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Post by jeffolie on Jul 22, 2011 17:20:41 GMT -6
"... More than four in 10 Americans now meet their end in hospice care..." My mother was recently offered hospice and my dad decided against hospice, rather selecting further treatment. She spent 20 days as allowed under Medicare in an assisted living care and then my dad took her home with the doctors' approval. My dad and mom are now considering hospice for her. This long piece details hospice: ================== Preparing Americans for Death Lets Hospices Neglect End of Life Jul 21, 2011 9:04 More than four in 10 Americans now meet their end in hospice care, drawn by its promise of palliation and pain alleviation instead of extreme measures in their waning days. Boise State University assistant professor of social work, Misty Wall, in Idaho. Wall’s lawsuit, filed in federal court in Dallas, accuses Gentiva Health Services Inc.'s VistaCare of paying illegal kickbacks to patients and nursing-home employees who referred residents to hospice. Boise State University assistant professor of social work, Misty Wall, in Idaho. Wall’s lawsuit, filed in federal court in Dallas, accuses Gentiva Health Services Inc.'s VistaCare of paying illegal kickbacks to patients and nursing-home employees who referred residents to hospice. With his mother wheezing and losing consciousness in a California nursing home, Robert Rogers wanted her moved to a hospital. Vitas Healthcare, her hospice provider, said that wasn’t in the plan. “Our job is not to prepare them to live,” a Vitas nurse told Rogers on the phone, according to a deposition he gave in April. “Our job is to prepare them to die.” Rogers called 911. At the hospital, an emergency-room doctor removed 11 maggots from an open wound on his mother’s big toe. Five days later, in September 2008, 91-year-old Thelma Covington died of a sepsis infection brought on by gangrene in her toe and poor circulation, her death certificate said. Rogers is suing Vitas, a unit of Cincinnati-based Chemed Corp. (CHE), in a California court for alleged elder abuse and wrongful death.... more... www.bloomberg.com/news/2011-07-22/preparing-americans-for-death-lets-for-profit-hospices-neglect-end-of-life.html
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Post by waltc on Jul 22, 2011 21:17:12 GMT -6
The level of care given to a hospice patient isn't much. Outside of a quick visit by a nurses aid once a day, you're on your own.
Yeah a nurses aid - some gal who makes less than the people at In and Out Burger.
They do nothing beyond a daily cleaning a bed ridden patient. Even then you have to watch so they do a good job. Don't call them for help on any medical issues.
24 hr. care? That's you my friend.
The primary instruction they gave my mother and I for my father was to give him a lethal dosage of Morphine when we thought it was appropriate to terminate his life.
Of course they were much more circumspect than to call it murder.
Overall their care proved to be so worthless that I called 911 and had him moved to a hospital who helped make his last days much better.
Hospice = the abuse of the dying.
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Post by unlawflcombatnt on Jul 23, 2011 12:57:39 GMT -6
Walt,
Your story reminds me of what happened when my father died. Though it did not involve hospice care, it involved someone else making the "death" decision for him--and against his wishes.
During my father's final days of his terminal hospital visit, he was asked to sign a Do-Not-Resuscitate (DNR) order. He refused. In fact, he tore up the DNR order, which the staff documented in the chart. Again he was offered a DNR order, again he refused, and again he tore the order up in front of the staff. This same procedure was repeated multiple times, with my father refusing every time.
Finally, when he was incoherent and only semi-conscious (with an O2 saturation of only 75%--which isn't even compatible with consciousness in most people), they forced the DNR on him again. This time he gave up and illegibly scrawled some semblance of his name on the DNR. (I saw the DNR after he died, and it wasn't even recognizable as his handwriting.)
After being coerced to sign against his will in a semi-comatose state, the staff could now stop taking care of him. Which they enthusiastically did.
They pulled off his oxygen mask and let him gasp for air. They were no longer required to intubate him or take any other measures to keep him alive. And they didn't.
While all of this was happening, I was flying across country from California to his hospital in Florida, to see him before he died. After 8 hours of travel time, I finally arrived at the hospital.
He gasped for air for the last time about the time I entered the hospital parking lot. When I arrived at his bedside, he had been dead for less than 5 minutes. His face did not indicate a "peaceful" ending. In fact, it was the face of pain. It was the face of a person who had asphyxiated--of someone who had died an agonizing death, struggling to get more air.
It was also the face of a person who had been forced against his will to sign an Do-Not-Resuscitate order against his will. Neither his wife nor I were contacted about the order.
That's because the hospital knew neither of us would have signed it. And they'd already gotten multiple refusals from my father.
So they just waited. Until he was too weak to refuse.
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Post by fredorbob on Jul 23, 2011 15:29:47 GMT -6
Do Doctors, or hospitals, deliberately not provide service or practice defensive medicine allot; especially if you pay out of pocket?
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Post by waltc on Jul 23, 2011 17:02:01 GMT -6
ULC, I'm sorry to hear that. That's a nightmare.
The medical staff acted in a criminal manner. They deserved to have their licenses revoked and serve a stint in jail.
Personally I've never signed a DNR nor any family members have either. And I don't like the way hospital staffs push it.
Every time I've went in for outpatient surgery they shove it you face and expect you to sign asap.
The DNR reeks of euthanasia. I know on-line resources make it out differently but I've had to deal with enough sick people in hospitals to know that they aren't really patient friendly places unless you have a advocate or are rich and famous.
In my experience, if you have a sick elderly family member in a hospital, they will need a advocate to look out for them. Otherwise their treatment and care won't be as good.
I know the few times I was hospitalized, I was treated better when I had visitors than when I did not.
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Post by graybeard on Jul 25, 2011 16:21:35 GMT -6
Why are they anxious for patient death? Is it because insurance has run out?
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Post by waltc on Jul 25, 2011 22:59:30 GMT -6
I'm not sure. To hazard a guess, it would take someone who knows hospital billing and how it relates to patients that are prime DNR candidates - which according to on-line sources are people with heart disease and similar illnesses with a fatal outcome. IOW people are going to die anyways no matter what is done for them and not waste ICU resources, etc.
On the proponent side of DNR - they do point out that a vast amount of resources and money are indeed spent on keeping the very sick alive a just a few months. Enough that it's draining medicare.
But what I've seen they give out DNR's to anyone that is hospitalized, even if they go in for outpatient surgery. So it looks like it's been extended beyond the traditional target group.
My main gripe though is with hospice care. I initially thought that hospice would actually help family members care for their dying. Instead they seem to act more like Dr. Kervorkian - they told my mother and I that when father was showing signs of distress to give him a massive dose of morphine to help him die.
We couldn't do that.
Oh yeah the hospice workers don't talk about the psychological ramifications of doing that and how to handle it. You're on you're own.
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Post by unlawflcombatnt on Jul 25, 2011 23:49:33 GMT -6
Walt,
Probably the smoothest and most painless way to die is from a lethal morphine injection. It suppresses the drive to breath, and suppresses the anxiety associated with respiratory distress. It causes the recipient to under-ventilate, lose consciousness, and ultimately die in their sleep.
But I don't blame you for not wanting to be the one to authorize the lethal morphine injection. I wouldn't have done it either. But if you're going to die, this is one of the best ways to go.
It's a lot more humane and comfortable than simply pulling someone off a ventilator, and then letting them gasp desperately for air until they expire from respiratory failure.
People given lethal doses of morphine don't usually die in agony. They just lose consciousness and die painlessly in their sleep from hypoxia.
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