LO on Hospice - Aide won't Give Morphine

Time for new aide

My SIL had the exact same thing happen with my FIL. She called hospice and also immediately removed the aid.

yep i'd fire her on the spot and report her to her agency. And she's incorrect about the morphine "killing" him.

Since it will be difficult to replace your aide, I would request hospice to provide education on the the medications, how they act and why they are important for the comfort care needed. Hospice is very good at supporting and educating caregivers. Hopefully they are able to help w this for you.

This will seem crass and I apologize. But it sounds like job security moreso than compassion to me. She likes her current arrangement and position, and it goes when he goes. I am so fed up with entitled-acting, opportunistic people right now I could spit!

I have come to believe there is a special place in hell for those who treat PWDs and their family caregivers (even if offsite) so dismissively. It is abusive - physically, mentally, and emotionally. Usually motivated by money, with more than a tinge of utter arrogance.

My heart goes out to you and to him. omg what a nightmare. Report her for sure. She violated his rights. Maybe in-patient hospice is an option? She doesn't care how her client and their LO feel so I agree with the others, she needs to feel unemployed.

If aides in NJ aren't allowed to administer, then hospice needs to devise a way for that medication to be administered. I understand that the aide's license would be in jeopardy, so fighting on that front would be useless. If there is a family member or friend that would be willing to administer, that would be great. If not, hospice may need to move him to a facility so he can be comfortable.

I’m in California. Two years ago my dad passed at home with us with him. We were given morphine by hospice and were shown how to administer it and when. The wonderful hospice person assured us that by helping him with his pain, we weren’t helping him leave this life sooner. What a blessing.

@Malka "Am I allowed to administer meds to my father?" Non-Dr. or Lawyer me here -- I am going to say yes. Because I have done so. You are the next of kin family member and person in charge of his affairs, right? If the meds are prescribed for him then it is not a crime or malicious. In fact I think it is a kindness. Hospice gives the comfort kit to whomever is the primary caregiver. At an agency that has to be governed by the facilities' rules, which follow state and maybe federal laws.

When LOs are convalescing at home, it means I have had the responsibility to medicate my elder family member years ago, and my DH now. Including controlled substances like Morphine when the nurse or dr says that's what is needed right now, or as needed on your own judgment when symptoms or situation calls for it based on what you have been instructed to do. When DH was at a respite facility, I gave him his meds the afternoon and night before I left him. The nurse was there for the last dose to record it, so they would not double dose him later by mistake.

FWIW, my little old nearly 100 year old LO was fairly resistant to morphine when we began giving it to her in her last weeks/days for pain - as instructed - when I called the hospice hotline to report she was moaning which was new. No dementia and she was clearly entering a new decline and needed relief. This little lady was able to swallow double and triple doses of morphine with no visible effect at all. It didn't manage her pain enough after dosing frequently around the clock, so after a couple of days we agreed to transport her to in-patient hospice so they could give something else (stronger) intravenously. She had less than a week to live, and we did not want her suffering. I say this to say, I was afraid of the morphine but it may as well have been kool-aid for her. Their comfort is what it is for. And if it helps, great. But it isn't like arsenic (or whatever would take someone out). Not in my experience.

DH also has had to receive morphine a few times last month. From me, at the on call hospice NP's directive. It was to keep him calm when his respiratory issues were so severe he would not allow me to put his nebulizer mask on (or oxygen - so he was fighting the very things that could give him relief from the inability to breathe! He actually almost died twice, struggling and gasping in distress (suffering that I could not just watch), until I gave him the morphine as instructed). It just relaxed him so he would wear the nebulizer and canula. If his lungs had not responded at that point, at least he would not have been panicking and suffering so. He is fine now (well, back to his 7a baseline), and the morphine is back in the comfort kit in the back of the fridge. Its worst side effect to me is constipation. So he had to take more Miralax and also prune juice while taking the Morphine.

I hope you can get this resolved for your sake and your LO's. So sorry you have to deal with this aide's refusal to do her job and follow you and the Dr's guidance.

I had a similar situation with my mom, when her caregiver of 6 years refused to follow hospice instructions. She was from Brazil, and their concept of hospice is not the same as ours, so we had a cultural problem. It was a real struggle and very stressful for me . We have a shortage of caregivers here, so I had to keep her on.

When my husband was at end stage ALZ, i was allowed to administer morphine and received specific instructions as to the dose. We live in Ma.

This is so frustrating. She’s in the wrong field if she would deny a dying person comfort medication. It was the nurse at my step-dad’s AL who not only gave him the morphine from hospice, she asked for extra syringes. That way she could get them ready and the aides could help him take it at night and the weekend. It wasn’t a shot as much as a squirt of the liquid into his mouth. If he could raise it to his mouth, they could push the button to inject it.

Just because he woke up didn’t mean the morphine didn’t work. The first day it helped dad be free from pain and he was able to be more alert. As the days went on, he slept more but that was because he was getting closer to dying from his illnesses, not the morphine.

(((Malka))) Hugs to you. You are helping him in just the way he needs, at the most important time. It seems like your idea for a nighttime aide for comfort medication management might be good, if that is possible.