Please Advise ASAP Confidential please

[harnof]

I received this note yesterday.Please advise ASAP. Urgent.

My...... has lung cancer and has been at... Hospice for the past week. We are not completely happy with the service, but are not sure if the service that we are receiving is standard for a hospice facility.

We feel that if ( person) can and asks for food and drink that we should provide it to person and we do. The staff at Hospice .... disagrees and advocates additional sedative medication to prevent any ability to eat or communicate.

Any input would be really appreciated.

Thanks,

[Iluvhospice]

Agree completely with tewdles... If they are not happy with the present hospice, there are generally several in any given area. The first step should be speaking to the present hospice about their perception regarding the hospice's stance on food/fluids at the end of life. At my agency, the patient and family are the primary decision makers on those types of issues with guidance by the hospice staff - not mandates.

[Daisy_08, BSN, RN]

It sounds like the family is not being educated on what is happening. They should seek clarity from the staff.

However my knee jerk reaction is no, that does not sound right. My pts can eat if they want, or not. Eventually they will stop being hungery and not want to eat becsue simply put thier body is shutting down and now longer needs the energy food provides. That can be very hard on the family, and they need a lot of reasurence. Some people don't understand why we dont force feed. Maybe that is the situation. The letter didn't say the pt was asking for food, it could be the family wanting to feed the pt and the pt is not able to eat. Either way, the family needs more education.

Sorry to your friend

[Capco56]

All very good replies. Rule of thumb, if he is alert and oriented enough and barring any swallowing difficulties or aspiration precautions, there is no reason he can't have a hot fudge sundae for breakfast if he wants. Hospice=Comfort Care. Whatever is needed to provide comfort is what should be done.

A lot depends on where he is in the dying process. A little known fact among familes and patients is that when a person is actively dying, unlike you and I, a little dehydration is actually beneficial because it releases "feel good" endorphines that help with pain control and a sense of well being...kind of like "runners high". And, as another post said, the body does not know what to do with this extra food given to the patient if the organs are shutting down. This is all part of the family education that hospice nurses should be providing. Instruction to not feed a patient without explanation is just not acceptable. When I explain this rationale to my families, it gives then much comfort that they are not "starving" their loved ones to death.

In answer to the sedation issue, it is sometimes very difficult to maintain that balance between pain/breathing control and alertness. Very often, families will opt for the sedation over seeing their loved ones struggling. Bottom line, if you are not getting this type of education from the hospice nurses, it is time to find a new agency.