Witholding food from Hospice resident.

[lizscott nurse]

Some of my Co-workers and I were confused and upset when we learned

Hospice had instructed staff not to feed a resident with end stage COPD

so as not to prolong his life. This was his last two days. I wasn't working

at the time, but this has haunted me since. Especially because

the resident was asking for food. He was pocketing a little food, but not

having any swallowing problems. He was very anxious and was fighting

death till the last hours. I don't understand this. If he wanted to eat

why couldn't he? Isn't it about resident rights and letting them have control?

Obviously we couldn't give him a t-bone.....but there are many items that would be appropriate such as lemon ice, soup, etc. The feeling was by giving

in to his desire to eat a little we were prolonging his passing and increasing

his suffering. I saw it as comfort measures. This has really troubled me.

Any input? By the way....I love the Hospice nurses who come into our

facility. This is the first time I've heard of this happening. We have

a meeting with Hospice coming up...gen. inservice and I'm going to ask

about this, but was really wondering if this is the norm or what.

[Hellllllo Nurse, BSN, RN]

I worked inpt hospice for four years, and I have never heard of withholding food from a pt who is asking for it. I don't think it would have prolonged his life at all to have it, since he was so close to the end, but if someone is hungry, and can eat, they should be given food. I would ask about this at the meeting you are having with the hospice.

Also, sounds like he was undermedicated near the end. In my experience, hospice care in a nursing home is not complete hospice care; it's more like hospice "light".

[Tweety, BSN, RN]

I worked inpt hospice for four years, and I have never heard of withholding food from a pt who is asking for it. I don't think it would have prolonged his life at all to have it, since he was so close to the end, but if someone is hungry, and can eat, they should be given food. I would ask about this at the meeting you are having with the hospice.

Also, sounds like he was undermedicated near the end. In my experience, hospice care in a nursing home is not complete hospice care; it's more like hospice "light".

:yeahthat:

I've never worked with Hospice, but have taken care of many dying patients. Soon enough he would have quit asking for food. I'm not understanding this. I would definately bring your concerns to management or to an ethics committee if you have such.

Sounds like this patient needlessly suffered which is the whole point of hospice I thought.

I agree that the patients sounds undermedicated at the end.

[babynurselsa, RN]

I have never suggested witholding food or water from someone who asks for it.

I always tell my families and facilities that as they near the end DON"T FORCE food or drink.

There is a difference. I have had families that are poking things into a unresponsive patients throat and I come in and have to dig it out when they call me and tell "Grandma is making a funny noise."

Your situation kinda blows my mind.

[aimeee, BSN, RN]

You state that you "heard" that the hospice nurse said this...I am wondering if what she said was misheard or misinterpreted by some of your staff. We would NEVER tell anyone NOT to feed someone unless it was a danger to them or unless it was to support the patient's own wishes. If the patient is able to handle food and fluids we encourage caregivers to offer it but advise them not to be concerned if the patient does not take it or takes only minute amounts.

[lizscott nurse]

You state that you "heard" that the hospice nurse said this...I am wondering if what she said was misheard or misinterpreted by some of your staff. We would NEVER tell anyone NOT to feed someone unless it was a danger to them or unless it was to support the patient's own wishes. If the patient is able to handle food and fluids we encourage caregivers to offer it but advise them not to be concerned if the patient does not take it or takes only minute amounts.

No-I said I "learned" that the hospice nurse had instructed the staff.

I did not hear this first hand, but it was charted and reported off to

me by the off going nurse. Appparently it had been discussed with

family and they were in agreement. My understanding of hospice in

regards to this is just as you say, which is why this is so bewildering.

Our inservice is coming up soon and I hope to find out more then.

Thanks to everyone for your iposts on this subject. Many of us

(where I work) are still having a hard time with this and I think your input will be helpful to us all. We all seem to be on the same page, so to speak.

[NRSKarenRN, BSN, RN]

I'll never forget the time I cared for a man with Heimlich valve due to End stage Lung CA at home. I was their as IV morphine being run on a pump and 20years ago you got private duty nursing. He wanted a beer at 9:30AM--convinced him to wait until SO cooked his scrambled eggs and eaten them. He asked me about his illness and couldn't understand about purpose of the valve.

After 20min conversation, he got up to walk into the kitchen, stopped in the doorway and said "This is it, I'm gonna die", collapsing into my arms. I was able to get him back into recliner chair and he was flaccid on left side.

That was the last time I ever told advanced CA patient they couldn't have what they wanted to eat. Even with risk of aspiration, patients have a right to bites of food if they want it. Maybe the nurse was new to hospice and just agreed to families fear of patient choking.

To make amends, I later did mouth care with beer dipped toothettes. Lopsided smile and eye twinkle let me know he knew he got his beer. He died the next day with his SO cuddled next to him in hospital bed in the Living Room which I had encouraged...think I made my amends and great lesson learned.

[aimeee, BSN, RN]

To make amends, I later did mouth care with beer dipped toothettes. Lopsided smile and eye twinkle let me know he knew he got his beer. He died the next day with his SO cuddled next to him in hospital bed in the Living Room which I had encouraged...think I made my amends and great lesson learned.

Beer dipped toothettes! :kiss Bless your heart, Karen! That was a wonderful way to help him get what he wanted!