WHAT TO DO WITH MOM
Yesterday, I dealt with the son of an 86 year old woman. She’s had some complicated health issues this year and a decline in her cognitive function. She has now stopped eating and drinking and is becoming weak. Her normally high blood pressure is falling to very low levels. The assisted living where she resides wants to call 911 and send her to the ER. Last time she went to the ER, they kept her in observation for days before admitting her. (Just as a side note: if a Medicare patient is kept in observation and not admitted as an inpatient to the hospital for at least 3 days, Medicare will NOT pay for him/her to go to a rehab or nursing facility.)
I started the conversation with the son by talking about what his Mom wanted. Does she have a Living Will? HealthCare proxy? Fiduciary HealthCare proxy? Five Wishes? Does she want to go to the hospital? Does she want any heroics? The healthcare proxy’s role is to know what Mom wants. And to make sure Mom’s wishes are followed as per Mom’s Living Will or Five Wishes. (FiveWishes.org).
I suggested that Mom’s senior living community most likely has a contract with a Palliative and Hospice agency. It wouldn’t be inappropriate to at least have a palliative care assessment. They help control chronic symptoms for a better quality of life. If they feel hospice is necessary, they’ll have the conversation with the patient and the family.
In most states, if a resident of a senior living community has certain symptoms, (ie low oxygen saturation levels, severe shortness of breath, blood in urine, high fevers, high blood pressure, low blood pressure, etc) they are required by law to call 911 and have the resident transported to the ER… even if the cognitively intact resident doesn’t wish to go. The only way to avoid such transport is if the person is on hospice. Once hospice care is initiated, there are no more trips to the ER. We all know what trips to the ER involves. Long waits. Hours and sometimes, days of waiting to be seen. Our healthcare system needs a HUGE fix.
We talked about what medications his Mom is on. The addition of any new medications to the mix could be exacerbating her current symptoms. Good question to ask her doctor.
Will she tolerate Ensure or similar high calorie protein drink if she’s not eating or drinking? It will give her nutrients plus liquids. It can also cause diarrhea. Forcing her to eat or drink can result in aspiration into the lungs. Don’t do it. And no feeding tubes at this stage of life… EVER! If Mom wants to eat but is having difficulty swallowing, that’s a whole different story. Ask for a swallow test to be done. There are substances we can add to fluids that thicken them, reducing the risk of aspiration.
Gatoraid is not necessarily essential if Mom is dehydrated. Better to offer her favorite fluids which she will be more likely to drink. An IV for the administration of fluids might be acceptable, depending on the Living Will and overall desired outcome and prognosis.
Keep her mouth moist with mouth swabs dipped in mouth wash if she’s not eating or drinking. Keep her lips lubricated with lip balm.
Falling due to weakness is a major risk. Do not let her walk unescorted. A walker and/ or gait belt is definitely required whenever there’s weakness.
Provide a 1/2 bed rail on her personal bed. It will help her move around while in bed and will help her get in and out of bed more safely. It is not for the purpose of physical restraint.
Utilize a bedside commode if she’s too weak to walk to the bathroom. Diapers/pull ups should be used when needed. Hygiene care should be done with the patient’s dignity as top priority.
Sometimes at the end of life, folks will stop eating & drinking, withdraw from things that used to give them pleasure and spend lots of time sleeping. It’s all part of the end of life process. Of course, you may feel driven to make sure there’s no underlying organic medical issue causing these latest changes in her condition. But how far are you willing to go to get such a diagnosis? Doing a bladder scan is fine. But would you subject her to any major surgery at this stage? Or chemo? Or an invasive procedure? Are you, Mom and the rest of the family willing to let nature take its course? Be sure you know what Mom wants. This is all part of the Important Life Conversations that families and aging family members should be having… way before there’s a crisis.
The delicate issue is always quality of life versus quantity of life. If you can successfully navigate Mom’s current situation, will she have quality of life afterwards? And who is best qualified to determine what quality of life is for your Mom? Ask her what she wants if she has the cognitive capacity to determine this..
This is a good time to ask Mom for forgiveness for not necessarily being the son she needed. And then you can offer her your own forgiveness for her perhaps not being the mother you needed. Mutual forgiveness is a huge gift to give her and yourself at end of life.
You should read my blog- “‘ACTIVELY DYING” on my website at KlemonsHealthCareConsulting.com.You may not need it now, but it’s a good end of life piece. It will empower you at such time when she does transition. You’ll better understand everything that’s happening to her.
In the meantime, continue to meet her where she is. Support her. Love her. Encourage her to be part of the decision making if she’s able to. And have NO GUILT. You didn’t make her sick. She’s led a great life. She’s gifted the world with a magnificent legacy of children and grandchildren. And her wonderful music! If you could wave a magic wand and make her better, you would. We all want more time. We all need to know when it’s time to let go. And at such time, be sure to tell Mom it’s OK to go.
