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Original poster

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

33 replies

zippyswife · 30/10/2024 16:25

MIL is in a care home. She is on a gold framework end of life care plan put in place by her GP. She has been in hospital, come out, not regained movement in her legs and is bed ridden and incontinent. She has advanced vascular Dementia and often very confused and distressed, living an internal nightmare of having ‘lost her child’. She is unable to swallow food or take medication orally. We have been told that she has hours/days and this is the dying stage. My husband has power of attorney for health.

MIL before dementia was a very strong and proud woman. She would be appalled at her current situation and would want to be removed from it as quickly as possible. Having seen her family suffer dementia, she was clear and blunt on her wishes if in similar situation.

She is in a nursing care home, and has a ‘Respect Form’ that she should not be returned to hospital, receiving care in the home. The home and staff, however well intended, are regularly giving her liquid based nutritional shakes/additive, soup and porridge. She needs assistance to take in any fluids, sometime the shakes etc are delivered with persistence that she would not want, but is not able to communicate.

The use of the nutritional drinks is prolonging her physical ‘end of Life’ and causing her mental distress in a way she would never have ever wanted. The most dignified and respectful thing she would want is to be left for nature to take its course, whilst of course bieng hydrated (with water/juice) and loved.

Do others have experience of this. Can husband acting as attorney decline nutritional drinks and additives on her behalf?

OP posts:
Soontobe60 · 30/10/2024 17:05

This is something very close to home so apologies if I upset anyone.
My stepfather (DSF) who had Parkinson’s and Dementia was in a care home. He ended up in hospital 3 weeks ago with an infection. He was put on antibiotic drips and fluids via a cannula. He was very poorly and semi conscious so could not eat / drink / swallow. After 10 days his infection cleared up but it was determined by the consultant that it had impacted him so badly that he was put on an end of life pathway - in my area it’s called a statement of intent.
It meant that they believed he would die within hours / days so all active treatment was withdrawn. This included IV fluids. He returned to his care home where it was very clear that he was actively dying. It took 6 days, fortunately he was unconscious during this time. Giving him any food / fluids would have just prolonged the inevitable. Carers just kept him comfortable, they moistened his mouth hourly. Honestly it was pretty awful to witness.
I would ask your DH to ask to see the documentation the GP has completed - it should state if all nutrition is to be withdrawn. If it does, then the staff are making a huge error by trying to give her food and drink. However, having LPOA for health doesn’t override a decision that a doctor may make to give nutrition at end of life. he can advocate for any decisions she made on her LP application form but if she didn’t detail this then it doesn’t help.

olderbutwiser · 30/10/2024 17:03

"sometime the shakes etc are delivered with persistence that she would not want"

His responsibility is to make decisions in his mum's best interests, and coercing her into eating when she is end of life and refusing food is surely not in her best interests at all. Is there no Respect form etc? What have the care home staff said about this? Has he spoken to the manager? At this stage surely it's all about her comfort and peace. If you can't get any sense out of the care home then speak to the home's GP.

DappledOliveGroves · 30/10/2024 16:56

How end of life is she? Is she on end of life medication?

My mother (advanced dementia) had an "end of life" period just over a year ago. She got a chest infection from aspirating food and was losing her swallow. We were told she was end of life. She had mouth care only. But, after a few days of us praying she would die (because her life was a living hell), she started trying to eat toothpaste when the carers were brushing her teeth etc, and was clearly hungry, so the care home staff started giving her nutritional drinks, Ready Brek etc which she wolfed down. It was a complete emotional rollercoaster and a total headfuck for us. We'd gone from trying to think about funeral arrangements to accepting she may just keep plodding on. The staff were sweet but explained they had to feed her.

Anyhow, thankfully, she died a few months later, quite suddenly.

One point to note - if she has been told she's end of life, she should receive Continuing Health Care immediately. No-one told us this, so my mother continued to pay out thousands for her care for another 4 months until she died. So do raise this and try and get CHC so that she doesn't have to pay anything to her care.

UltramarineViolet · 30/10/2024 16:54

Yes he can absolutely point out that knowing his Mum, she would not want her life prolonging at this stage and would not choose to take the supplements

The whole point of having LPA for Health/ Welfare is so he can advocate for her

I would suggest your DH phones his Mum's GP practice and asks to speak to whichever clinician tends to deal with the residents in this care home

CookieMonster28 · 30/10/2024 16:48

Sorry to clarify - he can obviously request they stop but I'm not sure as POA if he has the overall authority but a discussion with GP and care home to discuss what is in her best interests would be appropriate.

Hope that helps x

CookieMonster28 · 30/10/2024 16:47

Sorry to hear about your MIL.

Has she had her swallow assessed by a Speech and Language Therapist?

If she's imminently end of life it's unusual that care staff would be giving her nutrition...but keeping her mouth moist and hydrated for comfort. If it's any reassurance with dementia and approaching end of life it's very unlikely she will be experiencing feelings of hunger or thirst.

Its definitely worth your husband discussing with GP and care home manager. I'm not 100% sure if he can request they stop.

Original poster
zippyswife · 30/10/2024 16:44

@Hadalifeonce No- not that I’m aware of. Only verbally with DH. Nothing in writing to my knowledge sadly.

OP posts:
Hadalifeonce · 30/10/2024 16:30

Has your MiL left any expression of wish?
My mother had instructions in place to say that if she was at end of life she wanted DNR, she wanted no food or water, just pain relief. These instructions were also lodged with her GP.