Feeding tube after a stroke

[dixechk9904]

My grandmother was 93 with advanced stage dementia, and arthritis that was painful she for the most part was pretty much bed bound when she had a stroke August 06 . She had a basic advanced directive that no messures were to be used  "just to prolong life."  She never regained consiousness and as a result could not eat or drink.  My mother was told by the doctor there was nothing more that he could do and that a feeding tube must be installed because the nursing home required it.  I was totally against this etc. and not home in Al at the time.  The hospital had the copy of her advanced directive when she was admitted.  Mother was told if she did come around in two weeks or so they would remove the tube.  Well as the story drags out....there was no change in her medical condition..she never awakened and they refused to remove the tube until I went there in Oct. to see her ...her tongue was fixed and hanging out of her mouth chapped and cracked.  Mother said she had been like that the whole time....etc.  I insisted that mother have it removed and my grandmother be allowed to die with what dignity she had left.  It was a week or two before they finally removed the tube and Iv she died the 11th of Dec 06.  I feel comforted that her condition remained unchanged and she seemed not to be in any pain of discomfort from lack of food or water.  I believe that her treatment was inhumane and against her wishes as provided in the basic AL state advanced directive.  Sorry for the long story but my question is     from the described situation should the feeding tube have been installed?   it was my understanding that her wishes were covered in writing and I can't understand why a feeding tube was offered in the first place considering her age and condition...does anyone have any advice?  There are more details reguarding the nursing home theives...etc. but that is in another forum and another day.  Please, please make sure your family is aware of what medical intervention/procedures are to be used and under what conditions so that surviving family does not feel quilty in making medical decisions on your behalf.  

[katyzz]

You are so right. Most nursing home are predators.
Mum had a stroke in April 07after bilateral knee operation.  Hospital  installed trachea and stomach peg. Tragically mum's eye muscle also affected and she still cant open her eyes
Sent to a nursing home  at the end of May  with 3rdstage bedsore.
At first home was excellent but now I believe they reduce her milk and dont turn her much.
They probably benefit in keeping her bedsore at a certain stage as if fully cured we may bring her home.    I dont visit mum much anymore, cant take the emotional pain.  
At least your grandma is at peace now. I hope caregiver will continue her misson.
Some members of the family benefit by having mum put away in a home so I understand the girlfriend is up to.   With all that money, the guy should be in his own home with private nursing and with his girl around.

[dixechk9904]

Thank you for your response.  You can tell you are very concerned for your patients well being.  I am suprised Medicare does not require some type of advanced directive to be on file with them. or have rules governing the payment for these unneccesary procedures.  When this all happened I was not well myself..about to have hip surgery and I didnt want to upset my mother.  I tried to explain to her it was a trick.  The nursing home first said that grandmother could not be reentered to the nursing home because of Medicar required number of days between stays, etc.  A couple of days later they called back and changed the answer saying yes Medicare would cover her return.  Based on that mother made the decision to put the tube in because she felt she was being "kicked out of the hospital" That was in Aug first part of Sept.  I think it was In Nov. maybe in Dec. the nursing home gave mother a  billI stating grandmothers coverage was not a qualified stay and that we owed about $12000 for her stay that Medicare did not cover.  After that mother asked that the tube be removed and after telling them she had no money to continue paying they finally removed it.  I do not havae that  good of relationship with my mother.  She herself is no caregiver by any means,  but a martyr , it is always about her.  So I am not sure how much of it is her fault vs. the doctor and hospital.  At best, I consider it poor medical judgement and I am now leaning toward criminal intent since I have recently found out that the treating doctor is either on the staff of the same nursing home or a part owner.  I have been told to stay out of it etc.  But that is not going to happen...as soon as I can get an attorney I will see if there are any grounds to sue them to be shut down.  The way I see it is that they let her suffer for nearly 3 1/2 months to just bill Medicare. Empty beds do not pay the bills.  I had told mother this at the time etc.  but she said she didnt have a choice.  I had suggested hospice at home.  Something is really wrong here and I will get to the bottom of it.  I am sure you see this all the time.  I could not do your job.  I get to involved and would end up either having a stroke myself or being put in jail.  I consider them at this points predators on the greiving family.

[caregiver222]

As for the feeding tube being emplaced, the nursing home is giving you a snow job about it beiong "required". That being said, a person has the right to die in dignity. A have had a long battle with various nursing homes over various patients at various times, which usually involved them calling security and me calling the police and threatening to have them all arrested, the situation generally ending in a mexican stand-off. When I find a nursing home worth the powder to blow it to hell I'll let you know. I have had more than one nursing home owner arrested and indicted. All being said and done do not punish yourself for decision that could have been made. The situation is structured so as to minimize input by outsiders, and patients are usuallyu just "numbers" that represent cash flow to the owners. Yeah, I know I'll get another post telling what wonderful care their mom/dad/son lover gets, but over the course of my professional life I have been in probably a hundred nursing homes, and I have not found a single one I found satisfactory. I am presently involved with a patient who they did the same routine on, but not only did they put in a feeding tube they put in a trach, all on the apprival of his "girlfriend", who lives in his multi million dollar apartment and managed to get power of attorney over a number of skyscrapers he owns. It is very difficult to assert yourself with these nursing homes. You have my condolances, and I am sorry the last days could not have been more dignified. I will say a prayer for your grandmother.