I am having a serious personal inner struggle with a current issue at work. "Mrs. G" (who is 79) had a CVA last year with resultant hemiplegia & dysphagia. Subsequently she became a LTC resident of mine after her hospital stay. She came to us with a PEG and receives bolus feeds. She is cared for by CNAs and hoyered into a recliner where she watches TV, listens to her classical music and reads the paper on a daily basis. She is able to say a few words such as "yes, no, not now, oh, ok", etc. Actually just recently has been saying a few new words. She does not have dementia but her husband has been her medical POA. She was doing so well we had speech consult with her just last week and she passed her 1st swallow eval. with flying colors. (Mr. and Mrs. G are financially wealthy people, the opera, theater, and fine dining were a BIG part of Mrs. G's enjoyment in life)...
So, the VERY NEXT DAY, her husband, (the healthy one who lived at home) passed away. Her husband was her biggest advocate. I never even had the chance to tell him how well she did during the swallow eval, he would have been excited)-- Now her 2 sons, who have hardly been in to visit her now have medical POA. (One I'd never met because he admittedly has only been in once in the past year and the other one maybe 3-5 times over the past year)-
Well yesterday the came in to tell "Mrs. G" that her husband had passed away BUT when they arrived she was not feeling well. They asked me what was wrong and I told them she had a UTI- They talked between themselves a few minutes then asked if there was a doc they could speak to.. I responded yes then went to get her. 30 minutes later the MD came to me with tears in her eyes and handed me a new Advanced Directive and told me to D/C Mrs. G's TUBE FEED FORMULA AND that we would NOT be starting the MACROBID so NO TX FOR THE UTI EITHER.... then she said the sons want to put her on hospice.
1) Mrs. G- is not aware of any of this...
2) She was medically stable other than the UTI
3) She does have some quality of life, enjoys music, company, newspaper, etc..
4) She had JUST started eating small amt. during her eval- MD d/c'd speech consult too
Nurses I need your opinions, PLEASE, and ALL will be respected...
Wow....I would be right beside you fighting for this resident. The sons sound like selfish **** that want her to die so they can collect $$. Until the resident is deemed incompetent she has the ability and right to direct her own medical care. Will be waiting to see how this turns out.
Oh and, "Mrs. G" never had an Advanced Directive prepared for herself therefore after the CVA, dysphagia with little ability to communicate, her husband was designated as her medical POA or proxy.. I just DO NOT understand HOW or WHY- it can now be changed by the boys because of his sudden passing ??
This is EXACTLY how I feel. I could not have said it ANY better!! If I even remotely felt the sons' decision was truly about "quality of life", I would not be having such a hard time, BUT, to never see them visit and then have them just "pop in" and make this life/death decision .... I cannot rest..
If the sons rarely visit, do you think the shock of seeing her sick could have had something to do with it? It can be very unsettling for people without healthcare experience to see someone sick.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
Before I would comply...I would check that there is legal paper work. They are "next of kin" and can there fore essentially make those decisions.
Without seeing her it is impossible to make any real decisions. But if I felt strong enough I would get social services involved and I Would make a report to the state. In matters in mandatory reporting HIPAA does not apply.
I don't have any advice, but this sounds horrible!!! I hope you are able to resolve this and advocate for your patient. I can't believe someone would do this to their own mother
The BIG issue here is competence- And here is where my fight becomes difficult. Although there is no diagnosis of dementia there are times when she will say "yes" when she means "no" and vice versa. Sometimes I have to ask the same question 2-3 times because her CVA/brain injury will have her saying "no" when in fact she means yes. I only know this because I spend so much time in the room with her- I have found my own way to communicate and understand different motions, faces and gestures.
Yes I do believe you may be right, especially because she was in the bed..
Also, the sons had their wives with them and they were all just standing around her bed NOT saying anything. She was a little wheezy as she sometimes gets so I went in to do a neb tx.. I just went about talking to her as I always do while they all just sat quietly and watched along. I was trying to show them HOW to interact-- they appeared clueless. When I said her name she opened her eyes and smiled at me, so I said to her "Look who is here" She looked around the bed at everyone as if to say "Ohh my what's going on here" (I could see it in her facial expression).. and then I said "I'm going to do a neb tx"..
AND THEN (and I could NOT believe this) b/c I was still awaiting the CXR results, Pox below 92% so I said I may put her in some O2 for a bit then I left the room. One son literally chased me down the hallway, stopped me and said "Me and my brother talked and we don't want any oxygen on my Mother" I said, "Why is that?" He said something about it "prolonging things" I then SAID> "Your mother is not dying BUT even IF she was, the oxygen would not save her life it would only help keep her comfortable". Then he said that is was OK.
I will find out tomorrow what hospice used as the admitting criteria and I will let you know. I am thinking that a "projected decline" d/t withdrawal of the feeding tube in addition to the (UTI) actively untreated infection- or something like that...
If competence is the big question, you might want to see about having her doctor order a neuropsych evaluation. If they determine she's competent, then she can make her own decisions.
I agree with the other posters - it seems like her sons are after $$. For this reason, I'd also contact social services/adult protective services. This could be considered abuse/neglect, and APS would have to step in.
motherof3sons
223 Posts
Wow....I would be right beside you fighting for this resident. The sons sound like selfish **** that want her to die so they can collect $$. Until the resident is deemed incompetent she has the ability and right to direct her own medical care. Will be waiting to see how this turns out.