Journey along the palliative care bridge to hospice

I work in long term care and am discouraged by peoples lack of knowledge re palliative care, for instance, if someone gets a fever at end of life most nurses will ask for antibiotics, well my dad is and old country md who still makes housecalls and he would let families know that pneumonia at this point is a "gentlemans friend", nurses are mostly wanting to start iv fluids,clysis,and not allow natural death, they are pressing the aides to encourage food , then want to suction them when they choke!Oh yeah and lets do alot of vitals and count respirations while we are at it, it makes me cry. Dying in america is brutal.

You are right, dying in America is brutal. I just started my first job as a new grad at a ltc facility. Ultimately, I want to go into hospice. I am just learning the ropes at the facility, but I have to wonder at the treatment philosophy for some of the residents, and who is deciding. It certainly isn't the resident in many cases, as they can't make the decisions due to dementia or Alzheimer's. If a person appears dehydrated or malnourished, it seems the facility can be accused of neglect. So the facility, even against the patient's wishes (if they don't want to eat, they must not know what they are talking about and are incapable of making a rational decision) and so they just keep encouraging food, meds, etc. I think that culturally, we see death as a failure and we must succeed at all costs.

Dying in America can be brutal! It makes me very sad to see what can be a dignified death botched by those who don't get it. Unfortunately some of the blame is with hospice organizations that have gotten so big that they've lost the essence of hospice care altogether.Our physicians & nurses at all levels need to be educated on the benefits for the patient, family and the healthcare system of choosing hospice.

I believe that some have forgotten that death is a natural part of life - regardless of the age - sometimes at 98, sometimes at birth. We've become so terrified of it. I wish there were more education on palliative care and hospice in nursing schools. Thank you for an excellent article.

Here Here!

Quote from jlynn2303You are right, dying in America is brutal. I just started my first job as a new grad at a ltc facility. Ultimately, I want to go into hospice. I am just learning the ropes at the facility, but I have to wonder at the treatment philosophy for some of the residents, and who is deciding. It certainly isn't the resident in many cases, as they can't make the decisions due to dementia or Alzheimer's. If a person appears dehydrated or malnourished, it seems the facility can be accused of neglect. So the facility, even against the patient's wishes (if they don't want to eat, they must not know what they are talking about and are incapable of making a rational decision) and so they just keep encouraging food, meds, etc. I think that culturally, we see death as a failure and we must succeed at all costs.

I so agree with your article. As a retired hospice physician I see the huge need for more palliative care in the US and, of course, for more open discussion. As a society we are death-phobic and chase after futile cures and promises of immortality because we don't understand this: the fact that we will all die someday is exactly what makes our lives so precious and meaningful.