Determining the Right Time for Hospice

  1. How Nurses Can Help Patients, Families Determine the Right Time for Hospice
    By Marion F. Keenan, MA, MBA
  2. Visit NRSKarenRN profile page

    About NRSKarenRN, BSN, RN Moderator

    Joined: Oct '00; Posts: 27,489; Likes: 13,685
    Utilization Review, prior Intake Mgr Home Care; from PA , US
    Specialty: 40 year(s) of experience in Home Care, Vents, Telemetry, Home infusion


  3. by   SharonHopson
    As soon as the terminal dx. is made, the pt is ideally referred to hospice. I have two particular families in mind as I write this.

    Family 1: 79 y/o female pt. dx: lung CA. Hospice pt since March, 2001. She is now in the pre-active dying stage. (less energy, sleeping more, decreased appetite, etc.) We have had 8 beautiful months to help this family deal with losing their mother, funeral arrangements are made, decisions about where dad will live have been made, and my pt. is ready to die. Her family has given permission to her to "go home to Jesus" when she's ready". She knows that even though the family she leaves behind will miss her and greive, they will be able to go on.

    Family 2: 88 y/o male pt. dx: es dementia. Hospice pt for 3 days.
    The family was in denial. On his death bed, grown children and grandkids were crying and begging him to please not die. This little man fought death until the end.

    My prayer is that more docs will see the benefits of hospice and begin to refer their terminal pts. earlier than just a couple of days before they die.

  4. by   NRSKarenRN
    Sharon, Welcome.

    Agree with your posts as been involved in many similar situations.
    My grandmother was placed in assisted living in April due to dementia. My parents were in denial of her lossing her self care ability since Christmas of 2000. She will be 93 in 3 weeks. Physically, she is slowing down, lost all SQ fat down to ~110 lbs from 125 a year ago. Goes to dining room for meals 3 times a day but socializes instead of eating all food given. Lucky if she eats 50-75% meal. Tires from feding herself too. Having increased bone/joint pain due to DJD/polyarthritis advancing. I visit almost weekly as nearby.

    Lately, she sleeps most afternoons, is disgusted with her change in body appearnace and on two occasions expressed desire not to live long this way as she is also aware of her memory deficits. When I spoke with the NP MaryAnne last week who examined her, I requested DNR per her living will and order written.
    She agreed Nana is slowing deteriorating despite best attentions and a loving, caring staff who dote on her.

    She has two daughters. My aunt lives in neighboring state 1 hr drive, visits about every 2-3 weeks and has seen and heard similar concerns expressed and accepting situation. My mother gets to visit less than 1 x a month due to her poor health. I informed Mom about the above and stated that I think we will be luck if Nana is alive in 6 months time. She was shocked by this statement. Carefully, I explained my rational.

    I'll see how things are after Christmas and will request Hospice for I know her daughters need it. I'll need it too for I'm the oldest grandchild and have 46 years of great memories. Luckily, the assisted living facility will allow her to die there as Hospice been involved with residents previously and I've grown close to most of the staff too.
    Last edit by NRSKarenRN on Nov 30, '01
  5. by   SharonHopson

    How lucky your grandmother is to have you for an advocate! I lost my grandmother 15 years ago d/t Alzheimers. It is always so hard on the family to watch someone they love slowly go down. Good luck to you and your family.

  6. by   aimeee
    Bless you, Karen.

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