Hi Patty,

The nursing home my mother in law was in called us and asked our permission
for every single aspect of her treatment.   We had the option of saying "no"
to any and every medical decision.    We decided to go with certain things
and not others.   We said yes to physical therapy.   We said yes to any meds
they thought she needed.

When she was in gastric distress, we said yes to having her hospitalized and
diagnosed.   When they discovered pancreatic cancer we said "yes" to a
gastric stent to relieve her pain, fully knowing it was only a matter of
time till the cancer continued to grow, and took her life, but it was a gut
decision on our part, and we still think that it was the right thing to do.
I want you to know that it was OUR OPTION on each of those to just let her
go naturally if we had wanted to, or to treat.

There were no other decisions to be made after that.   Eventually she got a
lot sicker and died.   She did surprise everyone and lived another 8 months
after being diagnosed and the stent put in.   Usually pancreatic cancer goes
faster than that, so the stent either prolonged her agony or gave her a few
more months of life, depending on how you look at it.   For a long time
after the stent went in she seemed comfortable and content to us whenever we
visited her.   She had adjusted to the nursing home and was doing quite
well.   But eventually that brief respite ended.   We felt we made the right
decision and that at least some of the time the stent brought her was good.

I don't know what your nursing home people do, but all we needed was proper
paperwork in place and we were consulted on all decisions.   You may need to
consult with the people there about this.   If you have a DNR you shouldn't
have any problems.

As for treatment, you need to think about each situation carefully as it
arises.   If you feel she wouldn't want treatment of some issue that comes
up, then pass on it.   But for instance, I would think it a shame to allow a
person to die of an untreated UTI if that was the only other ailment (than
the alzheimers).  Others may not think so, and may feel that whatever takes
the person away, no matter how minor, will be a mercy.

Your mom has heart issues.   You could conceivably start saying "no" to
treatment and meds.   That is up to your family to discuss with the doctor.
You have my sympathy.  These are really tough decisions.   I suggest that
you all try to come up with a consensus.   Less regrets later that way.

We had DPOA, living will, etc. too but it is still a daunting path to take.
Do you have a local Hospice organization? They were recommended by the home
where our Alzheimer's stricken family member was staying and took care of
many/most of those details such as stopping meds when they felt they weren't
doing enough anymore, prescribing pain meds to insure the person was
comfortable, arranging for good bedding when the patient was no longer able
to get around, etc., etc. The pain meds may have had a slight effect on
duration of life as was stopping certain other medications but they balanced
  quality of remaining life as opposed to length. They took a lot of the
load off us and did consult with us frequently as to their acts and
reasoning for them. Cost was negligable as they work through medicare,
donations, etc.
HTH

Bud

Contact your local Hospice organization regarding end of life
care and you mother's wishes.  They have counselors who deal with
these kinds of issues all the time.  Services are free if you
can't afford them, or on a sliding scale based on income;
terminal care from Hospice is usually covered by Medicare.

They can also provide very helpful grief counseling to help you
and your family get through this difficult time.

For your sake, and hers, I hope that she has a painless and brief
passage.

I don't have any advice to add to the excellent advice you've
already been given, but I would like to add a few personal
observations.

First off, I think the loving and merciful thing to do when
a person is at the end of life, suffering from dementia and
other ailments, is confused, unhappy, and has no prospect
of ever recovering, is to allow the person to die.  You
don't need permission from me or anyone else to make the
decision you are making, but for whatever it's worth, I
think you're doing the right thing.

Secondly, it is my experience that the people who deal with
this problem every day - nursing home administrators and
doctors, understand the situation well.  They have to be
certain that they are due diligence in the care of their
patients and they cannot, should not, and will not assist
in a person's demise, but I don't think they are likely
to give you a hard time about the medical decisions you
are making.

I think the best approach in these situations is to make
a distinction between treatments intended to prolong
life and treatments intended to alleviate suffering.
Ask about withdrawing the former and increasing the latter.

Best of luck to you and your mother.

    Alan