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Archive of "What's Your Question About Nursing Homes?"
Column
What's Your Question About Nursing Homes?
By Kathy Gannoe
March, 2008
Question:
Does my mom have to have a feeding tube? The nurse says she needs one
and made it sound like I had to agree.
Answer: Federal law has several important points about feeding
tubes. A resident who is able to get enough to eat either alone or with
help is not to be fed artificially unless their clinical condition
demonstrates that this is unavoidable. Sometimes a feeding tube is
recommended when a resident is difficult to feed or they take a long
time to eat. Tubes should not be ordered under these circumstances
because it is for staff convenience. If a resident's clinical condition
calls for a feeding tube, it can’t be inserted over the objection of the
resident or their legal representative. The decision about the
appropriateness of tube feeding is to be developed with the resident or
his/her family, surrogate or representative as a part of the overall
care plan. Ideally, this would be discussed before a crisis point, but
even if it isn't, it is still a team decision.
Question: Then I don’t have to have this tube for mom?
Answer: The short answer is “no.” As with all treatment
decisions, the resident (or their legal representative) has the right to
refuse a feeding tube. The facility is obliged to explain the benefits
and burden of a feeding tube and to explore alternatives with you.
Question: Will they discharge her if I refuse a tube? The woman
who called me said they couldn’t allow her to “starve to death.” I don’t
want that either!
Answer: Sometimes staff say things to families that sound like
threats. They may say that the resident will have to leave the facility
if the tube is not used, or that they cannot allow the resident to
"starve to death.” This can be very confusing and you can feel like you
are backed into a corner. Food and water (nutrition and hydration) are
emotionally charged topics. Food and water represent the most basic care
we can give to another. No one wants to be responsible for "starving"
someone else. When a resident refuses to eat, it is easy to feel
personally rejected and to become frustrated and even angry with the
resident for "rejecting our help.” It is important to clarify one thing.
"Starvation" means to suffer or die of the extreme or prolonged lack of
food. It is an absolutely inappropriate word to use in connection with
the issue of feeding tubes. The decision families and legal
representatives are truly making is about care. It is a decision about
how a person will be taken care of at the end of life. It is a decision
about medical treatment. It involves assuring that a resident's life
values are respected and that their quality of life is supported.
Question: Will my mom die sooner if I don’t let them put a tube
in? She’s already lost some weight.
Answer: That is certainly something I can’t answer. But, the loss
of appetite and subsequent weight loss are a part of the progression of
the disease and dying process. While there are medical treatments
available to relieve many problems associated with disease and dying,
there is little to offer someone to halt or to reverse this weight loss.
The human body has many ways of adapting during the dying process.
Reduced interest in food and water is one of nature's strategies which
allows a resident to die more comfortably and peacefully.
Question: I just don’t know; I still feel uncomfortable. Is there
anyone else I can ask about this?
Answer: Hospice nurses have had a lot of experience with feeding
tubes and the dying. The Hospice philosophy is that death is a natural
process and that the resident and family have the right to make choices
regarding care. They believe that the body adapts as some diseases
progress and that these adaptive processes should not be interfered with
unless there is clear evidence that the resident would benefit. The
Director of Nurses or Social Worker at your mom’s facility should be
able to answer your questions and help you think through this decision.
If the tube is rejected, the facility must still provide all of the
other services which your mom needs, based on her assessment and care
plan.
This column is presented as a public service of the Nursing Home
Ombudsman Agency of the Bluegrass. If you have a question, send it to
Kathy Gannoe, NHOA, 1530 Nicholasville Rd., Lexington, KY, 40503.
DON’T FORGET...
MORE THAN 23,000 PEOPLE IN NURSING HOMES IN KENTUCKY
NEED US. THEY ARE KENTUCKY’S "FORGOTTEN PEOPLE".
Bernie Vonderheide
KENTUCKIANS FOR NURSING HOME REFORM
Tel: (859) 312-5617
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