Palliative care question - really unclear what to do based on circumstances

StephanT

Registered User
Jul 1, 2023
31
0
46
London/Marbella
Hi,

Long story short, my mother suffers from FTD/PPA for over 7 years now. 5 years ago I was told she had 3 months to live. You can understand the situation: it's the usual 'care home is well intended but is not a hospital' and 'hospital is well intended but is not a care home'. There were times when my mother was move back and forth between the two, 5 times a week.

Like so many others on this forums, I'm beside myself with grief as my mother is not eating 'properly' for over 4 months now. She's very frail, and everyone willing to speak on the topic is asking the question you must be asking yourself: 'how is it even possible'. I understand this forum is for everyone and therefore we have to be extremely careful how we phrase things, but to describe her state, how she sounds, looks and feels, look no further than the call i had with the director of the care home she's in i had this morning, where even her was sobbing uncontrollably - that's how bad my mother is, and yet, she lives.

I do have a question: why are we seeing so many different testimonies on these forums. In the space of 30 minutes, I read messages where people were able to contact their GP from within the care home (my mother's care home has a gp -so external GPs are out of the question), and other really , really different takes on the topic.

I'm therefore forced to think about 'is my mother even in the right country at this point'. I had her transferred to Spain through private means because at the time, it made the most sense: better weather , better staff and better overall facilities than my native France. But today, there's no need for 'fancy' facilities. She needs love and she needs professionals who know what palliative care is, as you may not know but palliative care didn't even exist in Spain until 2011.

So, i might need to move her to somewhere where she'll be better care for. But moving someone who is in a semi-vegetative state is so dangerous, so irresponsible, and so unethical, that you won't find a single private or public ambulance willing. No one wants the legal liability that comes with the unfathomable risk.

Which leads me to my question: what should I do? My mother is suffering , I'm at the end of my rope, physically and mentally, the staff in the care home is not trained for palliative situation, and no hospital will take her in spain as palliative units do not exists - and i can't move her. So what do I do?

Thank you.
 
Last edited:

canary

Registered User
Feb 25, 2014
25,430
0
South coast
Hello @StephanT

I have read your post several times, but I am not altogether sure that I understand some of the things you are referring to, so please forgive me if I have misunderstood. I am in UK and the things I talk about are the way that things generally happen here. I dont know about other countries.

The way you are describing your mum sounds to me to be the way that my mum was when staff referred to her as being in the "final stage". When she reached the stage where she was actively dying, this was what was referred to as being at "end of life". I know that other places use the term EOL to be what was called in my mum, the final stage.

When mum reached the final stage I spoke to her GP, but, to be clear, I meant the GP in charge of the care home, not an outside GP. When you see people posting about contacting the GP when their person with dementia is in a care home, this is what they mean. The (care home) GP agreed that mum was in the final stage and would not have any more hospital treatments except for broken bones as this would cause pain. She would also not go to hospital for IV antibiotics, but would continue to take tablets as long as he was able. I dont think anyone in UK would recommend a nasogastric tube or PEG feeding for dementia, but as her swallow weakened mum was given a soft diet and her fluids thickened to make it easier to swallow.

Your references to EOL medication are somewhat cryptic, but I get the feeling that you are assuming that these are medications which are intended to propel the person with dementia towards the phase of actively dying. Can I say that this is categorically not what they are for. They are to be used in the final hours/days when death is inevitable and they are showing distress.

These final months - and yes, there really is no knowing how long they will last - are deeply traumatic to watch. I found watching my mums final weeks and the physical changes that happen during the actively dying phase harrowing. And I do not use that phrase lightly. I think you are at the stage where you end up thinking "dear god, how much longer can this go on?". It is a stage I recognise
((((((((((((((((((((((((((((((hugs))))))))))))))))))))))))))))
 

StephanT

Registered User
Jul 1, 2023
31
0
46
London/Marbella
Hello @StephanT



Your references to EOL medication are somewhat cryptic, but I get the feeling that you are assuming that these are medications which are intended to propel the person with dementia towards the phase of actively dying. Can I say that this is categorically not what they are for. They are to be used in the final hours/days when death is inevitable and they are showing distress.

These final months - and yes, there really is no knowing how long they will last - are deeply traumatic to watch. I found watching my mums final weeks and the physical changes that happen during the actively dying phase harrowing. And I do not use that phrase lightly. I think you are at the stage where you end up thinking "dear god, how much longer can this go on?". It is a stage I recognise
((((((((((((((((((((((((((((((hugs))))))))))))))))))))))))))))

Thank you for your reply, its appreciated. Ok, I understand i misunderstood something, and I apologize, and I have edited my post accordingly. I guess, people in great amount of distress read what they wish to read in order to find 'some solution, any solution', as another day rises and we know what's in store for our loved ones.

Thank you for clarifying, and also thank you for sharing. Harrowing indeed, hence why sharing information on forums is surprisingly helpful, as we then realize that 'we are not alone' in this difficult journey.

Thank you again and ((((HUGS))) to you too!