End of Life — Transcript

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1. 0:03[Music]
2. 0:15Emily I'm just kind of examine your mom
3. 0:17by asking then we'll step out and talk
4. 0:19about okay Silvia Josh just gonna take a
5. 0:26listen to you okay can you tell me your
6. 0:29name Sylvia okay she's gonna take a
7. 0:35listen your heart in your lawn it's all
8. 0:36right you're gonna feel me touch good
9. 0:48yeah okay Sophie can you squeeze my
10. 0:59fingers
11. 1:22Emily thank you so much for me to come
12. 1:24out to your house and meet you and your
13. 1:26mother you know I do palliative care
14. 1:28which is really do towards symptom
15. 1:30management helping to have these tough
16. 1:32conversations about where we are now and
17. 1:34where we're headed
18. 1:39to me from your mom's doctor and what I
19. 1:41understand is that sounds like she's in
20. 1:43the hospital
21. 1:43about a month ago with pneumonia went to
22. 1:46rehab and since she has not been able to
23. 1:50walk has not been eating or drinking
24. 1:52much and has generally not returned to
25. 1:56the baseline she was that previously
26. 1:58okay I'm so sorry for what you're
27. 2:01experiencing this is it's very common
28. 2:04and it's normal for patients with
29. 2:08dementia often to have a experience of
30. 2:11decline after some type of
31. 2:12hospitalization or some type of
32. 2:13infection or event like that it's clear
33. 2:16she's had a functional decline and I
34. 2:19often use a type of functional test I'm
35. 2:22called a fast scale functional
36. 2:25assessment screening tool for dementia
37. 2:27that helps me kind of stage where she is
38. 2:30you know six months ago she was sounds
39. 2:34like she was able to really do more for
40. 2:36herself she was independent with walking
41. 2:38and now I have to change her I have to
42. 2:43Bath her I have to help her go to the
43. 2:46toilet I have to do everything for her
44. 2:47she's not responsive is she talking to
45. 2:50you at all very little very little when
46. 2:53she does I can't make anything out of it
47. 2:57she's not eating much like if she had a
48. 2:59plate of food before or would she take a
49. 3:01couple of bites so she wouldn't try any
50. 3:03of it if I'm persistent and keep
51. 3:06reminding her that it's there that I
52. 3:08might be able to get her to take a
53. 3:09couple bites but for the most part she
54. 3:12just said in her ways and doesn't want
55. 3:13anything I'm really worried about that
56. 3:14what about fluid is she drinking very
57. 3:17little for a little okay um
58. 3:20goodness sounds like her dementia has
59. 3:23advanced over the last six months or so
60. 3:25this is a tool that I often use called
61. 3:30the fast school functional assessment
62. 3:31staging tool for dementia is based off
63. 3:34of how not every patient follows it
64. 3:37exactly but it gives a fairly good
65. 3:39guideline of what you might expect to
66. 3:41see
67. 3:42as dementia progresses in regards to
68. 3:44functional loss or loss of ability to do
69. 3:47things for example as patients the
70. 3:50dementia progresses a lose ability to
71. 3:52talk and communicate well they lose the
72. 3:55ability to do things for themselves like
73. 3:57bathing and dressing they lose the
74. 3:59ability to toilet themselves they're
75. 4:01often incontinent have things progressed
76. 4:03further they lose the ability to speak
77. 4:05they lose ability to walk and that type
78. 4:11of progression that type of stage really
79. 4:14is fairly advanced dementia and it seems
80. 4:17to me like that's kind of where your
81. 4:20your mother is at this point if we look
82. 4:21at this scale you know she was probably
83. 4:25a stage six about six months ago and now
84. 4:30we're progressing into this kind of
85. 4:32seventh stage their loss ability to talk
86. 4:34loss ability to walk kind of sevens see
87. 4:38on this dementia scale and this scale is
88. 4:41often very helpful and in allowing us to
89. 4:45kind of assess for services that we'll
90. 4:47talk about in a minute as far as what
91. 4:49she might not qualify for this is the
92. 4:52last stage well so the stage seven is
93. 4:58sage stage 7c is the stage that many
94. 5:04patients would meet criteria for
95. 5:07forgetting hospice involved you know it
96. 5:11it's unpredictable but if things
97. 5:14continue my concern is you know
98. 5:16particularly in regards to not eating
99. 5:18and drinking your mother may be
100. 5:19approaching in two eyes
101. 5:40my sister lives my sister lives an hour
102. 5:44away she's not been able to help me much
103. 5:47with mom are you telling me that it's
104. 5:50it's time for me to bring her in and
105. 5:52have her around and have her help I
106. 5:54think it is I think it is I think I'm
107. 5:56hearing that they're caring for your mom
108. 5:59at this point has has become very
109. 6:01stressful which is me as you know I
110. 6:04think having as much support around you
111. 6:08as possible would be a good thing is she
112. 6:16available to to come in and help I could
113. 6:19try to get a hold of her she works so
114. 6:21much she works in an office where I work
115. 6:24at home and I can be close to mom so
116. 6:27that's why that's why I've done most of
117. 6:31this on my own
118. 6:32she's not been able to help Hospice is
119. 6:39covered 100% by Medicare and you know
120. 6:44it's a service that is geared toward
121. 6:46some providing comfort and end-of-life
122. 6:48care and based off of your mom's
123. 6:51dementia you know she would qualify for
124. 6:54that at this point what they would would
125. 6:57do is they would become involved they
126. 7:00would help in her care to try to keep
127. 7:02her home if that's her goal they would
128. 7:04send out a team of people they would
129. 7:06include things like nurses and social
130. 7:08workers aides things like nursing
131. 7:10assistants chaplains sometimes
132. 7:13volunteers they cover the cost of
133. 7:16equipment getting your mother or
134. 7:18something like a hospital bed that can
135. 7:19help with her daily cater other types of
136. 7:22medical equipment to help with her care
137. 7:24in the home they covered the cost of
138. 7:27related medications and they also cover
139. 7:30the cost of periodic respite care
140. 7:33meaning that they
141. 7:37a certain point in time they can come in
142. 7:42and if you are becoming overwhelmed as a
143. 7:47caregiver 18 give the caregiver break
144. 7:50often what they do is take the patient
145. 7:52to a contracted facility for a few days
146. 7:55and what the plan being of bringing them
147. 7:58back home but how often would they come
148. 8:01to the hub it's a good question so
149. 8:03Hospice you know often say they're not
150. 8:05in the home 24/7 the care steal or the
151. 8:09bulk of the care is still on family so
152. 8:12they may be in an hour to day four or
153. 8:16five days a week you see the nursing
154. 8:18assistant most often the nurse comes out
155. 8:20a few times a week to check on the
156. 8:22patient make sure that her medications
157. 8:24are appropriate to talk back and forth
158. 8:27with your mother's doctor if need be I'm
159. 8:30trying to prevent her from having to
160. 8:32leave the home to go to medical
161. 8:33appointments some family supplement that
162. 8:35care by hiring caregivers um they can
163. 8:39come in and inhale often in
164. 8:42out-of-pocket expense not covered under
165. 8:43Medicare hospice does provide a social
166. 8:46workers they can help you with
167. 8:48discussions about resources and help
168. 8:51with some of that that you know that
169. 8:53planning in regards to to take
170. 8:56caregiving
171. 9:00I'm certainly gonna need the resources
172. 9:02like I said with her not having a
173. 9:04medical card I can help as much as I can
174. 9:06huh but I'm out of I can't cover
175. 9:09everything I want to talk to you also
176. 9:12about about your mom's medications and
177. 9:15symptom in reviewing your mom's
178. 9:18medications there's some that she's on
179. 9:22that she's probably not getting much
180. 9:23benefit from at this point things like
181. 9:25the namenda and the aricept for dementia
182. 9:30things like even blood pressure
183. 9:32medications and diabetes medications
184. 9:34become less important to strictly
185. 9:37control as we would if your mom was
186. 9:40healthier or better able were able to
187. 9:43take those medications I'd even be
188. 9:45concerned with her blood sugars running
189. 9:48too low and she's not eating or drinking
190. 9:50lunch and so some of those medications
191. 9:53if you opted to do so could be stopped
192. 9:56with more of a focus on medications for
193. 9:59symptoms things like sleep pain anxiety
194. 10:04or agitation control of any type of
195. 10:08distressing symptoms nausea vomiting
196. 10:11constipation which is very common as
197. 10:14patients aren't moving much and they're
198. 10:16taking pain medications getting a plan
199. 10:19in place if you opted to do so of really
200. 10:22just focusing on her symptoms could be
201. 10:25helpful they're not giving her any of
202. 10:27the medication for her dementia at all
203. 10:28well the the aricept and namenda are are
204. 10:32very helpful in the earlier stages of
205. 10:34dementia
206. 10:35her mom's really in the late stages of
207. 10:37dementia at this point and so she's
208. 10:38she's unlikely getting any benefit from
209. 10:42those medications at all in my opinion I
210. 10:44do still give her her breathing
211. 10:47medication her pain medication her
212. 10:49sleeping medication right right yeah
213. 10:52those medications are all for the
214. 10:54treatment of symptoms and I think
215. 10:55they're very important to give now as
216. 10:57swallowing it's very common as dementia
217. 11:00progresses swallowing would be more
218. 11:02impacted and sometimes patients even
219. 11:06have trouble swallowing pills even
220. 11:08crushed she does have a hard time I'll
221. 11:11put them in the water when she'll drink
222. 11:13it all right that's how I've been doing
223. 11:15it sometimes we even offer to give
224. 11:17medications in liquid form to help so
225. 11:21there that's an option too
226. 11:27what questions do you have for me
227. 11:33where do I go from here well what what
228. 11:36do I expect you said that there's no no
229. 11:39way of knowing how long she has all
230. 11:41right I'm going to quit giving her the
231. 11:45medication for her to mention give her
232. 11:48the ones for the symptoms get my sister
233. 11:50involved bring them the hospice nurses
234. 11:53in and it will be covered by her medical
235. 11:57card about Medicare Medicare right and
236. 12:02it's not gonna be painful for her to not
237. 12:04take her medications no and it's um
238. 12:08many families often are concerned about
239. 12:10eating and drinking you know but that's
240. 12:12also a symptom of the pressure of the
241. 12:15dimension so she's not hungry and on
242. 12:17Thursday at this point I think it's
243. 12:19important to know how aggressive your
244. 12:21mom would want to do in regards to
245. 12:23treatment and medical care she doesn't
246. 12:27want to be she doesn't want to be
247. 12:29aggressive but she's we've talked about
248. 12:31it several times over the years and
249. 12:32she's told me she doesn't want
250. 12:34resuscitated she doesn't want force feds
251. 12:37no feeding tubes anything like that okay
252. 12:40she just what's the gal someone spent
253. 12:42her time it's her time so your mom
254. 12:44wouldn't want to be what we call you not
255. 12:46resuscitate that's it that's important
256. 12:48to know at this point would your mom
257. 12:51want to think to do things like go back
258. 12:54to the hospital and get tests or
259. 12:56treatment or which he just really want
260. 12:58to be home and be comfortable
261. 12:59yeah that's mom we can fill out some
262. 13:04paperwork outlining what those wishes
263. 13:06are things like I do not resuscitate
264. 13:08order or even on most medical workers
265. 13:11for scope of treatment form
266. 13:16as medical power of attorney or a power
267. 13:19of attorney we've never filled out any
268. 13:20paperwork for anything like that you and
269. 13:23your sister at this point what would
270. 13:25make those decisions on your mother's
271. 13:26behalf okay and and it sounds like
272. 13:30you've had discussions with your mom and
273. 13:32know exactly what she would want which i
274. 13:34think is very helpful yeah we've talked
275. 13:36about it but we've never had anything
276. 13:37for them Ronnie she doesn't have a will
277. 13:39or anything like that actually written
278. 13:40out you know even in the absence of
279. 13:42those forms having that conversation
280. 13:44with her was very helpful because you
281. 13:47know what your mother would want and we
282. 13:49can help ensure that a plan is in place
283. 13:51to meet those wishes thank you
284. 13:59[Music]
285. 14:09you
286. 14:10[Music]