Do Not Hospitalize Orders

[Gail in Georgia]

Yes; this is true.

What I was attempting to point out what that a "DNH" order does not mean a patient cannot be taken to the hospital but rather any attempts to address symptoms would be done on an outpatient basis and would not involve admitting the patient into the hospital.

It is not unusual that terminally ill patients may, for example, wish for medication to control changes in their levels of pain addressed but would then want to return to their previous living arrangement instead of being admitted.

Gail

 

[justalayman]

Yes; this is true.

What I was attempting to point out what that a "DNH" order does not mean a patient cannot be taken to the hospital but rather any attempts to address symptoms would be done on an outpatient basis and would not involve admitting the patient into the hospital.

It is not unusual that terminally ill patients may, for example, wish for medication to control changes in their levels of pain addressed but would then want to return to their previous living arrangement instead of being admitted.

Gail

I absolutely agree. Just wanted to clarify since there seems to be a concern with the hydrate order (not sure if OP is for or against the artificial hydration)

 

[Gail in Georgia]

"Regarding the question of Hospice...the facility has hospice care in the facility so I'm guessing that I need some sort of order to change her regular care to hospice care."

Most nursing homes (and I'm going to assume OP's sister is in a nursing care/nursing home facility) have several levels; rehabilitation unit, nursing home unit and, more and more frequently, a hospice unit. It would appear the patient may be in one of two first units.

Nursing homes hate to have their patients who are in the rehab or nursing home units die while they are there. Makes them look bad. Enough deaths while in these areas and the home gets investigated for possible neglect.

Patients in the hospice care unit are seen a bit differently; the assumption is that their life expectancy is six months or less. It is expected that they will pass away soon. The focus is on comfort care at the end of life. Thus, there is less likely to be the emphasis on eating and hydration as there would be in the other units as well as less concern that the patient may become "addicted" to any pain medication required for comfort.

If the OP does not wish to have her sister brought the ER for hydration (even if there done only on an outpatient basis), she needs to discuss changing the status of her sister to Hospice.

Gail

 

[maidao2001]

Issue resolved

Gail, you were correct. I finally got a hold of her social worker at her facility and have signed an order for "Comfort Care Only" which releases the facility from liability should my sister suffer weight loss, dehydration and death due to no feeding tubes, no cpr, no weight monitoring, no lab tests, no IV's or hospitalization. Oxegen and pain medication are fine for comfort measures.

Even though I intellectually knew all this already, and know with 100% certainty that this is what she would have wanted, it's the hardest thing I've ever had to sign in my life. I'm miserable.

Thanks everyone for your input and support.

Sincerely,

Mai

 

[ecmst12]

Hospice also offers support for the family. Don't be afraid to ask for it.