I am just a med tech at an ALF while in nursing school, so I hope it's okay to post on this forum. I am also a CNA with 16 years of experience on LTC, ALF, and medical offices.
We have a resident, let's call him "Joe" at our facility. Joe is a diabetic with an AKA and has colon cancer that had been deemed untreatable. Four months ago his doctor gave him three months to live. Until about six weeks ago, he got around on a mobility scooter, enjoying life with his friends at our facility with minimal assistance. His health has deteriorated now to the point he is bed bound and is seen daily by hospice.
Joe has has been refusing all of his morning meds. He has always known exactly what pills he took and what for. He takes Torsemide in the mornings and without it has become so edematous that he can no longer can move his arms and hands. They almost look "cartoony" if that makes sense. He also demanded that hospice remove his Foley catheter and his output without it is essentially zero. I believe he is purposely doing this to end his suffering. As he is in his right mind, I believe this is his right.
Now enter the family...sigh...his sister is his POA and becomes very angry with us when we let Joe refuse his meds. She said if we were "smart enough" we could get him to take them by hiding them in his food. Um...no... Then his brother came in (visits only every couple of weeks) and was very dismayed at Joe's condition. Began demanding that our caregivers give him information regarding the prognosis, what are we doing to "fix this" etc. Of course the caregivers deferred to me (weekend so our nurse wasn't in house) and the hospice staff. The brother wanted to know if we could "force" the catheter on the resident to "save his life" and what the prognosis was (I was thinking "He's on hospice, what do you think?"). I don't mean to seem heartless toward the family but this had been an ongoing problem of denial. My concern is the resident and his comfort.
Hospice, of course, refused to place a catheter against the resident's wishes. But they DID change the Torsemide from morning to night, knowing the resident takes his nighttime meds. To me this is wrong to do so without informing Joe that his "water pill" that he was refusing is now being snuck in.
My main concern is that once the resident becomes unconscious, his POA will demand we place a foley, feeding tube, the whole shebang, making this man's death a painful hideous drawn out ordeal. My nurse manager is at a loss. She called a family meeting with Joe there, which resulted in the POA letting his brother know he wasn't going to "kill himself" and that he would demand everything be done once Joe is no longer able to make decisions. Joe is too exhausted to argue. Is there anything we can do?
I'm sorry this was so long, it's a complicated situation. And it's breaking my heart.