As a retired Nurse, I can tell you that some States forbid (legally) “hiding” meds in foods other than crushed in applesauce, which doesn’t hide the taste!. I also had a number of patients who would spit out meds and fight. When the State Inspectors were not around, :blush:OR with a specific M.D. order, we would give essential meds such as cardiac meds, or meds for diabetes, crushed and put in a tasty pudding, just to maintain our lovely patients. The facility would not purchase the puddings, so most of the nurses purchased 6 - packs of nice puddings, such as tapioca (which is really easy to hide crushed meds in), but the most popular pudding for our patients was chocolate, and it hides the taste of meds beautifully! However, we did have M.D.'s, who with family agreement (whoever had the Power of Attorney), to cease all meds. This is not the same as withholding essential fluids and foods. It depends a lot on the meds. The one thing we could NOT cease was Insulin injections, which was often a battle, and in fact, I was permanently disabled by a patient who was a “brittle diabetic” in Hospice/Terminal Care who also had dementia. I was thrown into a door frame and had my tibia crushed for 2 inches, which resulted in difficulty walking & ended my outside work as a Nurse. I would do it again, just to keep my patient from dying of the diabetes when I could prevent that. Speak to your brother (and perhaps the Director of Nursing at the facility) about what type of meds she is on. And, have them explain what the meds are for! If none of them are required to maintain life (as insulin is), then this is NOT a life-threatening order from the Doctor. What they are basically doing is letting her go on naturally to her eventual end, and avoiding injury to her or to her Nurses.
However, they should do all they can to continue hydration (I even bought milk shakes (out of my own pocket) for those who would not take water, juice or other liquids) just to make sure they were hydrated, and which also provided some calories. If she is eating or accepting at least some foods and fluids, and the meds are not essential to maintain life (few meds will cause death if ceased when a patient is suffering from end stage dementia) then the order is basically legal, and will probably not cause any immediate harm due to lack of the medications. You should speak to your brother about her medications and find out how essential they might be to life. If it is a case of the facility not wanting to put out extra effort to get meds into her, they are not doing their jobs! And, they may have pressured your brother and the M.D. to cease them, rather than trying to work around the problem another way.
I had only a couple of “no medication” orders in the 18 years I worked as a Hospice/Terminal Care Nurse, and NONE of them cancelled any pain meds. There are meds which can taste good, or which can be concealed to give in liquid or food for pain. (Such as Roxanol, which is used for cancer patients in place of regular Morphine, and which is a small amount of liquid absorbed directly through the cheeks and gums.). I hope you find the answers and peace you need. There is nothing worse than arguing with family AFTER the death of a parent because some think the one who had the Medical authority actually “killed” the parent. This is seldom true!! Will say a prayer for your peace and that you achieve understanding with your brother and your Mother’s caregivers!
By the way, if they are having trouble getting foods and liquids into her, the FAMILY can provide such things as cans of “Boost” in her favorite flavors, puddings, milk shakes, etc… That will at least get her to take some calories and fluids. If one or two meds are absolutely essential, they can be placed in the puddings WITH a M.D. order. Watch out – as I said at the beginning, some States forbid hiding meds in food without an specific MD order, and there must be justification for it documented! God help you and grant you peace. Remember, your brother is living much closer to this and is watching what is happening on a daily or weekly basis, which must be very hard on him too!
