Expert: Mary Gordon - 8/29/2006

Question
My mother and I have been caring for my 83 year old Grandmother at home for a few years now with help of a home health aide.   On August 3 she took a turn for the worst and would not eat and her eyes were sunken in she only weighs about 110lbs. We took her to the Urgent care center, there they diagnosed her as severely dehydrated, her heart was in A fibrillation and her kidneys were shutting down.  The urgent care doctor sent her to the hospital for rehydration. Once at the hospital the dr there told us Gmother was near the end and to hydrate her is merely prolonging the inevitable. She went home the next day. Since Aug 4 its been up and down and is on a liquid diet Ensureplus,Pedialyte,Powerade,applejuice,broth&
Yogurt.Her breathing seems very labored at this time. She doesn't want to open her eyes anymore and is sleeping most of the time. She no longer can stand on her own and we are having a very rough time getting her off and on the wheelchair for changing and into bed.How long can a person survive on a liquid diet? Do you think its time for her to remain in bed now and continue to handfeed her? Or should we get hospice involved for inpatient stay as an alternative if so, would hospice handfeed her or would my Gmother go without food and water there?

Answer
I would urge you to call hospice and ask them your questions. Palliative care is all about compassionate and supportive care - not just for the person who is nearing the end, but for their families. Most people's experiences with hospice care are overwhelmingly positive, and they usually wish they had called them in sooner.

The normal drill is that yes, absolutely, hospice workers will feed patients who will take fluids and nourishment by mouth. Hospice care is about not letting the person suffer - so they do everything in their power to keep the person as comfortable, happy, loved and dignified as possible.

Palliative care usually means that no heroic measures are taken, no tubes or IVs, no medical treatment beyond comfort measures (i.e. they keep them out of pain and discomfort, but might not, for example, attempt to aggressively treat pneumonia. It means a do not recuscitate order, so if the person begins to slip away, they let them go.

It does sound very much like she is close to the end of her journey. I would not be surprised if she slipped away over the coming weeks. Call your local hospice care organization and ask to have a meeting with a worker, who can explain the process to you, and answer all your questions. I'm sure you will be very pleasantly surprised and relieved - and hospice care can really be a wonderful thing for you and your mother as well as your grandmother.

We opted for palliative care in the nursing home in my mother in law's last days. She had been bedridden for most of her last two years. She started refusing food about 6 weeks before her death, and despite lots of coaxing, took in less and less, and became weaker and weaker. The staff were very kind and supportive, and the end was very, very peaceful. She did not seem to be in any distress - I think when they reach a certain point, they just don't feel hunger or thirst and they just sort of drift away. She died with my husband (her only child) holding her hand, and he feels very, very strongly that we did the right thing with her care in those final weeks and days.  

I'll be thinking of you. Hang in, she's like a little bird on a branch about to fly.

Mary G.