morphine depresses the breathing and makes the patient unaware of what is happening. When you're undergoing respiratory distress, it accelerates the failure of the lungs and eventual death. She may have already been near the end since the fluid buildup indicates the heart is also failing.
What you describe appears to be heart failure and not a heart attack. The nurse is intentionally trying to lead you to a conclusion and get you to administer the morphine. The morphine depresses the breathing and makes the patient unaware of what is happening. When you're undergoing respiratory distress, it accelerates the failure of the lungs and eventual death. She may have already been near the end since the fluid buildup indicates the heart is also failing.
I heartily disagree, as does the medical community.
Morphine helps relieve air hunger and anxiety. In the doses used by hospice it does not depress the respiratory system. There are many studies and medical papers about its use and effects. Here is just one...
I heartily disagree, as does the medical community.
Morphine helps relieve air hunger and anxiety. In the doses used by hospice it does not depress the respiratory system. There are many studies and medical papers about its use and effects. Here is just one...
I heartily disagree, as does the medical community.
Morphine helps relieve air hunger and anxiety. In the doses used by hospice it does not depress the respiratory system. There are many studies and medical papers about its use and effects. Here is just one...
The air hunger is a symptom of respiratory failure since they can't get enough oxygen, even with the aid of an oxygenator. Opiates, such as morphine, reduces the level of breathing which can lead to acute respiratory failure. There are many medical journals and articles on the effect on the lungs of drugs that suppress the central nervous system.
The air hunger is a symptom of respiratory failure since they can't get enough oxygen, even with the aid of an oxygenator. Opiates, such as morphine, reduces the level of breathing which can lead to acute respiratory failure. There are many medical journals and articles on the effect on the lungs of drugs that suppress the central nervous system.
Your article talks about OVERDOSE of opiods can cause respiratory depression. If you look at my linked article, particularly the last paragraph on the 1st page, it does not cause respiratory depression when used in normal doses to relieve air hunger.
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