Hospice question(3)

jb19

I was told today by my mom’s palliative care nurse that she thinks my mom is going to need hospice. She had a fall last week, and according to her caregivers at her nursing home, there has been a significant decline in her functioning. 

She is very upset and has been sobbing, and they are not able to calm her down. She does not want to eat. She is still walking, but her nurse said that it is more wandering, where she used to walk with purpose and interact with her surroundings.

Before calling in hospice, they want to try to give her anti-depressants for a few weeks to see if there is any improvement in her mood. I am wondering if hospice is brought in, are they able to help with anxiety and mental distress? Is there anything I should be doing or asking her caregivers to do to help keep her calm? I would appreciate any thoughts or advice. 

Thank you!

M1

Welcome to the forum jb.  I'm sorry you're going through this, I'm sure it's hard to hear that she's at that point.  Sounds like the antidepressants are a good idea, and I expect the palliative care nurses are pretty good at assessing these things.  I would go with their suggestions; Hospice is not a death sentence per se, nor for a dementia patient does it necessarily mean that death is imminent.  And yes, they can bring more support than you might think, and can prescribe antianxiety meds if they are needed.  

Does your mother respond well to your visiting?  If so, it would seem to me that the best thing you can do is to be there with her/for her.  I wonder if she would respond well to soothing music, also.  Many do.

I'm sure others will have suggestions/comments for you too.  Good luck, and again I'm sorry.  All of this is so, so sad.

harshedbuzz

I'd ask for the hospice referral. 

My concern is that certain classes of antidepressants (The SSRIs) can take about 8 weeks to trial meaning it would take 4-6 weeks to build up in her system and make the determination if it's a good fit for her and then a few weeks to wean off before starting something else. 

I have known people of hospice who continued psychoactive medications they were already on as "comfort care", so it make be possible to have both. I would ask.

HB

Cynbar

Yes, hospice can be a big help here. Their number one goal is comfort, and they have a lot of expertise in soothing emotional distress. Some of it may be medications, some of it may be their services such as a chaplain and social worker and music therapy, some of it may be suggestions for family and staff on ways to soothe her. If she qualifies, there is no down side unless she would be seeking hospitalizations or aggressive treatments for any medical issues. Hospice puts in extra services to supplement the facility's care it really is a win-win. No need to wait and see how the anti depressants work, hospice will assess that as well as develop a comprehensive plan. Ask for a referral, you have nothing to lose.

King Boo

My LO saw a geriatric psychiatrist MD as needed for medication management during hospice so I can confirm she can obtain these services.  

Not every medical staff member understands hospice, the best information is from hospice directly.  

Read up on what hospice is.  It's not for those breathing their last breath or in final days, ideally.  In fact, there is very little hospice can do for those except pain management.  Hospice services are designed to be used in the 6 months prior to a possible anticipated end of life.  It is a good thing.  Very helpful to our LO and us.

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jb19

Thank you all for the information. It is very helpful. I am going to see if I can get the hospice referral for her now.

Rescue mom

Hospice, at least all those I’ve dealt with, can help with everything you mentioned and more. Hospice does not mean death is imminent, or even months away. Many take dementia patients regardless. I consider Hospice invaluable, they do so much to help. My mother with dementia had Hospice off and on for over 2 years. She’d improve “enough” and they stopped. Then she’d decline, and they came back. Repeat repeat. No cost to you.

towhee

Falls can indeed cause a decline in function. It happened with my LO. One thing seems to lead to another. I agree that hospice should be considered.

There is one basic thing which I am sure your palliative care has considered, but just in case it might be useful I will mention it. Persons with dementia sometimes don't express pain in a way we would understand. Even when asked if they hurt, they can't answer yes, even when it is obvious they should be in pain. Sometimes they express pain by not wanting to move, sometimes by hyperactivity, or other behavior. When there is a behavior change, especially after a fall, some medical practicioners will give Tylenol to see if that makes a difference in behavior. Also, damage from a fall does not always show up right away.

Wish you well-