Hospital - Hospice at Home, Or in the Hospital - Where Would You Choose to Die?.
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A noisy, chaotic, and bureaucratic hospital enduring tests and procedures? Or a calm, relaxed, and personal home, pain free and comfortable? Which would you choose for your final days and hours?
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My dad spent his last few months of life in and out of hospitals, SNFs, ambulances and doctors' offices while getting ineffective weekly chemo, tests, and procedures.
My mom spent her last few months of life at her assisted living facility in hospice care, with her sons around, hospice nurses taking great care of her, pain free, and her gerontologist watching her in her home.
My dad died in the hospital, an 87 year old man with severe bone cancer, prostate cancer and kidney failure. At the very end, the doctor wanted to put him on dialysis. We asked why, and the doctor said (basically) "because we can". When asked if dad was a good candidate for treatment, the answer was "not really". Noisy and chaotic, the hospital was impersonal, cold, and bureaucratic. The care was professional and good, but very expensive and relatively useless. Dad finally had a stroke and died as we brothers and mom watched.
My mom died at home, an 84 year old woman with dementia and pneumonia. At the end, her gerontologist tried some IV antibiotics for a couple of days, but deferred to her DNR and advance directives and stopped them when it became obvious they were useless. She was in her home - calm, relaxed, pain free and comfortable when she died.
Could my dad have stopped his chemo, his treatments and procedures, and lived out his days in hospice care? Yes. Did he choose to do that? No. Could my mom have chosen to forgo hospice and go the hospital and SNF route? Not really as her dementia was too debilitating. Did my brothers and I decide hospice was the right choice? Yes.
I am not trying to indict hospitals. I am not trying to make decisions for anyone. I AM asking caregivers and trustees to consider the option of hospice when caring for elderly parents and making medical treatment decisions. In our case, hospice was the right choice for our mom.
There is no one size fits all answer. The circumstances of any particular situation should always dictate the best choice of treatment. However, after living through both scenarios I would tell everyone to consider hospice as your aging parent's final treatment plan.
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You may have heard stories from friends about someone who they knew had been ill and then seemed a little better,then surprised everyone by having to be admitted to a hospital, and may even had passed away. " He was fine" "He didn't even have a fever" What could have happened so fast?
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How is You May Be Sick Without A Fever
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There are times when an illness takes an unexpected course,and complications arise.
In an attempt to control the spiraling cost of health care.Your visit to your doctor as well as the length of a hospital stay has been shortened.This makes it even more necessary to be aware of the importance of your own self care, and of those in your family.
This will never replace medical care, but will make you a partner in maintaining the health of your family, as well as your own.
It is reasonable to consider the education of patients in a hospital a high priority in the health care system.This does in most communities reach into the community,with home health care,pharmacy support and education, and doctors offices that will see you with out an appointment.
Most often when we are ill with an infection, we will have a fever. Maybe a low grade fever that we hardly notice, or it can be 99-100.5 and may be self limiting.That is ,it runs a course with maybe sniffles or a slight cough. Most viral illness' and some bacterial infections will be of this nature.Within a week or two you feel progressively better and then return to your usual state of health.
But if you are ill,with a cough,sore throat,ear ache, or generalized discomfort, and have an elevated temperature of 101 or greater. It is best to see your doctor.Although this too can be viral,it is best to keep on top of it, and see that it does not worsen. If you are unable to take fluids and feel progressive weaker. Going back to your doctor a second time, is not a waste of time or a mistake,it is a wise decision.
You may be put on another antibiotic if the first one has not cleared up your infection. If at anytime during the course of your antibiotic,you develop a rash or it makes you feel ill.Contact your doctor again.
But, there is also something else that is important for you to know.If after an infection , you are not feeling quite like yourself,but maybe a little worse . There is a chance that you have developed SEPSIS. If you feel worse then you did before,don't be fooled by the fact that you do not have a fever.
SEPSIS at times develops in a quiet way, and can easily be missed,but it is critical that it not be ignored in it's early stages. You can then be admitted to the hospital and receive intravenous fluids and antibiotics. You then will be monitored until you are stable again.
The very young and the elderly are at great risk for SEPSIS, as well as people who are under going chemotherapy or radiation treatments. People who have an illness where their immune systems are compromised ,such as HIV and AIDS , as well as some other illness' are also at risk for SEPSIS.
Some signs that you need to get to your doctor or your hospital Emergency Room as soon as you can are:
An awareness that your pulse rate is rapid,or your heart is "fluttering." Have a increased breathing rate, chills or feel clammy or damp, have a feeling of fatique, weakness,and lethargy ,have decreased or no urine output.
Remember,you may have a fever or NO FEVER WITH SEPSIS !
What has happened is that the infection, has caused your body to have an overwhelming inflammatory response, that is affecting every organ in your body. IT MAY BECOME CRITICAL IF MEDICAL INTERVENTION DOES NOT TAKE PLACE.
Smart living and healthcare monitoring, lead to optimum health care maintenance.
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Hospital - On Death and Dying - Ten Things You Need to Know About Hospice Care
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Your family doctor and your neighbor have both suggested you call hospice for your ill loved one but you continue to be reluctant. You fear that accepting hospice is "giving up" and that your loved one will no longer receive state of the art medical care. This article will help you to sort through many of your spoken and unspoken concerns about hospice care.
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How is On Death and Dying - Ten Things You Need to Know About Hospice Care
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1. Isn't hospice a place where people go? No, hospice is a service, not a place. Hospice brings care into your own home, be it a private residence, an assisted living facility or a nursing home. Most people want to and can stay at home but if your care becomes too complex to manage at home, hospices also provide short term inpatient care to control symptoms in a hospice unit, a hospital or a skilled nursing facility.
2. What does hospice provide? Hospice provides a lot of professional services. Hospices are mandated to provide both routine and after hours nursing visits. This means that the nurse will visit regularly, assess for changes and arrange for medicines and medical supplies as they are needed. She/he will put emergency medications and oxygen in your home in advance of a crisis. The nurse will spend a great deal of time answering your questions and preparing you for what comes next. Where in the past, you brought your ill loved one to the doctor's office or to the emergency room, now the services will come to you. Should you need help or direction on a Saturday or Sunday, a nurse will visit. You are no longer alone; help is just a phone call away. Other services that the hospice provides include an aide to help with bathing, counselors to help meet emotional needs and volunteers. Some hospices provide physician visits. Some hospices even provide music therapy, massage therapy, aroma therapy, pet therapy and art therapy.
3. When do you qualify for hospice care? Unfortunately most people get hospice care too late, in the final days or weeks of life. They qualify for it as much as six months earlier. Getting hospice care earlier reduces the family's stress, avoids burnout and guarantees an improved quality of life. It keeps the patient well, which allows for special moments and memories to be shared. It affords both you and your loved one the opportunity to say "thank you" and "good bye."
4. Don't most people die at home? While is true that 90% of Americans want to die at home, in actuality, very few do. Currently, 75-80% of Americans die in facilities (hospitals and nursing homes) and less than 25% of them die at home. In contrast, hospice patients almost always get their wish to die at home as their families are well prepared and supported to care for them at home. Hospice patients rarely die in the hospital.
5. Can hospice patients die in a hospital? Of course. If they choose to die in the hospital, the patient will need to be discharged from the hospice, a simple matter of signing a paper.
6. Will entering a hospice make you die sooner? There is a great deal of unfounded concern about the use of medications like Morphine and the fear that its use will shorten life. There are several studies that show that Morphine eases pain but does not shorten life even in the most debilitated and ill patients. Another unfounded fear is that someone will die sooner if they find out that they are terminally ill. Family members sometimes insist that no one mention the word "hospice" to their loved one out of fear that their loved one will give up on life. The reality is, being ill and in failing health is a lonely experience. Most patients know on some level how ill they are. Many want to talk about it and put plans in place. Sometimes they don't bring it up because they see how painful it is for you and they are trying to protect you. This conspiracy of silence robs both parties of opportunities. Many patients want to ask questions about what will happen to them. They look for reassurance that their symptoms will be controlled and that they will remain in control and comfortable. You also may want to ask them questions. Questions about their funeral and how they want issues handled after their death.
7. Do patients admitted to hospice ever improve? Yes, some patients admitted to hospice actually improve and in time, they are discharged from hospice. This makes sense that when you improve someone's pain and ease their loneliness, they will eat and sleep better and regain some health.
8. Will hospice make me give up treatments that are currently benefiting me? You don't have to give up treatments or medications that are benefiting you. The hospice focus is on quality of life. Medications that promote quality of life are usually covered by the hospice. If you find a new treatment that may prolong your life (but not improve your quality of life), you can sign off the hospice benefit and return at a later date.
9. Is hospice care expensive? Hospice care is covered by most insurance. Medicare and most Medicaid insurances cover hospice care at 100%. Many private insurances have modeled themselves after these federal and state programs and also cover hospice care at 100%.
10. Hospice care is a necessary service that many people never receive.
Sometimes it is never offered and other times, the patient or family is reluctant to accept hospice care. Most families who did receive hospice care say that they could have benefited from hospice much earlier. Ask you doctor about hospice care. If your doctor is not sure that you qualify, most hospices will send a nurse to the home to evaluate your appropriateness for hospice. Don't allow your fear to prevent you from getting the help that you need.
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