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Old 08-20-2011, 07:11 AM
Location: Los Angeles area
14,018 posts, read 17,729,443 times
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Originally Posted by imcurious View Post
I am interested in how you can possibly know that.
The poster explained it in his/her post. He/she said the hospice nurses explained it that way. I would think if anyone would know, it would be hospice nurses, who work under the direction of hospice doctors.
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Old 08-20-2011, 07:35 AM
Location: Los Angeles area
14,018 posts, read 17,729,443 times
Reputation: 32304
Default Nursing homes versus hospice

Luzianne in post #17 above is absolutely right. There is too much aggressive medical care administered to people who are both terminal and very old. That is the beauty of hospice, which I think is under-utilized. In hospice, the only medical intervention is to keep people comfortable. It is a situation where what is good for us on a human level (being allowed to die when our time comes) is also good for us on a financial level. End of life care is a huge percentage of Medicare expenses and it is bankrupting this country.

My mother had a wise doctor who said to my sister, "Let's try to keep her out of the hospital". I agreed 100%. The doctor ordered hospice. You don't necessarily have to go into the hospice facility; the hospice people can also come to you. My mother was still in her own independent living appartment in a retirement community, attended by paid caregivers 24/7 because she had trouble getting around without falling. The hospice people came there, installed a hospital bed, put her on oxygen, and my mother died peacefully in her sleep a few days later. Since she was legally and officially under hospice care, the caregiver knew not to call 911 for a ressusitation attempt, so none was made, and I think that was the right thing. What a wonderful doctor she had; it's too bad more doctors do not have his attitude. A lot of suffering and a lot of money could be saved.
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Old 08-20-2011, 08:10 AM
Status: "Be yourself. What's the alternative?" (set 17 days ago)
8,681 posts, read 10,833,943 times
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Most physicians won't order hospice until way late--maybe when a person has a few weeks. They are reluctant to order it for the most part is what I've seen over the years. Maybe they don't want to let go? Hospice can be an inpatient facility (if you have one in your area) or hospice home care visits. I think they'll visit in nursing homes, too. Families have to push...
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Old 08-20-2011, 08:16 AM
Status: "Be yourself. What's the alternative?" (set 17 days ago)
8,681 posts, read 10,833,943 times
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Originally Posted by imcurious View Post
Thanks for your response. I think nurses are in a great position to comment on this subject because you have actually seen all of the variables, so you must draw conclusions . . . I still do not "understand" why super old/super sick people can live a looooooooooong time, as you said . . .Do you think it is because of their "will to live?" or something else?
If you have a constitution of a "fighter" you don't just turn that off when you get to a certain age. It's part of who you are is what I've seen. Fighting to hang on regardless. It's your constitution. But, the psychology is one thing. Your biology doesn't just quit cuz you want it to.
So even with diseases, you can hang on a long time. They can put feeding tubes in you or give you antibiotics for every infection, keep turning you to prevent bed sores, treat the bed sores once you get them and on and on and on... The best thing to keep a loved one safe is VIGILANCE. Be there every day, at different times. Watch what's going on. Report things that don't seem right. Be the thorn in their side.
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Old 08-20-2011, 08:54 AM
Location: Around the UK!
156 posts, read 110,419 times
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Dieing (or is it dying?) seems to be, illogically, a very emotive subject although, as it eventually happens to everyone, we are really just considering the timing.

My wife is a frail care nursing sister and has endless stories of people wanting to die and just hanging on, sometimes for years. While other people just go very quickly.

With all the rights we have it seems that we should have the right to choose to die gracefully and with dignity. To have to suffer pain, degraded health and quality of life; and the indignity of nappies and incontinence to "live" (or merely exist) for another few months or years seems to be pointless.
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Old 08-20-2011, 09:24 AM
6,441 posts, read 4,428,799 times
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I haven't read any replies here but with what you have written, my impression is that there is someone in your life that you would prefer gone. I could be wrong.

Originally Posted by imcurious View Post
I am wondering what the possible reasons are for people lingering in nursing homes. I have seen statistics that say that an average stay is around two-and-a-half years . . . I don't know if that is categorized by age upon entering or any details and I honestly don't know if that is even accurate.

But if you think about it, people entering nursing homes are typically old and sick. I am only speaking of the old people here, not young people who have had accidents, etc.

If you are old and sick and entering a nursing home, and it is a depressing place, and you have a roommate who bugs you and people are screaming and crying or whatever, and you can't get up to go to the bathroom and you don't like the food or the staff . . . WHY would you continue to live?

Do you believe that people CAN will themselves to die? Or are we doomed to live even when old and sick and we can't get up to go to the bathroom?

I personally cannot see any reason why a person would WANT to live in such circumstances (but I have been told that there may be spiritual reasons . . . things they need to experience or whatever).

A long time ago a doctor wrote a book called "How We (or You) Die" - something like that. I have not read it but I understood it described how various organs shut down - I don't know if it talked about circumstances or if it was just what happens to specific organs or systems . . .

I have always wondered about "the will to live," and if people can actually will themselves to die - if you can "let go" on your own - when people are dying, relatives will often advise them to "let go" and then they die - is that because they have permission? Could they have done it on their own?

I personally am against the warehousing of the elderly - I see it as "Big Business" - and I also think that people are too attached to living at any cost - through artificial means - whether it be drugs or machines. I like to think that the human body just wears out and then you go . . .that suffering does not have to go on for years and years . . .

Any thoughts on any of these issues?
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Old 08-20-2011, 09:48 AM
Location: earth?
7,288 posts, read 10,851,419 times
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Originally Posted by Kitty_FL View Post
I haven't read any replies here but with what you have written, my impression is that there is someone in your life that you would prefer gone. I could be wrong.
Yes, you are wrong. Projection, maybe?

I had an experience with a loved one in a nursing home (he actually willed himself to get better and got out - it was a miracle) . . . I observed quite a bit during the time he was in there (six weeks, I think). I visited many of the people and walked around and peeked in the rooms (what I mean is I actually looked at the people and wondered about them).

I may have shared this before, but on those rounds I saw a beautiful woman with white hair lying still on her bed . . . she never moved. One day I ran into someone I know there and it turned out the woman on the bed was her mother. I told her how beautiful I thought she looked and she said that she had Alzheimer's and had been laying there like that for 20 years!!!!

She died a couple of YEARS later . . .that did get me thinking about this subject . . . I also did go to visit my relative in the hospital every day during many illnesses . . . .and I observed a lot . . . I was his advocate . . . hospitals are very inefficient . . .I saw people dying and that got me thinking . . .

As I said in the OP, I do not believe in warehousing people. Do you?
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Old 08-20-2011, 10:16 AM
Location: delaware
688 posts, read 864,170 times
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Originally Posted by Chanygirl View Post
I don't quite know where to start here...but I will say I was a CNA in nursing homes for almost 20 years..I have seen alot of people die. Some went so quickly and peacefully and some lingered so long the families were in anguish.
I think it is a process.. dieing, and it starts with a general loss of interest in life itself...you can't drive anymore so you lose contact with acquentinces, you can't hear anymore so you can't talk on the phone or listen to the radio..you can't see anymore so you quit watching tv and reading. The kids and grandkids are grown, you're on a special diet, so cooking is no fun. Thats why it's so important to keep active to stay involved with life. If your spouse preceeds you and you are not involved it so easy to slip away. To stop caring for yourself, to not pick up after yourself, to stop eating....
I have always said it only takes 30 seconds to completely change your life...one minute you are taking out the trash and the next you on the floor with a broken hip..put all the above into play and you could very well find yourself in a nursing home.
Being in a nursing home prolongs your life because you are constantly being monitored medically. If you have a heart condition your vital signs are taken every day..if you are diabetic they may be taken 2x a day. If you run a fever for more then 8-24 hours the doctor is called, your vitals are taken every shift, tests are run and you are put on antibiotics. Pnuemonia used to be called "the old mans friend" because it was a quick death. No more... If your blood pressure is higher then a certain number your medication is adjusted. If you have something contagious you are put in quarantine so no-one else gets what you have. The house doctor is required by law to visit regularly. The podiatrist comes regularly and the dentist even comes if necessary.
You are given 3 meals a day prepared specifically for your diet. If you have had a stroke your food is prepared to the consistancy required for you to be able to consume it. I was specifically trained to feed stroke patients as well as patients on feeding tubes. Go into the dining room of your local nursing home during meal times and you will see CNAs feeding patients. We are trained to encourage (feed) those that don't want to eat. Actually we are mandated by law to feed those that don't want to eat..if a person loses weight it is investigated by the state...there is no room for "Well, he just stopped eating."
If you have dementia you also can't say "I don't want a shower today"..you are cajoled, sweet talked and as a final resort medicated so that you can be bathed. (That was the hardest part of the job for me..)
You are actively and passively exercised so that you remain flexible..they have special machines that help you to stand so that you bear weight to keep your osteoporosus from getting worse. There are special lifts for those that are unable to stand for transfers and bathing.
Nursing homes are very closely monitored by the state especially if they have had problem surveys. If a person developes a bedsore it is investigated by the state. All "incidents" skin tears, falls, occurances between residents and or staff.. these are all reported to the state. Even if you have the will to die the NH staff are required by law to do every thing medically necessary to keep you alive, except in the case of CPR and a DNR.
I think that Suzie Orman needs to look at her statistics again...I would say the average nursing home stay is closer to 2-5 years. When I started working at one NH I had a permanent section of 10 residents..I worked there 61/2 years. The month before I left my last patient of my original 10 had just died. And they had been there several years before I got there.
I would spend the money on LTC insurance especially if you have a family history of dementia, diabetes, parkinsons, any heart related issues or longevity of 90 plus years. It is important to make out your living will and your medical directive...be as specific as you feel is necessary to let you family know your wishes. When my parents celebrated their 50th wedding anniversary we sat down with them and had a family meeting about all of the above...5 kids and we are all on the same page. They have been together 65 years now and every thing just got updated.
These are my insights...I hope this answers some of your questions.

i worked as a social work director at a long term care facility-"nursing home"- for eight years, and i agree with this poster completely. those who enter a skilled nursing facility usually have a much better chance of living longer than those who do not because they are "sent out" to the hospital for the slightest change in their condition. the health care industry is closely monitored by the state and any change in a person's condition has to be documented and, if not sent to the hospital, the reasons for not doing so have to be fully substantiated. if a person does not have a "do not resusitate' (dnr ) order they will be sent to the hospital for every little change. when i worked in such a facility, one of the main reasons a person was sent to the hospital was "unresponsive" which, depending on the patient's normal cognitive state, could mean a lot of things.
my mother was in a skilled care facility for 5+ years and i have no doubt would not have lived as long had she been at home.
regarding viewing nursing homes as "warehousing" i feel , at this point in time, it is a generalization and oversimplification of the complications of aging . there are many facilities that offer good care, better than what a person can receive at home, and, yes, there are certainly some poor ones. but the good facilities serve a purpose and sometimes it is not in the best interest of the person to have them remain at home.

catsy girl
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Old 08-20-2011, 10:16 AM
Location: SW MO
23,605 posts, read 31,471,910 times
Reputation: 29071
Why do people linger? The indomitable spirit most of us are born with.

Can people will themselves to die? Yes they can. My father did so a bit over a year after my mother died. One system after another began to shut down until he was "delivered." The process took less than three weeks.

Hospice care is palliative care, only. Medical intervention largely revolves around pain management if such is necessary. DNR orders, when in place, are strictly adhered to.

Average stay in a nursing home is a bit over two months and connected with recovery. Beyond that, a stay of around two years is normal and generally ends with the death of the patient.

Life is precious and usually fiercely clung to. Life without quality is a bane. Death is a natural part of life. It's one thing we can all expect, some sooner rather than later.

None of this is any mystery to me nor anything to be feared.
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Old 08-20-2011, 12:39 PM
Location: California
4,554 posts, read 5,467,791 times
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So, if you are curious why not volunteer in a local facility to see for yourself? No one can provide you better experience than what you see for yourself.

My aunt died a few years ago after spending 7 years in a home where the food on the plates couldn't be recognized. One November the county had to come in and demand they repair the heater so it could be used. I could go on and on but it really is distressing to remember. The county wouldn't do much as long as her greedy son and dil provided minimal food (something dead on a plate was acceptable), clothes (second hand with holes was great) the heat turned on when the county stated they would be there the next day for an inspection. No one would hear my aunt when she tried to complain about men coming into the house at night to sleep on the floor and watch porn. When I inquired about it with the workers they suddenly couldn't speak English. My aunt's home was worth over a million dollars but the county did little to protect her assets and of course didn't care about the quality of her life in that "home". Some of the other residents would be pulled out of there as soon as their loving relatives noticed what was going on. My aunt's only son hated her and he finally got his revenge when she couldn't defend herself with the help of the old age home industry. If that is the way old people are treated is it any wonder they would want to will themselves to die? I'm sure things will change, and not for the better, under our new health care system.
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