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Old 08-15-2012, 02:09 PM   #1
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Hospital

It has been more than a month after my late FIL passed away.
I have thought of all reasons and comforting thoughts so we can let him go. He is at peace now.
I still can't help to think if we could have done something. One thing that is not clear: There was no hospitalization. He needed oxygen and they didn't know why. No hospital. He had trouble eating but they fed him by hand one meal or two per day that week. For sure he was weak but they said he was "OK" or "eating" but the nurse did say he didn't eat "last night" and etc. So it was a so-so situation. I cannot help but wonder why they didn't consider the hospital? They sent him to the ER before for minor issues! (When he fell and had a little breathing issue.)
My husband did sign the polst that says no hospital if needed for comfort care and no food iv. He changed the order that Monday (my late FIL left on the next Sunday later.)
How does this work? When he may need the hospital, the NH would tell my husband and said no they won't? Or they will silently keep him at home without doing anything or telling us anything about what we could have done?

The thing is he died without any palliative care signs and etc. It is just like the last minute heart attack or stroke.

Do you think the NH's nurses/doctor really didn't try the hospital anymore given that he could not walk/talk and was very weak?

Nina

Last edited by ninamarc; 08-15-2012 at 02:15 PM.

 
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Old 08-15-2012, 09:05 PM   #2
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Re: Hospital

If your husband signed the order for no hospital then they would not send your FIL to the hospital. That is the way it works. Before the order was signed they would send him for changes in condition... but not afterwards. Comfort measures only keep him comfortable. If there is no discomfort then they do nothing. Palliative care is not aggressive care.

We can question and surmise what might have happened if.... We can look back and wonder what would have happened if.... We can drive ourselves crazy trying to come up with the answer to if....

I suspect it is exactly as your care givers said. He was eating ok. You do not have to eat a full plate three times a day to survive. He was probably comfortable which is a good thing. It was his time to go. If he had a little more oxygen he might have still died at the same time. Or he might have died sooner due to the stress of hospitalization. or he might have died a day later with aggressive intervention. Or he might have lingered for a long time in tremendous amounts of pain. You never know... and you will never know. What you do know is that he had a horrible disease and evidently died with a measure of comfort. So please do not make yourself crazy asking if if if???

Love, deb

 
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Old 08-16-2012, 08:01 AM   #3
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Re: Hospital

Thanks Deb. To be honest, we were going toward hospice at that time so my husband signed those things (he did it in April for no hospital already.) I do know that the doctor didn't send him to the hosptial in in late Feb when he needed oxygen (he had some infection.) As long as they know how to cope, they don't send him to the hospital anyway.
I am just thinking that when he was at his own house, the caregiver always sent him to the ER because the home could do nothing for him. Everytime he was fuzzy but saved and came home.
Guess it was not the time anymore. He was at the end of his disease - both AD and heart failure.
Just wish there were better communications in the NH. I do feel that the NH/head nurse/director has their own opinion of staying in the NH.

Nina

 
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Old 08-16-2012, 06:45 PM   #4
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Re: Hospital

this so brings me back 3 years ago when my mom passed. the nh did not call the hospital right away. i kept going over it and over it in my mind. my mom died of copd and not demtentia. the only peace i have is i was at the hospital before she went into a coma. she said debbie i am so scared and i told her she will be fine and hugged and kissed her. time is a healer and the thoughts will be leaving you. hugs to you

 
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Old 08-16-2012, 08:55 PM   #5
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Re: Hospital

Nina, in home care givers do not have the expertise and availability of medical support personnel to decide what is important or life threatening. They will tend to send a loved one to be checked out for minor symptoms just in case. Also your FIL was much earlier in the disease.

In a care facility there are usually doctors and nurses to assess the situation. If they can handle whatever is going on they do not transport the residents to the hospital. But if the patient become critical or they believe there is a good reason then they do send them to the hospital.

When you make the decision to go with Palliative care it changes dramatically. At that point you are concerned with comfort. Most dementia patients do not die of dementia. The dementia does deteriorate the body, decrease the immune system, and limit the ability to recover. It is normally some other complication that takes their life (pneumonia, heart attack, stroke... and many other causes). At the point of Palliative care you keep them pain free and let the progression of the dementia and other complications take their course. You may try antibiotics to cure an infection or use oxygen in place for breathing difficulties... but these are also comfort measures. The facility can do as much as the hospital can.

Dad had vascular dementia. He also had chronic heart disease and some other medical problems. For a while he would go to the heart doctor, have stents, etc. Then the family, along with his cardiologist, decided it was time to stop the aggressive treatment. He did not understand that he needed to lay still after the last stint and bled out. It was scary and what lead us to decide... no more! Other problems were address over the next two years. He had antibiotics for a UTI. He had PT for his arthritic knees. He was in the ER for falls. Then the decision was made (mainly because of the trauma of each ER visit) that we would go with Palliative care. From that date he never did go back to the hospital. I am not sure if he died of heart failure or kidney failure but it was peaceful, in his familiar surroundings of the facility, with his family around him... including Mom.

SO have peace in what was done. Perhaps it was sooner than you expected but again... they chose the time. I never imagined that Dad would live over 2 years after the cardiologist released him but he did

Love, deb

 
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Old 08-17-2012, 05:22 AM   #6
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Re: Hospital

Re: Hospitalization

In my opinion, be glad that your father was spared the confusion of the hospital. The hospital is geared for actue intervention. Alzheimers doesn't require or benefit from the hospital in any way. I signed papers to the effect that my father NOT be taken to the hosptal for any reason. It just adds confusion for a person that is already confused. You did the right thing. The hospital would do more harm (not purposely) than good. There is a time to let go.

Try to remember the good times. I started to write my memoirs, which awakened a lot of funny and happy memories.

 
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