Comfort measures

fairegoldJuly 19, 2005

I got a new form from the nursing home today, and long discussions, with more to come, on some of the points.

Mother is a candidate for "Comfort Care" and the form that I got lists each measure, with a yes/no column, plus a comments column. Here are the things you must decide on when a loved one is facing end of life issues. (notes are as I understand the issues from discussions today, with reference to my 95 yr old Mother's care specifically.)

1. Oxygen for comfort

2. suction for comfort

3. pain medication as needed

4. continue with other medications (BP, etc, this can be pick and choose, for example, delete the vitamins)

5. Intake as desired (what does patient want--not clear on distinction between this and #8 below).

6. Intake and output monitoring (How much eaten and how much excreted. With Mother, we don't care how much.)

7. Weights (on a regular basis. With Mother, for a while, but since she is not eating, we will stop this soon, because it is not anything that will help her.)

8. Meal monitoring (see #5, but today the dietician said that they figured that Mother ate between 20 and 30% of her meal volume)

9. Turning and repositioning to the resident's comfort

  1. conservative wound and skin care

  2. activity as tolerated (for Mother, this will be communion from the person who visits from the church)

  3. minimal environmental stimuli (Sit outside on the patio? Visits from all the staff to say hello?)

  4. transportation to hospital (This gets trickier... if she falls and gets hurt, yes, perhaps, the hospital is not the best place for a person in the last days... perhaps this is an open question in our case)

  5. social service intervention as appropriate (Call me if I am not there)

  6. Enteral feedings (tube? no)

  7. Standard personal care as resident allows

Basic hydration by IV is not on this list, but we did discuss it. Obviously I didn't get the whole story, but I am working on it.

This list gets marked yes/no, and also signed by the patient's doctor.

It's a lot to think about, isn't it? Far beyond the "Advanced Directive".

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Helene, all i can think of is WOW! what alot to take in! most of the questions you have to answer are questions that we have here when you are admitted into an actual room in the hospital here, but they wheel in a computer and a nurse does it (she reads you answer) but to see it written in front of you......also another standard question here is, do you want to be an organ donator. as you said it is sobering. debbie

    Bookmark   July 20, 2005 at 3:50AM
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It sounds as if you have placed your mother in an ideal place. #13...hmmm, this can cause problems with some families. Time begins to run out and they cannot accept the fact that "this is it." They feel helpless and want the Home to "Do Something." They insist on the hospital where they truly believe that the loved one will be made well. Sometimes, they will improve for a few days. And then the poor soul has to go through it all over again later. It can be so sad when it's sooooo hard for the family to let go.

    Bookmark   July 20, 2005 at 10:42AM
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Hydration by IV: when my mother was on hospice last year, this was one of the things that the hospice nurse and I discussed. She said that many families want to keep the person hydrated, but what happens is that the body retains the fluid and the person swells up tremendously. It might depend on the diagnosis, and the individual circumstances, so you might want to check with the doctor and/or nurses.

    Bookmark   July 20, 2005 at 11:00AM
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Excellent points on both the hydration issue and the hospital. Yes, I'd already gotten some feedback from staff about the hospital issue, and I had planned to talk to the nurse about the IV issue. More problem with the IV is that Mother is 80 pounds, thin skin that bruises easily, and every IV has been an ordeal for her.

    Bookmark   July 20, 2005 at 8:50PM
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Hi this with interest, as my mother was also a hospice patient and nutrition was a huge issue with us. She had a PEG tube, but IV was not a question. Dehydration is not uncomfortable in the end stages of life....thirst, dry mouth, etc ARE, but are not the same as dehydration and are not corrected by IVs. Agree with the sounds like a good place your Mom is staying.Like that they write down your preferences and decisions. Derry

    Bookmark   July 22, 2005 at 12:05AM
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Derry, thanks for the added info. I sat down with staff yesterday and filled out the form. We made a couple of modifications, such as stating that transport to the hospital is only for more fractures or other injuries. And we specifically excluded IVs, because just getting one into her is horrible. But everything on the list can be changed. For example, I requested that she be on the normal weighing schedule, which is weekly for a month, then monthly, but this is subject to change.

I don't know if this (the comfort measures form) is a state requirement or corporate. This home is owned by Evergreen, out of Vancouver Washington, and most of their facilities are in the western states.

I greatly appreciate how flexible things are there, and how nice everyone is to both me and Mother.

    Bookmark   July 22, 2005 at 9:44AM
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It sounds as if you have everything well in hand. Not having to be faced with making decisions on a day to day basis will be most helpful to both of you.
I think the Comfort Measure form is a common thing with the compasionate homes that care for those that could be considered, either from age or disease, in the last stages. It keeps both the home and the family from undertaking unwise treatment, while ensuring the patient's comfort.

    Bookmark   July 22, 2005 at 10:05AM
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