Studies: Some Nursing Home Elderly Get Futile Care

God, this is a great thread!!!

I work in ltc, and I see garbage like this ALL the time, it just makes me CRAZY! Right now I'm thinking about an elderly man in my place whose wife just cannot let go...this guy is 97 years old, a FULL CODE, and gets sent out to the hospital, basically, every time he passes wind because staff is so afraid he will die on them, and the crazy wife will find some way to sue. This poor guy used to be a cop, and is now practically a vegetable, and he is so miserable, fights everybody who tries to care for him. You know he just wants it to be over, and every time he gets close to finding final peace, the wife drags him back. He gets his food and meds through a tube, and it takes three to do this, cause he is still a big guy with some strength. When you go in to him, he just completely tenses up...some of us refuse to force things on him, and when you tell him you aren't going to have him held down for his accucheck, bolus feeds, etc, he visibly relaxes and will actually smile at you...
Oh, the importance of a living will! Don't depend on your loved ones to do what's best for you, often they can't let go, and you may end up like this poor guy!

As a post note....today we have a growing anger and hysteria over "death panels" and government types who want to "kill granny". Just heard Rush Limbaugh yesterday making a point about a democrat who, when making a speech, commented something to the effect that it might be better to just let some old people die. Rush, of course, will succeed in getting a sizeable number of people outraged about such a thing...but he is being misleading to his "fans". Afterall, those old people are going to die whether or not we prescribe the $300 drug, or push the $2500 procedure, or promote the exhausting therapy. The issue is not IF they are going to die, the issue is HOW they are going to die. What many are saying today is that we CAN advocate for a more dignified, peaceful, and yes cheaper end of life especially when it comes to the elderly. And, yes, they still get a choice to pursue those options...that is just not what the healthcare professional is recommending.

IMHO if the daughter had to pay for the treatment-even just a portion of it-she may have honored her mother's wishes. I have pitiful residents now undergoing futile treaments-the family breezes in for maybe 4 mins every week or every 2 weeks.They are not there to actually see the lack of quality of life. In LTC they get to the point where any hands touching them cause discomfort.What a crappy way to live...

I see it on the med-surg unit where I work. Bring in GM or GP in their 90s and expect us to make them like they are in their 20s again. Or bring in one of them confused, found wandering around their neighborhood, and family says that this is only the 1st time.....only the 1st time that they know of, or are willing to own up to.....I only pray that my family honors my advance directives.

I can't get over the people that age, or younger people with, say, advanced Alzheimer's, who are on cholesterol medications!

advanced dementia on Aricept

In my opinion, a living will is not worth the paper it is on IF the family will not agree to honor it. The resident can be half dead and unable to make decisions towards their care. Then you have dear daughter standing there demanding Dr. do this and do that (ie: put that Gtube in, put them on a vent, etc) and Dr. will follow these requests nearly every time. What choice do they really have. After all, it will be the family that is still alive that sues them.

The morale of my story... you HAVE to depend on your loved ones to do what's best for you. Tell them early and tell em often how you expect to be treated when you are end of life. Share your beliefs about live and death with them so they can take comfort with the hard decisions later.

Many years ago I was the sister-in-law in a family where Dad had suffered a catastrophic GI bleed, was intubated, ventilated, and having spiral seizures. The eldest child, my husbands sister, was dictating the care of her dad through her inability to cope with the events and situation. The record was clear that Dad had a very grave prognosis. He was elderly and in terrible shape...having been sick and marginally compliant with his care for some time. I stepped in (with my husband's permission), arranged a meeting with the MD, the MSW, hospital clergy, and the family. I assisted that staff in getting the information to my sis in law through the fog of her anticipatory grief...so that she could grieve without torturing her Dad and the rest of her family. (of course, I didn't word it quite that way when speaking with her) The staff at the hospital had sort of taken a step back, and had a sort of hands off approach to the situation prior to my actions. When they had initially tried to discuss the situation and possible options, my sis in law had a sort of emotional break, becoming shrill and almost hysterical about "doing everything". My husband, also a health professional, was grieving himself and not really able to address his sisters actions effectively. At the time, I was managing a PICU, so I was very comfortable working with other disciplines when interacting with grieving families...hence my request for MSW and clergy. What is surprising to me is that the hospital did not initiate that sort of meeting...the nurses whispered about the case at the nurses station but no referrals were made, they didn't speak to the family about these choices. I most definitely felt that there was not a comfort level, on the part of the nursing staff, to directly address the psycho/social and emotional issues in the family which were clearly impacting Dads quality of life. Currently, I think some nurses are uncertain as to what their role is in cases similar to that...cases where there are advanced directives but the family member seeks to derail those. As you might imagine...I routinely encounter situations with family members in disagreement with the advanced directives created by their loved one. I follow the directives unless the patient is unable to speak for his/her self and the designated advocate chooses to change the course described by the now incometent patient. I do make sure, however, when that happens that they understand that they are directly contradicting the wishes of that family member.
Frequently, the majority of the family members will "go along" with whatever mom/dad had decided for themselves...it is usually just one, maybe 2 vocal members who object and try to direct the care in a more aggressive direction. My recommendation to my peers is to use the social workers, use the pastoral care department...use whatever resources you have to advocate for your patients in these situation.

Oh, don't get me started. The nursing home in my town has staff that is completely ignorant about hospice/palliative care, and what's worse is most of the staff doesn't even care to be educated about it, even though our agency has offered to come in and give information. I've heard nurses say "Oh, your job is to kill people" to me about being a hospice nurse. "I can't give him morphine...he'll stop breathing".....The doctors in my town are just as bad about the whole thing....they are sure they know it all and don't need anyone to educate them, thank you very much, but we won't prescribe morphine because it's too strong for the patient and he might stop breathing..... It is a constant battle to get the patients the care they need at the end of life. Families are convinced 95 year old grandpa will live forever, and heaven forbid we even HINT otherwise.....physicians are convinced that expensive drugs like Aricept will help with the dementia patient who is curled up into a ball in bed not responding....

We have had a situation on my ward with 2 patient latley both refusing food/fluids anything and everything was offered to see if a food fluid would be taken and often and nweither did. both fought nurisng care b/p, dweash turning blood sugar monitoring etc. one in particualr went brady and had a tia/seizure and i felt looking at him he was going to die not sure how to explain just knew. he died later that night.
Well the consult/team decided to initate the care of the dying pathway and the famillies who didn't visit were unghppy when notified care didn't change they still wopuld only tolerate so mcuh and we focussed on comfort.
i worked in a dementia unit as a na and some nurses would send out pt and others would talk to the familly but if they were detrioting and had been felt that hosptial care was inapprioate all were dnr though.