Are Ensure Shakes and Hospice Compatible?

ensureMom has been moved into hospice care. We’ve not been told her death is near, but there is little hope her condition will improve. When it was suggested, The idea was to have a doctor who would focus on keeping her comfortable. She’s been more communicative than she was two weeks ago, but those moments are sporadic and unpredictable.

I realize what a gift my Mom gave us when she told my brother and I that if she were in a poor health situation, with little hope of improvement, we should “push grannies chest on her.” Since we don’t have a legal or moral option to help fulfill our Mom’s wishes, we are being very vigilant about how to best navigate this final phase of my Mom’s life.

I’m currently fixated on the figures released by Health & Human Services that share 7 out of 10 Americans over the age of 65 will need some form of long-term care services. Women on average need it longer (3.7 years) than men (2.2 years). Most of us hope we will die in our sleep or at least swiftly. That just isn’t the reality of our current world. A colleague that focuses on helping individuals put together their health care wishes M. Jane Markley reminded me of a tool that individuals can use to start thinking about and discussing what they might want to happen in their final years. It’s called the The Conversation Project. It was very easy for me to complete my copy. If you are caring for a loved one, how valuable would this have been to help guide you through the tough decisions you must face/faced?

I know that I have been aiding or managing matters for my parents for nearly 5 years. I was fortunate my parents talked about end-of-life issues before they were needed. It wasn’t dark or gloomy, it was just something that came up as dear family friends became ill or passed away. I was fortunate that I spent a lot of time with my parents as an adult so I knew them. Knowing what they believed didn’t make the decision on how we supported our Dad and managed his cancer any easier, but looking back, I’m confident we did the right thing for him.

Yesterday I was asked to pick up some Ensure for my Mom. I immediately confirmed that I would, but I started to feel a fracture in my belief that I was fulfilling Mom’s wishes. We have the DNR in place and is giving her nutritional supplements the beginning of the slippery slope?

When my brother was visiting he said he witnessed those caring for her working very hard to get her to eat. We spent an entire evening talking through this and felt that our Mom wouldn’t want to be coached so vigorously into eating. For several years she has bristled at any who commented on her food choices or lack of appetite. We want to follow her lead, but also recognize she has dementia and don’t intend to have her starve. It could just be that she’s having trouble swallowing the pureed food.

I reach out to both the Assisted Living Community and my hospice care case worker. “Help!”  The head care manager calls me to share that as long as my Mom’s eating half of her breakfast, which she’s doing, they don’t see the need to provide supplements unless she is saying she is hungry. The hospice care manager shares that many of the individuals in their care use these supplements. If drinking them provide enjoyment, don’t hesitate to offer it. The best reason she gave was that the nutrition provided would help her skin which is now started to get red and threatens to tear. The reality is that when she’s ready, she will just stop eating and drinking. I realize the shakes might be a better option than the pureed food and dropped off a variety of flavors.

This is just another complicated issue we are facing as we want to make sure our Mom is comfortable, but not do anything that might unknowingly extend the poor quality life she is now living. Considered. 

Your Mom Refused to Give Blood

bloodMy mom is very thin and as you might suspect, her nutrition poor. She has been taking vitamins to help bring up her numbers which is monitored with periodic blood tests.

The nurse on duty calls at 6:45 a.m. to let me know that my mom refused to allow the lab technician to take blood this morning.  When I call to see how my mom is doing, she says she is doing fine. I ask her how she’s walking today — on my last visit she refused to join us for lunch because she felt too unsteady on her feet. She tells me her foot still bothers her a little, but taking off her shoe helps.  She doesn’t remember that the day before she was so dizzy she stayed in bed most of the day.

When I ask about the blood test at first she doesn’t understand my question. I let her know that I believe if  some of the numbers have gone up, she won’t have to take as many pills — which she hates. After a few minutes she admits that she doesn’t like the idea of having her blood taken in their apartment. “If something goes wrong, they have no equipment for any emergency procedures!”

When we were moving my parents from Independent to Assisted Living, the Executive Director shared some ways to phrase things to illustrate the benefit. I have used this suggestion many times and today I respond by telling my mom how lucky she is to have “concierge healthcare”. I share with her the last time I gave blood I had to drive to the clinic and it took over an hour just to have them draw two vials of blood. How lucky she is to have them come to her home and get it done in a few minutes.

I am surprised and humored by my mom’s response. This would be at least the third time they have taken blood from my mom in her apartment. I’m quickly reminded how her Dementia can bring on other types of mental illness which today presents itself as anxiety. Schooled. 

I just don’t have any energy today

club sodaI arrived at my parent’s and as we were finishing up the grocery list (yes, the only thing on it again was club soda), my mom asks if my dad will just go with me. “I just don’t have any energy today,” she says.

The one thing I do hope for each visit is to get them out of their apartment (maybe it will squelch the urge to take a cab to their town house). We usually have fun on the grocery store trips. We talk her into joining us, but once we get there, she says she doesn’t feel well and wants to stay in the car.

On the drive back she comments that she doesn’t recognize anything. “Oh yeah, there is the place I used to work with our boy,” my mom comments. My dad agrees but I have no idea when she would have worked in the industrial complex we passed and who “our boy” is. I stay quiet.

When we get back she is out of sorts. It’s only 11 a.m. but I suggest she go rest to see if she will feel better.

Later in the day, one of their friends calls to express concern about my dad. She mentions they didn’t come to dinner last night. I realize that my mom who is down to 100 pounds now, probably didn’t eat last night. She is now about 5’8″. I know she ate this morning, but I can only imagine what happened the night before that kept them from going to dinner. Concerned.