In 2022 the post WWII Baby Boomers will turn 76 which is the average life expectancy of men in the United States. There will be a tidal wave of deaths caused by chronic medical conditions that doctors will not be able to treat because the patients’ bodies will be too delicate to withstand the side effects of treatment, or the stress caused by surgery. When a team of doctors agree that a patient has less than six months to live then they refer him or her to Hospice which is not a treatment program. The purpose of Hospice is to make patients as comfortable as possible during the dying process.
The author of this article was surprised to discover that many Hospice organizations are private “for-profit” businesses that have greedy owners, or are owned by corporations that report quarterly profits to their board of directors and investors whom are fickle and will fire the CEO and sell their stock when their profits are not high enough.
In theory, Hospice programs offer the following services to their patients where they live: A physician, social workers, chaplains, volunteers, registered nurses (“RN”), licensed practical nurses (“LPN”), and certified nursing assistants (“CNA”). However, some of those services have to be requested by the patients or their families. In 2015 there was a patient who was in Hospice for seven months and he met only registered nurses and certified nursing assistants. Sadly, he was a lifelong devout Baptist who longed to attend church but he couldn’t and so he would have benefited from chaplain visits, but he and his relatives didn’t know that the service was available and so they never requested it.
It’s important to emphasize that if patients refuse care from the staff, which they frequently do, then the staff are not allowed to help them. Patients have different reasons for refusing care. Some of them have a combative form of Alzheimer’s disease and are no longer able to rationalize, and when nurses try to help them they become aggravated and oppositional. Others may be confused because they are insulin dependent diabetics who stopped testing their blood sugar and it became extremely high. Unfortunately, the patients who need a nurse the most are the ones who refuse care, and the nurses are not allowed to help them because it would be breaking the law. It’s actually a crime.
The vast majority of Hospice registered nurses are awesome people. There’s no doubt about that. But there are malicious ones, too. For example, in April 2016, a female registered nurse from Hospice Northeast Georgia Medical Center, Inc., visited a new patient whose wife had moved him into a personal care home (not a skilled nursing facility) in order to save money. When the nurse arrived she was greeted by a new trainee who was paid $25 per day (a day is a 24 hour shift). The nurse kindly offered a training session. However, after she left, she called the owner and complained that the trainee was nervous and overwhelmed, and she added that the trainee walked away several times when she was the one who sent her out of the room to get supplies. Later, an experienced CNA who heard that story said that it’s common knowledge that the registered nurses from the local Hospice are vicious, and that they have a long established history of making frivolous, petty complaints, and so resident CNAs avoid them.
With that said, Hospice nurses have witnessed terminally ill patients living in the wrong facilities, such as amateur personal care homes that are owned by impostor registered nurses and staffed with caregivers who are nearly unpaid volunteers, and the owner has misrepresented them as certified nursing assistants.
Hospice provides their patients with standard “Comfort Packs” which are very important. They contain the following prescription drugs: Morphine, Haloperidol, Acetaminophen, suppositories called Bisac-Evac, Hyoscyam, Lorazepam, and Prochlorper.
With that said, Hospice comfort packs have backfired on a few patients. For example, in 2005 a woman named Jennifer was shocked when she discovered that her uncle’s Hospice left a “Comfort Pack” that contained morphine in his home and then they accused her mom of stealing it and they filed criminal charges against her. The same thing happened at a personal care home in Lawrenceville, Georgia, where Hospice accused the employees. Years later the owner opened a new home and when she admitted her first Hospice patient there she asked them to remove the morphine from their Comfort Pack and they sent it anyway.
Hospice staff are trained to estimate when patients will die. Generally, they use the following guidelines:
- The patient will die within three months if: One withdraws from people and the world, and stops drinking an adequate amount of fluids, and loses one’s appetite.
- The patient will die within two weeks if: One has difficulty swallowing water, and has noisy congested breathing, and becomes confused and disoriented, and sleeps eighteen hours a day, and loses mobility in one’s legs, and becomes agitated and restless. Additionally, some patients also talk to unseen people who are not visible to others (imaginary friends). For example, one woman heard her mom calling her even though her mom had died decades earlier.
- The patient will die within a few days if: One becomes incoherent (or falls unconscious), one’s speech becomes difficult to understand, one’s noisy congested breathing gets worse and makes a gurgling sound (this is called the “death rattle”), one accidentally sucks saliva into one’s lungs which is called “Aspirating” which is like gasping, one’s breaths become rapid and shallow like hyperventilating, and one has fecal incontinence, one’s hands, knees, and feet are blotchy red-blue in color due to lack of circulation, one’s eyes appear sunken and one experiences blurred or worsening vision, and one has a surge of energy (“rallying”) where one can eat and talk which gives others the false impression that one’s condition improved. Once the kidneys begin to shut down they produce less urine and it’s brown.
Resident nursing assistants and live-in caregivers who take care of Hospice patients where they live know that some of the Hospice registered nurses practice euthanasia (“mercy killing”). For example, when a patient’s suffering becomes unbearable then they kill them with a morphine overdose. It’s a common practice regardless of whether it’s legal or not.
Hospice patients usually have a legal guardian and financial conservator who is usually a spouse or adult child. Sometimes they tell the staff to feed the patient extremely little even though the patient has already lost over thirty pounds within a year due to loss of appetite (“unintentional weight loss”), and the doctor has already diagnosed him or her as malnourished and recommended nutrition shakes such as Boost. Starvation is not mercy killing, as there are better ways to die, and dehydration is a very painful way to die. Most patients who have lost their appetite will still eat certain foods and so there’s no reason to starve them. The author of this article recommends spoon feeding them high calorie foods that are mechanically soft such as chocolate ice cream or scrambled eggs with melted cheese. The goal is to get them to gain weight and so keep feeding them until they stop eating even if it means giving them three eggs instead of their usual one egg. Keep a food log and keep the doctors informed so that the patients’ cholesterol levels will be closely monitored. They may need to increase the patients’ prescription statin drugs. No one likes to do that but it would be worse to allow an underweight malnourished patient to remain that way. In other words, caregivers who feed patients should take direction from doctors, not legal guardians such as temperamental wives who don’t know anything about reversing unintentional weight loss. Doctors and registered nurses have the difficult task of explaining patient care and defending caregivers to the patients’ guardians.