What can Hospice do for my mother?

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My mom is 82, with end stage CHF. She lives alone, is on 6L 02 via nasal cannula, occasionally raising to 8 via mask. She still bathes herself and feeds herself but has difficulty getting around, even with her walker. She doesn't want to go into a nursing home, nor does she want to move in with my sister who has offered.

She has been hospitalized twice in the last few months, last time in a cute renal failure; her BUN got to 70 and creatinine 5.4. We thought that was it. But it backed off. When the ambulance came to get her she cried and said she wanted to die at home. I am wondering, what can Hospice provide for her that we cannot? :nurse:She uses a nebulizer just about every three hours. She has a bloody nose most mornings, so we have humidifiers running. (One bloody nose went for 4 hours and she eventiually had to call an ambulance for that one.)

She says she wants to die at home, but when she gets super short of breath she gets panicked and wants an ambulance. I want her on Hospice, she SAYS she wants Hospice, but I can see her panicking and asking for an ambulance if she gets very hypoxic. I don't know what to do. I want her comfortable but this is not so much a pain issue like one would have with a cancer pt. Shes not really in any pain. Will Hospice be able to bring in equipment to make her breathing easier near the end, like with a non-rebreather? I want to be able to tell her we are doing everything they would do for her in the hospital. (Except intubating, she absolutely positively doesnt want that). Any answers would be helpful; I am meeting with a Hospice nurse next wee and would like to go in with a little more knowledge than I have right now. TIA!:o

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Specializes in Hospice.

A good hospice agency will provide and teach you about rescue meds that work faster than an ambulance can arrive (often morphine and ativan for dyspnea). They will begin assisting your mom in a life review and providing emotional support for the entire family. They will provide aide services (often even if pt's can bathe themselves, it does not mean they are doing the best job of it, or that it does not take lots of energy to complete hygiene). I rarely ever use non-rebreather for my patients- this does not lead to a reduction in dyspnea at the end of life and can be artificially life pro-longing.

The sooner someone is on hospice, the easier it is to change the mindset from call 911 to 'lets keep you safe and comfortable at home'. I think hospice may be able to stabilize your mom for awhile and provide a better quality of life. Beyond that, you can call 911 while on hospice, there are just some significant financial repercussions if the revocation is not done in a timely manner. Hope that helps.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.
My mom is 82, with end stage CHF. She lives alone, is on 6L 02 via nasal cannula, occasionally raising to 8 via mask. She still bathes herself and feeds herself but has difficulty getting around, even with her walker. She doesn't want to go into a nursing home, nor does she want to move in with my sister who has offered.

She has been hospitalized twice in the last few months, last time in a cute renal failure; her BUN got to 70 and creatinine 5.4. We thought that was it. But it backed off. When the ambulance came to get her she cried and said she wanted to die at home. I am wondering, what can Hospice provide for her that we cannot? :nurse:She uses a nebulizer just about every three hours. She has a bloody nose most mornings, so we have humidifiers running. (One bloody nose went for 4 hours and she eventiually had to call an ambulance for that one.)

She says she wants to die at home, but when she gets super short of breath she gets panicked and wants an ambulance. I want her on Hospice, she SAYS she wants Hospice, but I can see her panicking and asking for an ambulance if she gets very hypoxic. I don't know what to do. I want her comfortable but this is not so much a pain issue like one would have with a cancer pt. Shes not really in any pain. Will Hospice be able to bring in equipment to make her breathing easier near the end, like with a non-rebreather? I want to be able to tell her we are doing everything they would do for her in the hospital. (Except intubating, she absolutely positively doesnt want that). Any answers would be helpful; I am meeting with a Hospice nurse next wee and would like to go in with a little more knowledge than I have right now. TIA!:o

Okay "fiona"...your grandma needs hospice. Get her permission to call her doc and talk about it. What hospice would you use...do you know anyone who has used hospice? Your grandmother may use the hospice of her choice.

Once she has elected her hospice benefit the case nurse, social worker, chaplain, and physician will help her to develop a plan for her last days/weeks/months. The focus will be on her comfort, her environment of choice, and her personal/spiritual goals. The hospice team will be very interested in involving you and the rest of your family in the care and in the "living" that is still to be done.

The hospice team will be able to help your grandma get MUCH more comfortable. Most e/s CHF patients never use a mask of any type. Hospice will help her to manage the anxiety and fear that accompanies her disease process...we understand and know how to help.

Please don't hesitate a moment longer...your grandmother deserves hospice care just now! and so do you!

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The patient is her mother, not her grandmother.

We have many good hospice nurses on this site. Although they can't give medical advice, they can certainly help to explain what hospice does and the possible benefits for your mother and your family.

It's good that you are reaching out. Neither she nor the rest of you should go through this alone when excellent services are available.

I wish you all the best.

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Specializes in PICU, NICU, L&D, Public Health, Hospice.

my apologies for the misread...

I wish the best for you, your mom, and the rest of your family...

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Specializes in ER, Cardiac, Hospice, Hyperbaric, Float.

Your mom sounds like a very appropriate candidate for hospice. Just a few things that can (and should) be provided to help based on what you described (although this is definitely not an all-inclusive list):

-CNA services to help her at home. Even if she CAN do things for herself, she probably gets short of breath easily and the help would help alleviate this, and thus probably alleviate some of her anxiety. Just having someone there for a bit can sometimes help a lot.

-A nurse assigned to her, and on-call nurses to contact instead of 911. She sounds like when she has situations where she calls, she really doesn't want to go to the hospital, but she needs some help, and doesn't know what else to do. Sometimes, it may be as simple as having a nurse to talk to over the phone to help give her instructions about things to do to ease her situation and anxiety about it.

-Medications to help her. She sounds like she needs some ativan to help with her shortness of breath. Having a nurse going out to assess her regularly, and to evaluate her current medications, condition, concerns, etc. should be very helpful. Not to "bash" physicians, but sometimes nurses (especially hospice nurses) are better able to get the "whole picture" regarding medications, treatments, etc. and are therefore able to recommend changes/interventions that may not have occurred to the physician.

-Social workers and chaplains. These folks are INVALUABLE to hospice, and any agency that doesn't recognize that and disrespects these folks (case in point: the agency I worked for) is doing a disservice to their patients. These folks are sometimes even better than nurses at seeing the "whole patient" and coming up with creative ideas and solutions to problems. Because your mom wants to live at home, and lives alone, AND has health problems, these folks can provide so much insight, support, and assistance to help her.

As I said, this list is not all-inclusive, but if you find a good agency and a good team of RN, CNA, MSW, and chaplain to help her (and a good physician to consult), I think hospice will be a wonderful thing for your mom (and for you and the rest of your family).

Best of luck to you!

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