Teeing off on raee's comments: 1) Yup...family members, even those with "power" often have differing views of the end-of-life situation. Among those views are often included whether or not the person is even at the end of life. Some people want their dad to go or "be allowed to go". Some want everything possible done all the time. For many (most?) caregivers it comes down to reaching that point where we know we're over our heads/out of our depth/beyond our abilities. We HAVE to involve more able people. Hospice folks have to deal with ALL of those varying attitudes along their path. Part of their service is examining and determining whether or not the person is nearing the end of life and conveying that opinion. This they do realizing that neither they nor their doctors actually know for certain. It's a tough job. I couldn't do it. 2) The argument about "allowing a natural death" versus "doing anything that hastens or causes death" is still with us. It likely always will be. From my limited experience, it's clear to me that the end of life is very seldom the movie-version of the event. Sometimes they pass quickly. Sometimes they become comatose and linger for many days even without food or water. It may not be any kind of peaceful or pretty. There may be peace. There may be pain of incredible intensity. "Nature" is utterly indifferent to comfort or to suffering. The Hospice folks certainly know that. They're better equipped to deal with it today than they ever have been.....but there are still no guarantees. The process may or may not go smoothly and they have to handle any eventuality. Yes...tough job. They have better drugs now than they did twenty years ago and better understanding -- MUCH better than forty years ago. Still, I've seen what I regard as the senselessness of several cases. In the cases of my own mother and father who died at home under Hospice care, we pretty much kept them under the drugs for their last days because allowing them to emerge allowed them to feel what was happening....by which I mean to feel the intensity of the pain that came with even a vestige of consciousness. Neither I nor my family are law-breakers/flouters and we allowed the Hospice folks appropriate control during this time. Their efforts were successful all along the way. However, during the end-times I often thought how ridiculous it was to continue the dosages of pain killers prescribed. What, exactly, would be the difference between giving enough of the pain med to keep the person comatose thereby, in my folks case, allowing them another few comatose days without food or water when you absolutely know they're going to die, actually intend that they die, and simply giving them a life-ending substance when that point is reached? The only difference I can discern is additional hours or days unconsciousness, possibly punctuated by periods of intense pain if the meds wear off too soon. Unfortunately, that's the euthanasia argument and I have no wish to open that box. But it is coming to all of us if we live long enough. I think it's a rational question.

HOME HEALTH CARE - this is a service that can also be provided by a home health care agency AND PAID FOR BY MEDICARE....Mom had that for several years, however, it is very limited in what they provide. When she had that level (home health care paid for by Medicare) she was still able to get around with a Scooter, feed herself, use the toilet; as her abilities declined and after a ten day hospitalization with massive bladder, kidney and lung infections, her urologist stated that we needed to consider Hospice care. I contacted the agency we use (Heartland) to ask what the requirements were....did it mean six months to live? They told me NO, you needed to have an incurable condition - they told me they had folks who had been clients for more than five years. I am in Texas - you may find it different in your state, but Medicare did pay for home health services for several years prior to hospice; the rules may have changed on home health care since she has gone to hospice. If you have a loved one needing more care than the family can provide, your best bet is to simply call one of the agencies in your area that provide HOME HEALTH CARE and HOSPICE CARE. Ask them what qualifications you need to be accepted. Once you know if you qualify for either one, then ask them what the regulations are regarding care....that is your best bet. Carolyn who is now dealing with a 95 year old father who is feeling guilty over putting wife of 71 years in a nursing hom; Mom aged 91 who cannot do ANYTHING for herself, and who has some dementia and DH age 58 who is fighting esophageal cancer. Does anyone have the timetable for when I am allowed to have my nervous breakdown?

Re: pneumonia; you can, of course, refuse treatment if you choose (ie; the old man's friend); but if it isn't a natural progression of the terminal condition for which the pt is being treated; then the pt is eligble to have the pneumonia treated; antibiotics, etc.. . Pneumonia is not a natural progression of CHF. Yes, in CHF the lungs do fill with fluid, but it is not the same thing. Pneumonia is an inflammation of the lungs caused by bacteria, virus or chemical irritants. CHF is caused by failure of the heart to adequately pump the blood throughout the body, causing a buildup of fluids in the lung and tissues. Unless it is an emergency that can not be taken care of at home (fall with a fracture, etc.) you do have to wait for the hospice nurse to evaluate the pt; you don't simply take them in to the doc. If you are medicare eligible, medicare will pay for hospice treatment, but once you go on hospice, you cannot use medicare to pay for treatment from your personal physician. You CAN seek treatment, anywhere you want; you simply have to be willing to pay for it yourself. And you can take yourself off of hospice and at that point, you would be eligible for Medicare payment of your primary physician again. There may be a short time period in which you would not be elgible, but you would become eligible again. In my father's case, his cardiologist actually wrote the order for hospice care for him, along with the medication orders. His primary physician was willing to work with hospice and continue the cardiologist's orders, so we did not have to change physicians. Chickaroonie, I'm sorry that you are having a difficult time with Hospice. (But trust me - that nurse NEEDED her vacation! It's not an easy job, and it's very emotionally draining.) We have been on hospice for 12 weeks now; and have had only one thing happen that was frustrating and that was easily remedied. It is very important to read through all of the information that they give you; that way you will know what they can and can not do. You should have been asked to designate one primary caregiver who can make decisions, that is the person who can make requests for durable medical equipment, medication changes, and other needs. Other people can ask, but hospice will wait for the primary to tell them what they want before bringing anything out, because the primary is the one who has signed on the line to be responsible for the equipment, etc.. We do not always see the same nurse, bath aide, phyical therapist, etc...; but for the most part, they have all been wonderful folks. Pop is so fond of his primary bath aide that he made me go out to the garden and pick some tomaotes and sweet corn to have ready for her when she comes today! I am an RN, so I did have a little bit of difficulty switching from nurse mode (where I'm in charge) to daughter/caregive mode (where I have to listen :) ). Luckily, the nurses have been willing to work with me on both levels. Lisa - if your lady is aspirating, has she had a speech therapy consult? If not, ask for one. They can teach her exercises to help strengthen the muscles in her throat. This is often done with stroke victims.

Sunday afternoon ... voted (again) ... don't know whether I can make it one more time, prior to 10 a.m. Pacific time, tomorrow ... ... when the curtain comes down! Looks as though the agencies seeking support cover a wide area - nationwide? (In a furrin nation to mine, that is). ole joyful