Can an Attorney ask a care home staff to not provide nutritional shakes/fluids for an end of life patient?

Having seen residents (with fairly advanced dementia) at my DM’s care home being badgered and pestered to eat and drink when they clearly didn’t want to - crying or whimpering and repeatedly turning their heads away - I must say I’d be very forceful in such circs. To me it’s almost a form of abuse - but at the same time I do know that it was done with the best of intentions - however misguided.
I had already made it clear that there was to be no ‘striving to keep alive’ of my DM who was over 90 with advanced dementia.
OP, I would have a very firm word with the staff, and say you know it would certainly be against your mother’s own wishes to have her already limited life prolonged in this way.

@zippyswife

I think no one wants to be responsible for hastening death so fluids/ nutritional shakes are given unless contra indicated medically.

This is why any instructions from the GP need to be in writing and expressly shared with the care home. Has this happened?

So sorry for your DH and his mum.

The care home are correct in that they should offer.

However your DH would also be correct to respond 'you asked once, she said no' if they keep asking over and over if she wants a drink.

I agree with you OP, also people can say 'yes' to this whilst not knowing the implications of this which is that eating and drinking actively in their last hours interferes with death and also they can choke or aspirate very very easily which is so distressing.

I hope you get this sorted as this is not appropriate care for a confused patient who is 'hours' away. This is a hard time being at a remove as well, be kind to yourselves.

@TizerorFizz i think we should ALL make our own wishes clear. And way before it looks like it might be needed too.
(Same than with a PoA or a will for that matter)

I worked in a care home ( just as a housekeeper) and even at end of life the carers were trying to get fluids in and recording amounts. I think no one wants to be responsible for hastening death so fluids/ nutritional shakes are given unless contra indicated medically. It might be a kindness but I remember several they killed/ attempted to kill my gran press stories about Liverpool care pathway.

Hi OP

What's the link between her GP and the care home? MILs GP practice is directly associated with the nursing home, so any diagnosis / prescriptions / other medical issues are (in theory at least) passed directly to the nursing home staff by the GP. Is your DH expected to be the link?

What is the 'gold framework end of life care plan put in place by her GP'? Is it a written document (and does your DH have a copy?) with clear steps / actions that the carers are expected to follow - and does it specify that she is not to be offered the nutritional shakes etc? I imagine that unless they have it clearly in writing from the GP they will continue to offer and to encourage her to take some as they will be covering their own backs.

@Oblomov24 I think I must write my own wishes! I don’t want any crap end of life care. I want out before I get so bad I’m not making coherent decisions. We don’t take personal views into account early enough. DM had a great life but hospital was a nightmare in her last year. It’s mostly a horrible end to a life.

@zippyswife - I'm so sorry. It's such a horrible situation. If you can raise the CHC point with the GP and the care home (and potentially Local Authority if they are involved in any way in the funding too?). I don't know what happens, but it's supposed to be straightforward. I'm still so angry no-one told me and that my poor mother burned through another £16k in care home fees that she needn't have done.

Glad I read this thread. I must speak to my mum about this, about her wishes.

Hope you can get this sorted op.

I think it depends on what you mean by needing assistance to drink. If they are holding the drink to her lips and she is sipping and swallowing, even with encouragement, then to me that is correct. If she is distressed and they are forcing her that would be different.

My experience of end of life care where the patient's mouth is being moistened hourly is that this not only keeps their mouth comfortable but if they are well enough to swallow when they taste water, it is not witheld. It is not totally clear to me from your description that your MIL is at that stage, as much as we can all agree her mental state makes prolonging life feel cruel.

I doubt very much a tiny amount of nutritional shake is keeping her alive OP.

I think this is unusual, the person may drink and not eat, so nutritional shakes feel like force feeding. Usually homes recognise the futility and cruelty of this. The person is not dying because they’ve stopped eating, they’ve stopped eating because they’re dying. It’s a normal part of end of life and wrong to prolong it. I don’t know where you stand legally but I would be very distressed if someone was doing this to my loved one. I am sorry.

There are no easy answers.
My elderly relative is on an oncology ward. He's bedbound. Can't speak much. Isn't eating. Isn't drinking.

But.
He's on a drip. With antibiotics.
On oxygen.
The latest - they're feeding him via an NG tube.

Now, he's not in any pain afaik.

But here's the thing. He is still in there. He has capacity. As does his wife, who has health LPA. I have health LPA too.

I might see if I can buttonhole one of his doctors (easier said than done) and say, "He was a big Dignity In Dying proponent, see what he wrote in his LPA, have you sat down with him and honestly asked him what he wants?"

Trouble is - we all know there's a chance - a tiny one maybe, but still - he might have some sort of recovery. So maybe he reckons, as long as I'm not in pain, I'll go with this and see ... And if so, fair enough.

YES you can. It is very comforting to read @AnnaMagnani's post tbh. I'm a speech therapist who used to work in palliative care and the daughter of a woman who had a brain bleed three very long years ago. She had an Ensure opened and put on her table every day for two weeks. Luckily my mother was still feeding herself at that time and wouldn't touch the things, and it was a hospital so I was able to persuade the doctors it was nothing but waste, and they got taken off her prescription before she ever left hospital.

I'd try the GP. It wasnt until we were 'those relatives' and were so unpleasant and awful that the GP had a best interests meeting with us and the nurse in charge to shut us up, that we got something real put down. That was when we finally got antibiotics crossed off the PRN list. Make trouble if you have to. If only the obvious and sensible decisions to reduce years of misery could be done without a revolting fight.

Yes you absolutely can.

However as a Palliative Medicine consultant I have found it very difficult to get care homes to do it.

Generally they are very scared of CQC criticising them for not meeting nutritional needs and families accusing them of starving patients, sometimes even as in your case, the families are just asking for personalised decisions.

Forgive me if I'm speaking out of turn, but if she has hours/days, I'm wondering if your DH or a sibling is not sitting with her? If a close relative is, then they can "help" give throw away the nutritional drinks, and let the carers move on to their next patient.

We had a close relative die recently, and they had the nutri carton of drink next to them and water etc., and it was us that helped with the water (they didn't want the nutri shake), and there was always someone sat with them, the carers only changed their adult nappy.

It doesn't sound right at all that the nutri shakes are being forced, so can the person witnessing this not just say "it's ok, I'll help mum with that, you can go to your next patient now".

She is on a clear pathway fur end if life. Do you know what’s included? I would have expected things like withdrawing food and water to be included in it (as in when to do that etc….).
As your dh has POA, he is speaking for her.
He needs to check with the care home

• they know he has POA
• they’re aware of the pathway agreed with the GP
• Theyre following said pathway (he needs to ask them what’s in the doc and how they are implementing it)

Sorry to hear about your mil. My dm expressed her wishes for DNR a few years before she passed. She had a lot of health issues. There was no POA, but the drs had this on file and she used to have a letter that she was DNR. She’d had enough of her health issues and wanted join df.
if mil was done and didn’t want this prolonged I’d be looking at the POA and see what can be done.

I'm a care home manager, you need to speak to her GP about end of life care, the nursing home staff and manager will give her nutritional supplements. The end of life care will include medication and guidance to staff re mouth care.

Consult with her GP as LPA - with Health LPA it can be the PA that has the say or medical staff - if they are both recommending it can't be ignored. THe decision is usually made in consultation with family members etc.

For keeping the mouth clean and fresh we were advised pineapple juice - just apply with a cotton bud, keep the teeth and tongue clean with gentle motion - it can "plaque! up and be quite dreadful. Often patients get almost a kind of lockjaw so it can be tricky. It is normal to stop all by mouth when you are in that final care path as otherwise you can aspirate and liquid or food goes on the lungs and you end up dying of pneumonia. It ca still take a few weeks as well.

It is a truly difficult time, thoughts are with you all

@DappledOliveGroves my DSF had been a partial funder but the hospital discharge team told me all his care home fees would be paid from the day he was admitted to hospital. I didn’t have to complete anything.