I have had lengthy conversations with Ron Panzer at Hospice Patients Alliance as well as the administrators, medical directors, and pastoral staff of a number of hospices in this region.
Unfortunately, every patient receives morphine and haldol in the pack of meds prescribed to every patient admitted to hospice and it is used quite frequently even for those patients not expressing concerns of pain or showing signs of agitation.
I'm glad your experience was positive and you were not involved in or exposed to this kind of abuse, but it is widespread in the industry.
>Unfortunately, every patient receives morphine and haldol in the pack of meds prescribed to every patient admitted to hospice and it is used quite frequently even for those patients not expressing concerns of pain or showing signs of agitation.<
You are correct about the kits of medication. They are a crisis medication kit that a nurse will order if she believes the time of death may be approaching. This is not something you order and take into the home immediately upon admission unless that pt is close tho the dying process. Usually you have a standing order for this kit which usually contains aspirin and tylenol supp., haldol, ativan SL, scopolamine patches or atropine drops, phenergan supp., etc. In order to get roxanol you have to Ho and get a script from the doc. Roxanol is not given until the pt is actively dying.
I realize that you speak to a lot of people in the Hospice or medical field and again I’m not trying to belittle anyone’s experiences. But a lot of people are in the field that never step one foot inside a home of a person dying and actually see what happens day to day with pts.
I would argue very few physicians even in a hospital setting have a tally been with their pt when they pass. Believe me I have had to “advocate” for my pts with some of these Docs with no disrespect, only know about the dying process from something they read in a book.
The Haldol in my dads case was PRN. When the time came I used it. The Morphine? He had been on it almost a year before Hospice that and Hydrocodone due too ongoing Chemo treatments. I knew better than stop the Morphine and Hydrocodone and gave it pill form as long as he could swallow. Then it went liquid.
In our not so distant past about three decades ago persons who chose to die at home were sent home with a lot more and a lot stronger medications than that of today. Yes the medication usually took the persons life.
There are truths and misconceptions. Some think for example a nursing home wants the patient to die? Why? Patients is how they operate even NPO's. The good news is many of the nursing homes as well knew them are not being used as much due too the idea of assisted living which means many who were nursing home patients 20 years ago are now assisted living and pretty darn independent with minimal help. While they can't maintain a home they can thrive there as a community.
I had to retrain or learn myself on that issue due to my sibling. My sibling 59 has onset of Dementia. The primary caregiver died suddenly from a massive heart attack and the grown kids were not suited to do care. One was out of stae as well and had medical issues. As well there was the reality of walking off from the homes so a secure facility was needed. My family comes to me to ask about such issues. They asked me about assisted living and I said I doubt it due to the need of 24/7 monitoring. I was wrong. My niece found one for Dementia. It's great. Granted a secured unit but great.
We did have some issues at first over nourishment. It seems somehow it got put in the records of a pre-Diabetic condition. The Dementia unit director insisted nothing like a hamburger, snacks, etc be brought in. They proceeded to begin a diabetic diet as well. We made a doctors visit and had a Blood Sugar test done one that can detect levels for prior three months no evidence of problems.
The facility Administration and my family had a talk. The administrator was on the same page as us. The administrator said they have had a lot of things taken from them. The last thing taken will be foods they like or rather the ability to eat. The administrators belif was if they can eat safely and enjoy their food let them have what they want. That is how it should be IMO and we did achieve that part. The administrator believed give them what they want and so we do.
I want too tell you about something else this happened many years ago in about 1980. I didn't see it but my wife did as a nurses aid workjing there and told me about it later after we had met. The administrator of the nursing home she worked at had a massive heart attack at work. The nursing home medical director also the county M.E. was there and began using all his skills trying for 45 minutes to keep him alive plus additional time in the ambulance till he got to an ER. He lingered two weeks hooked up too every modern support they had before his family said enough.
Now the doctor was a very compassionate and Christan man. He loved the patients as did the administrator he tried to bring back who had left orders in his will that certain acts of kindness he did in private for a few wards of state with no family be continued.
Anyway the medical director said he would never do that again for that long to anyone it was cruel. It's a matter of this man for all medical purposes had died. Bringing him back prolonged death and increased suffering. It was his best friend it happened too. His new orders were give all patients TLC. Unless requested by family no heroic measures. This was before living wills etc had become popular.
Medical science though many things discovered and increases in knowledge and technology has increased the wisdom has not. Machines can keep some people alive a very long time. Machines can breath and do the cardiovascular functions but the patient? Are they there? I don't mean a Vegetated State only needing feeding tube and hydration I mean a lot more extensive. How far do you go?
I lost my first wife when she was 23 to a massive heart attack. I was at work or enroute to work and she was going to ride to her moms with my dad on his way too work. She collapsed getting in the vehicle. Dad did CPR for about 45 minutes waiting for an ambulance but she was gone and pronounced dead in the driveway.
A few years later I became friends with a Paramedic. He told me he had seen this happen before and even had she been in an ER she would not have ever walked out but simply kept alive for days.
>have had lengthy conversations with Ron Panzer at Hospice Patients Alliance as well as the administrators, medical directors, and pastoral staff of a number of hospices in this region.<
I also wanted to comment that these people you list, esp. Administrators and medical directors never step near a bedside.
What field do you specialize in Dr. Kopp?