Hospital is Manipulating Us??????

[floridafam]

We went through much of the same things when my brother was dying of colon cancer.

His DNR was changed after he told them he wanted to be kept comfortable.

Hospice would not "take" him after he changed it. I don't think they do if you have a feeding tube.

When it got to the point where we knew the end was near he then went back with hospice and they came to the house to care for him and give pain meds until he died.

I haven't read all the posts and I'm sorry you are going through this.

I would see about getting a meeting with the social worker or nun and the Dr. and hospice.

It was very confusing when my brother had to go through it. I actually got mad at the hospice rep because she told him to not write down that he wanted to be kept comfortable.

Good luck and keep us posted.

 

[Mackey Mouse]

This thread is just so upsetting and I guess I must be pretty naiive about the workings of hospitals and insurance companies. You would think I would not be after doing battle for my husband who survived pancreatic cancer, a cancer that has a 98% mortality rate, but we had insurance and they paid for most of it. We were also able to pay for what they did not. I think back on the day we got the diagnosis, I actually called someone who helps us with finances....her words of advice to us were do not let him retire. Best advice anyone ever gave. If he had retired, medical insurance would have been dropped, then all the paper work trying to get a cobra....and treatment might have been interrupted... not good when you are that ill.

I am just putting this question out here.... would a hospital recommend further care or surgery if the patient does not have medical insurance and has no means of paying. I am sitting here thinking does he have a chance and because no insurance, they just say he does not. There are accurate medical charts to back up what stage this colon cancer is...right? I do not know what to think but worry that people are left to die because they do not have medical insurance. Probably the reason why we are now self-paying on a cobra, (husband retired after recovering, not the same man before all the treatments, but alive,) and also have long term health insurance as well. It is bad enough to fight with insurance companies over treatments when you do have insurance.

I just wanted to say to Lora that I will be praying for her FIL and the family....this is so hard to deal with. Big hugs..

 

[PrincessKitty1]

Some hospitals do provide "free care", and that care is comparable to the care that anyone else gets. Money is available, albeit it has become less and less over the years. Major cancer centers have many, many donors and would not turn someone away based on their inability to pay to the best of my knowledge. Granted, as I said before, it may be more complicated, but free care is alive and well at many hospitals. Obviously, funds are not unlimited, but are designed to get someone over the hump until medicaid can kick in.

True. I work at a major teaching/trauma center that provides some free care.

To the OP: Whatever happens, don't let BF sign anything saying he will be financially responsible for anything. Medicaid may NEVER reimburse for nursing home care (you have no way of knowing whether they will or not), so BF does not want to agree to pay for anything out of pocket. Also, if he can not provide 24/7 at-home care for his Dad, he needs to be very clear with the hospital that he cannot do this. The hospital legally cannot d/c your dad if he has no care and is not capable of caring for himself. They need to find a place that can provide care for him. (That's why I said in the other thread that it is in the hospital's best interest to help him apply for Medicaid).

If they try to d/c him to the street with no care, this is called "dumping" and is illegal.

If your BF's dad has any assets (e.g., a house), a nursing home may be willing to accept your dad signing for financial responsibility for himself.

 

[Pea-n-Me]

I am just putting this question out here.... would a hospital recommend further care or surgery if the patient does not have medical insurance and has no means of paying. I am sitting here thinking does he have a chance and because no insurance, they just say he does not. There are accurate medical charts to back up what stage this colon cancer is...right?

I can only speak from my experience, but the answer is yes, depending on the circumstances. For instance, we do heart transplants on patients without insurance. As you can imagine, it's a lot. They are not denied because of their inability to pay. There may be other reasons they are denied, but not that.

Colon cancer which has spread to the stomach would be stage 4. The OP didn't say, but it may have spread to other areas as well. They have said that surgery will not help him live, unfortunately. If it would, it may be a different scenario. Every case is unique.

 

[lsyorke]

The OP has been told that the cancer is inoperable so not having surgery has nothing to do with the financial end of this(this is a recurrent cancer). Where financial does come into play is when you are trying to find alternative placement, when acute care is no longer required. Yes, it's a hard thing to grasp, but dying is not an acute process. Comfort should be the priority now.

 

[momof2inPA]

This reminds me of the Terri Schiavo case, only it's the doctors trying to withold feeding instead of the husband. As long as your boyfriend's father wants to be "fed" or hydrated, he should. It should be his decision, not the doctors' or the hospital's. Is he still lucid enough to make his opinion known. You should have him state it to the doctor and videotape it. I understand why the nun was so livid. If I didn't know better, I would think you were living in Texas.

 

[Divamomto3]

Nope. Unfortunately there is only stupid me and my equally stupid boyfriend available.

Lora! You and your boyfriend are NOT stupid! I'm thinking she means having someone else there with you that is personally removed from the stiuation who can be a neutral third party. Sometimes you need someone to help you advocate that has no emotion attached with the situation.

When you go to the hospital, where is the nurse assigned to your boyfriend's father? Can't they give you any kind of information on the situation?

I'm a nurse, but an ICU nurse. Our focus is usually treating an acute situation, so I don't have a lot of Hospice knowledge. I'm thinking the purpose of Hospice is only to keep a person comfortable until the moment of death and that an IV would only be prolonging that. I am not sure about whether or not they usually take NG (nasogastric---the anti-vomit) tube or not. They can , however, administer medications that would be anti-nausea and also dry up any stomach secretions.

The bio-ethicist may be there just to explain to you what true comfort measures vs. limited care is. True comfort measures only do not usually include IV fluids. As far as his medical record being altered...well that's just completely illegal. You may need a lawyer.

I'm sorry you are going through this, but I do have to tell you that I think whatever hospital you are dealing with is one of the most horrible places I've ever heard of. Hugs and prayers to you.

 

[lsyorke]

This reminds me of the Terri Schiavo case, only it's the doctors trying to withold feeding instead of the husband. As long as your boyfriend's father wants to be "fed" or hydrated, he should. It should be his decision, not the doctors' or the hospital's. Is he still lucid enough to make his opinion known. You should have him state it to the doctor and videotape it. I understand why the nun was so livid. If I didn't know better, I would think you were living in Texas.

It's the Dad's choice to continue hydration, but it will not change the outcome since this cancer has spread. IV's are not feeding, he is unable to be fed.. they are keeping things wet, which can actually make things worse as body systems are compromised by cancer. To keep IV fluids in a terminal situation looks nice, but it serves no purpose except to prolong the dying process. There is no hospital that is going to keep someone in the hospital for IV fluids that are only prolonging the inevitable, insurance or no insurance.Yes, this sounds horrible, but it's the reality of a terminal diagnosis.

LoraJ, sit down with DB's Dad once you have all the options and talk. Hopefully other family will be there to help you with all this. It's not easy, anyway you look at it.

 

[LoraJ]

Hopefully tomorrow we will get more info from the hospice. She's supposed to call DBF in the morning.

I'm going to discuss the hydration issue with DBF tomorrow once he talks to more family members. Because once we remove that, he could go pretty fast. Just want them to have the chance to say goodbye if they want it.

Thanks again everyone. This plae is better than google.

 

[momof2inPA]

It's the Dad's choice to continue hydration, but it will not change the outcome since this cancer has spread. IV's are not feeding, he is unable to be fed.. they are keeping things wet, which can actually make things worse as body systems are compromised by cancer. To keep IV fluids in a terminal situation looks nice, but it serves no purpose except to prolong the dying process. There is no hospital that is going to keep someone in the hospital for IV fluids that are only prolonging the inevitable, insurance or no insurance.Yes, this sounds horrible, but it's the reality of a terminal diagnosis.

IT SHOULD STILL BE HIS DECISION!!! If he is conscious, lucid, and wants to die slowly-- he should have that right. It's inhumane to speed up the process of dying if someone doesn't want that process sped up. If he wants IV fluids, that is different that requesting an extra operation to try to remove some tumors. Even one poster here said that IV fluids are given in hospice. End of life decisions should be made by the patients and the families, not the doctors, insurance companies, and the state(s).

 

[PrincessKitty1]

IT SHOULD STILL BE HIS DECISION!!! If he is conscious, lucid, and wants to die slowly-- he should have that right. It's inhumane to speed up the process of dying if someone doesn't want that process sped up. If he wants IV fluids, that is different that requesting an extra operation to try to remove some tumors. Even one poster here said that IV fluids are given in hospice. End of life decisions should be made by the patients and the families, not the doctors, insurance companies, and the state(s).

I totally agree with this. My dad had IV fluids and oxygen and a feeding tube right up until his death. We wanted him to be comfortable, and that was our choice (not his, since he was incapacitated). It is the OP's BF's father's choice re: comfort measures. IV fluids and NG suction can be considered comfort measures.

In my geographic area, a hospice nurse will be at the hospital within 2 hours if a patient/family wants to talk about hospice. And at my hospital, the hospital will tap charity care to pay for a nursing home if necessary. Hospice will visit patients in nursing homes to provide comfort in their final days--you do not have to have a loved one at home to have hospice care (again, in my geographical area).

 

[lsyorke]

It is always his decision, that's not in question and no one can make that decision but him. But the hospital cannot keep him in an acute care setting due to this choice. Like I said before, dying is not an acute care situation.If we kept every dying patient in the acute hospital, there would be no room for patients that require acute care. This is why there is long term care and hospice. The family would have to find a facility that is willing to take him with IV fluids and pending insurance. That is the problem, not the decision to hydrate... it's where is he going to go if thats the decision he makes that needs to be solved.
The hospital absolutely dropped the ball on this. With his admitting diagnosis and charity care situation, they should have been on top of the medicaid process immediately.

 

[m&m's mom]

If I didn't know better, I would think you were living in Texas.

What in the heck is that supposed to mean?

 

[momof2inPA]

What in the heck is that supposed to mean?

Doctors in Texas can make legal decisions about the care of dying indigent patients, even if those decisions go against the wishes of the patient or his/her family. This would be the case if the patient were in a hospital and another facility was unwilling to accept him/her. Basically, a Texas hospital can make a decision for a poor, dying patient based on money without regard to the patient's wishes. It's a George Bush law.

 

[disneyfanz04]

Just wanted to see if there was any update, and wanted to see how your DFIL is doing?? Hope everything is getting a little easier.

 

[luvwinnie]

Just wanted to send hugs to you and your family. I hope your DBF knows how lucky he is to have someone so supportive and caring.

 

[LoraJ]

He's just hanging in there. They are only giving him a Potassium Cholride/Sodium Chloride solution. They are no longer giving him vitamins. Not sure how that happened. We thought they were going to continue the IV's as is until he moved to the Hospice. But, I guess it was something his Dad decided with his doctor.

My BF's little sister is coming up with her mother this weekend. He really wants to see them, so I hope he can hang in until then. He's been getting very confused about things lately.

A cousin he hasn't seen in 13 years dropped by over the weekend. It was so nice of her to come. He was so happy to see her. He must be so sick of me and DBF lol.

Good news is, the Medicaid is getting closer to kicking in.

Thanks for thinking of us.

 

[PrincessKitty1]