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My 86 year old Mom has been in and out of hospitals and rehab facilities since early November 2021. 2 years prior, she had so many health challenges: heart stents, removal of part of colon, congestive heart failure and Stage 4/borderline Stage 5 Kidney Failure. Yet, she's come out of each challenge although weaker every time.



In February, she was back at her home, living independently, driving, appeared to be "on the mend." In March, she had shortness of breath, low oxygen and went back into the hospital. Her kidney function was still Stage 4/borderline Stage 5. Oxygen demand very high. There was fluid around her heart. After about 6 days of treatment, doctors approached her about hospice care as an option. She admitted that she did not want to "fight" this anymore so she agreed to go into a very nice, reputable hospice facility. All of her doctors signed off on the paperwork admitting that they thought she had less than 6 months to live.



When she arrived, she was very weak with nausea but relaxed. But, she deteriorated quickly. She's been in hospice care for about 25 days as I post this. What is really frightening is how angry and vicious she has become. She keeps trying to get out of her bed without help. Even though she is on meds for pain and anxiety she is restless all night. My sibling and I have avoided calling her or visiting because she is so mean to us when we are there, accusing us of abandoning her, leaving her to die. She is very lucid but the things she says and does scare us. Visiting her does not seem to comfort her it seems like a trigger for her anger. It's not comforting for us either.



Has anyone been through this and what's the best way to deal with this? The hospice staff where she is at are wonderful so that is not the issue.

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So sorry ElleW
Wishing you peace and comfort.
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Elle, I am so sorry for your loss.

Praise The Lord that her last couple days of transition were peaceful. May The Lord give you all grieving mercies and comfort during this new season in life.
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Hugs, Elle. I'm sorry this has been so rough on all you. Wishing peace to your mother and comfort to you and family.
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ElleW1 Apr 2022
Thank you.
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I'm so sorry for your loss, Elle. Glad that your mom is at peace.
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Update: Mom passed away a few days ago. I am not sure if they gave her morphine but she went into a "sleep" about 2 days before she passed. During what ended up being our last visit while she was alive, we had the chaplain play some audio for her of my speaking to her, singing a couple songs and the song that she considered to be her and my Dad's song. My sister and fiance also spoke to her while she was sleeping. My Mom squeezed hands and Mom was reacting to the sounds. She passed about 1/2 hour after that last visit. She might have waited for us to leave. Anyway, she was resting peacefully those last 2 days.
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LisaSF Apr 2022
I'm so sorry, Elle. You did right by your mom and are a good daughter. The dying process is difficult and you handled it perfectly.
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My husband is in memory care and when I visit or my children he becomes agitated after a short time. He is on all sorts of meds to calm him down, sometimes they work and sometimes they do not. We all have learned to live with it and when he gets like that we leave.
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ElleW1 Apr 2022
My sister and I went through this with our Mom when she was in Hospice care. They suggested that we do not linger or visit her when she was like this.
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Hospice is there for the patient and family. Have you discussed with them the enormous stress that visits create for you? Be specific. Are there meds she can take for comfort measures—calming her down. My brother has had problems with restlessness to where he’s a serious fall risk. With the brain tumor they give him seizure meds. Depakote is the big gun and it helps. Morphine is also relaxing. He gets the minimum dose. Our hospice nurse appreciates getting input from me and his daughter. Visitors are an extra set of eyes to observe the loved one. Not that you should visit frequently if you can’t. Hospice also understands that families can find it really tough to visit. Are there strategies they could suggest to get through this?Good luck. It’s really hard to visit under these conditions.
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ElleW1 Apr 2022
Thank you for sharing your experience and thoughts. My Mom has since passed away but hoping these thoughts will be good for others to read if they have a similar experience.
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Sometimes anxiety meds can have paradoxical effects and trigger anxiety instead of calming it.
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Less than a month ago your mother said that she “did not want to "fight" this anymore”. She agreed to go into a very nice, reputable hospice facility. Now she seems to have changed her mind. You think that “she thought it would be more peaceful for her than what she is experiencing”.

It would be good if you could ask her why it’s not as pleasant as she was expecting. What is going wrong for her? Why is it so much worse? Perhaps the doctor or one of the staff could have the conversation, as it’s not going well with you.

They could then talk to her about the alternative, of continuing treatment. She is currently thinking that her alternative is to “feel better, get stronger and go home”. She needs to know that she simply can’t go home, and why coping at home is impossible. Making sure that she knows it isn’t an option, and why, puts her back into making the choice between treatment and hospice.

For so many elders, ‘going home’ in their own minds means going back in time to when they felt better and were much more able to cope. No wonder she’s sad and angry, if she thinks you are preventing that.

That isn’t a magic solution, but it just possibly might help. Best wishes in a no-win situation, Margaret
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ElleW1: Please speak to the Hospice nurse as they should have already been able to get these anxiety ridden nights under control.
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I think you have to consider that when your mom lashes out, she is not being lucid. It's hard to reconcile what she's saying with who she is, but she can't help it. It's like a 2-year old who is having a tantrum. Medication, her pain level, or changes in her brain may be making her agitated, and she can't help it. Adjusting medication often is a trial-and-error thing.

If you and your family really can't handle the stress her outbursts are causing, then take the hospice nurses' advice - step away for a while, but know that it's not to stop her outbursts; it's to help you recoup.

My mom also said similar things to me, & she, too was lucid. She eventually came to an understanding, but it wasn't easy.

My Significant Other said hateful, hurtful things to me, but I don't think he remembered saying those things when he was lucid. It didn't help to discuss them when he was calm, because it made him feel bad, & he couldn't control the outburst when it happened, anyway. Maybe he couldn't verbalize pain - I don't know. But I was able to separate the words from the man.

End of life caring isn't easy.
Good luck.
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Most likely, she will be this way no matter where she is at. And she will not get any younger. Her health condition will persist and get worse. How did she care for her parents when they were alive? Our culture does not prepare us for getting old, or for the inevitable death.
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Perhaps a geriatric psychologist could make a visit and learn what the anger is about. Perhaps you could meet together.

The 5 Stages of Grief
GLPG
October 27, 2020

Considering the multitude of ways the pandemic has changed our lives, many people have experienced grief in reaction to all kinds of losses this year. Grief can be experienced in reaction to any significant loss, whether it be job/income loss, loss of child care, loss of routine and a sense of safety, loss of community and togetherness, or loss of a loved one. 
Instead of consisting of one emotion or state, grief is better understood as a process. About 50 years ago, experts noticed a pattern in the experience of grief and they summarized this pattern as the “five stages of grief”, which are: denial and isolation, anger, bargaining, depression, and acceptance.
The experts who published these stages have since clarified that someone who is grieving could experience the five stages in any order, and they may experience only some of the stages as opposed to all of them. Further, there is no set amount of time for which someone grieving will remain in any one stage, and someone can be experiencing more than one of the stages at any one time. In other words, grief is a very personal and nuanced experience, and everyone grieves in their own way. 
Understanding the dynamic nature of grief can help those coping through loss as well as those helping others who are grieving. Here is more information on the five stages of grief:

1. Denial and Isolation
When we lose someone or something important to us, it is natural to reject the idea that it could be true. In turn, we may isolate ourselves to avoid reminders of the truth. Others who wish to comfort us may only make us hurt more while we are still coming to terms with the loss.

2. Anger
When it is no longer possible to live in denial, it is common to become frustrated and angry. We might feel like something extremely unfair has happened to us and wonder what we did to deserve it. 

3. Bargaining
In this stage, we might somehow seek to change the circumstances of the situation causing their grief. For example, a religious person whose loved one is dying might seek to negotiate with God to keep the person alive. Bargaining may help the grieving person cope by allowing them a sense of control in the face of helplessness.

4. Depression
In this stage, we feel the full weight of our sadness over the loss. Feeling extremely down in the wake of a loss is normal; however, it is important to be aware that clinical depression is different from grief, and they are treated differently by mental health professionals. See “The Blurred Line Between Grief and Depression” for more information.

5. Acceptance
Eventually, the grieving person may come to terms with their loss. Accepting a loss does not necessarily mean the person is no longer grieving. In fact, many grief experts say that grief can continue for a lifetime after a major loss, and coping with the loss only becomes easier over time. Waves of grief can be triggered by reminders of the loss long after it has happened and long after the person has “accepted” it. These waves may also trigger a crossover into any of the other four stages of grief.

In sum, grief is a personal, nuanced, and complicated process; it will not look the same for any two people who are grieving. However, those who are grieving may experience similar emotions along the way.
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ElleW1 Apr 2022
Thank you for sharing your experience and thoughts. My Mom has since passed away but hoping these thoughts will be good for others to read if they have a similar experience. I appreciate knowing the stages of grief as well.
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Angry and restless are two things hospice should be able to help mom AVOID feeling. She should not be up all night with restlessness. Speak to the nurse at her hospice facility about increasing her anxiety meds to help her stay calm and avoid this unnecessary restlessness and agitation. Perhaps then your visits will be more pleasant. When my mom went onto hospice care in her Memory Care AL, my #1 goal was to keep her comfortable. The hospice nurse and doctor agreed and did just that, adjusting her Ativan as necessary throughout her end of life journey.

We kept 40s music playing in moms room all the time too, which she enjoyed hearing. I always sat with her at the end and talked to her a lot too.

Please disregard comments intended to make you feel guilty when all you're trying to do is EASE your mom's passing. This is a difficult time so please be kind and gentle with yourself.

Best of luck
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ElleW1 Apr 2022
Thank you for sharing your experience and thoughts. My Mom has since passed away but hoping these thoughts will be good for others to read if they have a similar experience.
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Hi there. I feel your pain! My mom is not in hospice yet, but I had to place her in a skilled nursing home almost for all the same reasons with a new dx of Vascular Dementia; lived independently, contestant trips to rehab, had IPF, mental health issues, and other physical and health conditions. She refused help when she was home and always angry there. She's mid-stage and high functioning which means she is very aware that she is not home anymore and that she does not belong in a nursing home. She has burned many bridges with family and friends because her personality is vile all prior to this move. Add Dementia to the mix and everything becomes a false accusation, insults, protests, anger, crying tantrums etc. It's almost been a year and she STILL angry I had to place her there for her own safety. My visits, and phone calls, also trigger her anger more often than not. It's difficult to defuse her behavior. So I cut my visits to every other day to every other 2 days. She hates the food there so I bring her food that lasts 4 servings (4 days). She's too scared to shower alone or with a nurse, but she needs to be accompanied for safety, so she waits for me to help her. But cries really loud while showering and it scares me that a nurse may think I'm hurting her. I play soft piano music while she showers to help ease her. I think it helps me more. With all this said, even with therapy and learning about Dementia Behaviors, I still can't filter out her hate for my decisions for her. It's very abusive. I'm alone in all this with her, so I have no other safe outlet for help other than a few trusted friends and therapy. Please, I encourage you to still seek professional help with coping with you mom's behavior and continue to limit your visits for your own well being! Your mom is safer in a facility than at home alone. Speak to her social worker about your concerns for your mom and often reach out to the nurses who assist her. If you do visit, go with a purpose (to bring a news paper, snacks, puzzle, etc), breath, prepare for any vile behavior, look around for nay concerns you may find, speak to her calmly in short sentences, and leave. it wont always bee smooth, but it will lessen the painful feeling of being insulted for you. I hope you find some of this helpful. I know it's not easy. No miracle button to push for better results. I really hope your mom is able to calm down to spend the rest of her life more tranquil and positively receive the love from you and the family. Be well.
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It is probably the drugs they have her on!!! Please look into this immediately. Do NOT abandon her! If you do not show up because she says things to you, then you are doing exactly what she said you are. She needs you right now. Get her off these drugs. They love to drug people in these places so that they are sedated and they can be LAZY and just let them sit there and ROT with no one to talk to or care about them! If you can, get her OFF the drugs and into a home care situation where she is in her own place again with people who truly love and care about her.
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lealonnie1 Apr 2022
What kind of a horrible comment is this???? She is in HOSPICE fgs! Shame on you, yet again, for your continued foul comments on this site to folks who are hurting and asking for SUPPORT. I'm reporting it.
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What are the medications she is on? Several years ago my mom was put on Lorazepam (Ativan). It helped her sleep at night and then when it wore off and she woke up the next morning, she was demon possessed. We know it was this medication because of trial and error. Apparently it does not work for everyone.
Mom does take Buspirone for a mood regulator, we call it her HAPPY PILL. If she forgets to take it, it shows that same day.
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Maryjann Apr 2022
I've also heard that seroquel is good but can't get MIL to take it. I'm writing down the buspirone for future reference. Thanks.
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If she was sent to hospice by her doctor, it means that she had exhausted all medical available treatments. In hospice they stop all medical treatments to prepare the patient to die with the minimum of suffering. Obviously, the patient will deteriorate for lack of treatment. Your mother is showing signs of that deterioration. Forget about diagnosing new problems on her. That's too late now. If the visits are disruptive to both parties, stop them or cut them up in frequency.
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FamilyNeeded Apr 2022
Actually that is not true any longer! When they put my sister on hospice, I asked what was wrong? Is she dying? They said no, nothing is wrong. They just do that to get extra help coming in. But yes, they will not do anything to save them and often try to escalate their death! They care nothing about human dignity or life in most of these places.
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I should keep your heads down. Are there any times when she is usually sleeping or calmer? If there are, time your visits around then (and don't wake her up! - or seek her attention) and just sit quietly with her. If there aren't, and the hospice staff agree that she is more agitated when you and sibling visit, then... sorry, but probably best to stay away. You can call for updates for peace of mind.

I've never been more relieved to hear that a call was cancelled than I was when our dying client was admitted to hospital last week (skin breakdown is the issue, needed 2 hourly turning 24/7 which we can't provide). Trying to make someone comfortable when she's completely out of it and giving you directly contradictory orders, and obviously in extreme discomfort, and worse when you handle her no matter how carefully - miserable for all concerned.
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ElleW1 Apr 2022
Thank you for sharing your experience and thoughts. My Mom has since passed away but hoping these thoughts will be good for others to read if they have a similar experience.
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This sounds typical of early stages of Dementia/Alzheimer’s. It is difficult to deal with. You might want to be straight up with her about her behavior towards you and other siblings. Say it in a non-threatening tone. Tell her that you love her but do not like the way she speaks to you. Give her examples. Tell her that you want your visits to be enjoyable, but if she starts getting mean, you will have to leave. Explain to her that her many health conditions (or other constraints) are not something you can handle and it requires her to be in a facility that can provide constant monitoring and 24/7 care when needed. Maybe agree to get her out for lunch once a month if she can be nice. I would talk to the facility doctor and see if she can get on an antidepressant as well. Agree to regular scheduled visits and calls with the stipulation that she has to be nice and stop blaming you.

All the best!
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I learn so much on this forum and appreciate all the shared experiences, insights, advice. In one reply you mention your mom's anger is at peak around 3am, As a holistic bodyworker who has partaken of acupuncture for years, my understanding is the body's meridians have cycles at certain times of the day. If you have acupuncture in your area it might be helpful to consult with an acupuncturist for ideas to ease this intensified agitation at that time. All the best.
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ElleW1 Apr 2022
Thank you for sharing your experience and thoughts. My Mom has since passed away but hoping these thoughts will be good for others to read if they have a similar experience. My Mom would not have agreed to accupuncture even though I would have been glad to pay for it. I am sure it helps in some cases.
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Hello, I am so sorry you are going through this with mom. I can relate to your conflicted feelings regarding visiting. I recently started some counseling due to both parents’ rapid decline with dementia/Alzheimer’s. Both are in memory care now, dad has been in hospice there for five weeks. My mom is is in a severe state of emotional distress all of the time, a situation that started over a year ago and has been getting worse each week. She is living in torment, cries all day, shakes, begs me to stay with her or move in with her. Then can’t remember I was there the day before and blames me for abandoning her during my next visit. Every time I go it’s the same behavior. She is living in hell and it’s turned my life upside down also.

Things changed for me ten days ago when I had a GI scope to help me get to the bottom of the bad stomach problems and weight loss I was experiencing. Turns out I have an ulcer that’s bleeding—and non of the risk factors for ulcer other than trauma/situational stress.

It has been so traumatic watching my parents suffer, the futile task of trying to help them.

i am struggling with the counselor’s recommendation that I take a break from visiting in order to allow my body to heal. My husband is losing patience with me and is angry that I can’t let it go for a bit. I am a nervous wreck either way, when I go it’s so disturbing and when I don’t all I do is feel guilty.

The doctors are starting my mom on a low dose of antipsychotic meds, after trying everything else to help her brain regulate itself emotionally. She may have to be hospitalized this week due to a hunger strike she is on, protesting my dad having affairs with the med techs and staff. He can hardly stand up.

I don’t know what to say but wanted to pass along my counselor’s input. I love my mom so much but her life is literally making me sick and I have a family of my own to care for. We do have to value our lives and health as well.

this disease is terrible. Prayers for you.
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Moxy234 Apr 2022
Sending you love Stacyy xxx
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Is she in atrial fibrillation with rapid ventricular response? You mention she has a history of atrial fib and the hospice took her off most of her routine meds. If they stopped her metoprolol or similar drug to control her heart rate in response to her atrial fib, her heart can beat very fast and it feels like your heart beating hard and fast in your chest. (heart rates 110-120 up to 160's per minute). This Could definitely cause a sense of anxiety due to the palpitations. Since you say they are not checking vital signs, does anyone know? I wouldn't know why they would need to stop her A fib medications? They are not prolonging life, just keeping her comfortable so she doesn't have the sensation of uncontrolled palpitations. Metoprolol is not an expensive medication. Maybe the blood thinner she was on is more expensive. Just a suggestion to ask the RN or MD if they stopped those and why.
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ElleW1 Apr 2022
Thank you for sharing your experience and thoughts. My Mom has since passed away but hoping these thoughts will be good for others to read if they have a similar experience.

They did take her off those meds and I did insist they put her back on them. They did, after I insisted. I am not sure if this helped or not.

They told me they took her off all life saving meds because she chose Hospice Care. In Hospice, they do not give meds to prolong life just to help comfort. But, I insisted that she go back on those meds. Maybe I insisted too late. I feel terrible about all this.
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Talk to her hospice staff about these issues. They have experience with many people and may have some advice on how to handle your mother's anger. Ask them what they do when she tries to get out of bed without assistance. Is she falling? Can they put a portable potty near her bed? Also talk to her doctor to find out if there might be a medical reason for the anger and restlessness. Would your mother benefit from counseling from a trusted counselor? Is she better when you call her? She may be frightened about dying. Does she think she's going to get better and go back "home"? Write her letters when you are not visiting. Let her know that you love her and would like to be visiting her more often if she wants you to visit.
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ElleW1 Apr 2022
Thank you for sharing your experience and thoughts. My Mom has since passed away but hoping these thoughts will be good for others to read if they have a similar experience.

I did send audio messages when I was not there and they did play them to her.
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Since she has multiple health challenges, I suspect those are causing her irritability and irrational behavior. Toxins build up in her bloodstream from the poor kidney function. That can make her feel itchy, irritable, and cranky. Try slathering her skin with lotions with a high oil content. Since she has problems with fluid build up, she probably feels short of breath all the time. That can be frustrating when she wants to do things but doesn't have the energy. Ask what she would enjoy doing and find ways to allow her to participate - slowly with frequent rest breaks. When she gets frustrated, expect her to be anxious and easily upset. Look for signs that she is becoming "tense" and turn to activities or topics of discussion that cause her less emotional anguish.
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ElleW1 Apr 2022
Thank you for sharing your experience and thoughts. My Mom has since passed away but hoping these thoughts will be good for others to read if they have a similar experience.
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My mom had a poor reaction to Ativan each time she was given it.
Sounds similar to what you describe.
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ElleW1 Apr 2022
Thank you I will mention this to the hospice people. Right now she has been sleeping most of the time which she needed.
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This is all due to the decreased oxygen levels in the blood and the buildup of toxins in the body. Also, the dying person goes through those five stages of grief. As disturbing as this process is to you, the anger is one of the stages of the dying process.

I've gone through this with close family members. It is not easy to watch someone you love to go through this process. It is painful for all involved. If you can't bear to go through this, take a step back. You can call and check on her periodically.
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ElleW1 Apr 2022
Thank you. That is what I decided to do.
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When patients are close to dying, they may undergo behavioral changes due to medical conditions. She has severe heart and kidney failures. Delirium from encephalopathy is common. Encephalopathy develops from the toxins that the kidney can't eliminate and from the medicines they give her. Poor oxygenation in her brain also contributes to her delirium. I do not believe that visiting her brings any benefits to anyone. Keep them to the minimum.
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ElleW1 Apr 2022
Thank you for your thoughts. This is what the hospice nurses also told us.
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You say you suffer from occasional AFIB. Can your mom also be having episodes of AFIB?

I ask because my father-in-law had a few episodes of AFIB after a surgery. My FIL was the sweetest, kindest man, but the AFIB completely changed his personality. He was yelling and cursing at the hospital staff, he tried (and succeeded) to pull out his catheter, he was hallucinating; in short, nothing at all like his personality.

We, his kids and daughters-in-law were horrified by his behavior and apologized up, down and sideways to the staff; but they all reassured us it was from the AFIB. Once they got that under control, he went back to his old personality.

It was interesting, however, that he could not remember what had happened. It was a blessing, actually, because he would have been mortified by his behavior.

Maybe ask the staff if that's possibly what is going on here.

I wish you peace. My mother died of CHF, it is very hard to watch someone you love deteriorate like that.
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ElleW1 Apr 2022
Thank you for sharing this experience and for your thoughts. That could be what's happening as I think they took her off her Afib med without a taper. I was told it needed to be tapered. When my own med dose had to be reduced, I had to taper it.

Afib also makes a person feel very weak. But, they do not administer meds to extend life at this place. However, maybe her Afib med might make her feel more comfortable and less anxious. She is the angriest at 3am and that is the bewitching hour for Afib for both of us.
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A couple of observations - decreased oxygen flow is going on, and toxins are building up in her body due to kidneys just barely working. Both can contribute to rage, hallucinations, etc. Who is her nurse care manager at the house? (head nurse). Medicare requires it. Ask to meet with the RNCM and her social worker, and her chaplain.You and one other family member can share what you observe, and find out what she is receiving for medication and what other options exist for comfort for her at this point. (she's clearly not comfortable). And ask them to out line what is most likely to happen next. They can consult the MD with particular questions, and often the RN and MD communicate about issues and then RN provides info to family and implements any changes MD orders.
This may be a part of her dying process, that she is expressing with anger, as well as physical signs of what is shutting down in her body.
The hospice house sounds lovely...is it based in the same religious faith that your mother practiced as a child or an adult? Religious people might seen suffering as having a redemptive value, or suggest asking a deity for help. Can you sit in on a chaplain visit (out of her sight line) and see what seems to go on? It's a long shot, but I have seen it happen in hospice.
Be gentle with yourself. Her anger is not about you.
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ElleW1 Apr 2022
>>>A couple of observations - decreased oxygen flow is going on, and toxins are building up in her body due to kidneys just barely working. Both can contribute to rage, hallucinations, etc. >>>

This is what the head nurse told us but without a blood test to determine her GFR, how would they know for sure? But, they say they do not do blood tests. They do not even check oxygen level and I was told by my sibling (they are the health care proxy, not me) that I better not ask them to check vitals as it is "wrong" and might give my Mom "false hope."

My sibling has met several times with the MD, RN and Chaplain. They told them that this is all part of the process. But, we are just not able to talk to Mom or visit her when she is in the angry state...which is all of her waking hours that she is not sleeping.

>>>>The hospice house sounds lovely...is it based in the same religious faith that your mother practiced as a child or an adult? >>>

Yes, it is although they accept people of all faiths.

>>>Can you sit in on a chaplain visit (out of her sight line) and see what seems to go on? It's a long shot, but I have seen it happen in hospice. >>>

I like the idea of trying to have the Chaplain visit her right before we visit. Maybe we can stand outside the door while the Chaplain is in there and then come in and the Chaplain can help with the transition from Chaplain to family.

Thank you for your thoughts.
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