Hospice nurse and AL nurses clashing

Beauchene105

Who has dealt with this situation? My mom, 94, dementia and bedridden, began hospice a few months ago. The territorialism of the AL nurses didn't come to the forefront till now. My mom moans and complains whenever she is turned, diaper changed, or otherwise moved. Otherwise, she rests peacefully due in part to her fentanyl patch. . She's been in this AL for years and loves it, so moving her was not an option for us. (I travel here each week and stay 3 days-I'm an only child. I can't lift her due to back surgery issues/history)

She is declining slowly, barely eats yet her vitals are ok. I asked if she might need more pain med for the sponge baths in bed, which she protests about. I mentioned not wanting her to hurt. The hospice nurse feels the AL nurses are not knowledgeable about morphine and that a tiny amount might help. The AL nurses fear morphine could depress her respiration. The hospice nurse disagrees. I am caught in the middle trying to be my mom's advocate. Temporarily I am having them give her Motrin before the sponge baths (starting today) to see if that's sufficient. If it's not, then we'll go from there. The AL nurses feel they "know her better" and she's not really in pain, just "doesn't like to be messed with". The hospice nurse thinks my mom is likely very stiff and sore and morphine given judiciously would take the edge off the pain.

I researched this topic and read medical journal articles- there is definitely resentment between AL and hospice nurses.

Any feedback is appreciated.

BassetHoundAnn

The aids at my mom's memory care once told me that they have on occasion clashed with the nurses from hospice. It's usually been over medication. One aid told me that a particular hospice likes to take residents off medication and often quite abruptly, which is rarely advisable. She, and the MC nurse, told me that they've seen several residents die because of the extreme medication withdrawal.

My mom, who is in stage 7, was on morphine to stabilize her erratic breathing. She was on only briefly. Just days I think. She slept the whole time as morphine does make one sleep.

I would consider very seriously any advice given by MC aids and nurses because they deal with dementia patients every day. Hospice nurses deal with lots of different types of patients. And specific hospices often have a specific regimen of procedures and advice that they follow. Sometimes MC aids don't agree with that, which is o.k.

Morphine seems to be a very common prescription from hospice.

The bottom line, as I'm sure you've discovered, is that as a parent's medical POA it's up to you to advocate and research the best path for you loved one. You will be the one who will make the decision about what medication will be given and which will be skipped or withdrawn. I've found that both hospice nurses and MC ones always respect my opinions and my ultimate decisions, even if they occasionally have different opinions.

Beauchene105

Thank you, BassetHoundAnn. I appreciate your supportive comments. It's a sad, long, lonely journey and I'm grateful for reinforcement.