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My mother, age 94, has stage 4 kidney disease, a tendency to get blood clots, advanced dementia, and high blood pressure. Her doctor recently suggested hospice for her and offered to stop or reduce her prescription for Eliquis. As the oldest daughter, I have both medical and financial POAs.



Apparently, the doctor wants us--me and my two younger sisters--to decide when or if Mom's Eliquis should be discontinued. (Can we just leave it up to him to decide? After all, he's the doctor.) Stopping it suddenly could cause her to have a fatal blood clot, but I've read that Eliquis also has some serious side effects. Serious bleeding could occur if she were to fall, for example. She can just barely walk anymore and has to grab onto the walls or furniture to make it to or from the bathroom because she's forgotten to keep using her walker. She is basically incontinent, doesn't seem to have any short-term memory left, and doesn't remember our frequent visits. Also, much of the time, she makes repetitive noises that sound like wha, ha, ha, ha, wha, ha, ha.... Other times, less frequently, she'll be able to say a few short sentences (for example, "It looks like nice weather outside, where are we? and will it rain today?").... It doesn't seem like a high quality of life, and I wouldn't want to linger myself if I were in her condition, yet it's hard to say how she feels about it. Back when she didn't have dementia, she did sign a DNR form, though.



I visit her in the mornings and my middle half-sister visits her in the late afternoons. She usually sits on a couch all day with the radio playing and the tv on mute because she doesn't want to leave her room. Our youngest sister currently lives out of town but will be in town for the holidays in about a week. We're planning to meet with Mom's doctor at that time, to discuss when or if Mom's medications should be discontinued.



The problem is, my sisters disagree about what should be done. One of them thinks Mom should be allowed to stop the medications and die naturally, while the other half-sister (Mom's favorite) wants her to continue taking the medications indefinitely, which could potentially keep her going for some time. I tend to agree with the sister who thinks the medications should be stopped, but I don't want to be the decision maker because I'm sure that I'd be blamed for Mom's death if I were to decide. The middle half-sister is already quite hateful towards me and has all the symptoms of NPD that I've read about.



I 'd say we all love our mother but it wasn't always easy growing up with her, and I probably had the worst relationship with her. My dad had her put in a mental hospital twice--once when I was five and again when I was about 11. My sisters hardly remember that but still experienced her mood swings, paranoid thoughts, etc. So, I don't want to feel guilty about making a decision that could hasten her demise. On the other hand, visiting her all of the time leaves me feeling tired and depressed. A lot of the time, she's kind of grouchy with me and will say things like "shut up" or "goodbye" when I visit. She even hit me recently, because I offered her a dental flosser, so it's not always pleasant to visit her. I do it mainly so I won't feel like I didn't do enough after she's gone.



Next month, her assisted living bill will increase so that we'll all be paying about $862.00 each per month to keep her where she is. We took her on a tour of another assisted living place back when it became clear she could no longer live alone, one that would take Medicaid if she ever needed nursing care, but she insisted on the private pay place she's at now. Now, in her frail state, my sisters won't agree on moving her to a Medicaid nursing home, and such a move would probably kill her anyway (or any potential roommate since she doesn't like people and would probably be mean to anyone unlucky enough to become her roommate).



What would you do in this situation?

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Unless your sisters have a medical degree, they should listen to the doctor.
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OldAdultChild Dec 15, 2023
I like this answer--thanks!
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You have the DPOA, it is up to you to make these hard decisions, goes with the territory, If you cannot handle the responsibility you can step back and rescind your power of attorney, and let them fight it out.

Your mothers wants no longer matter, it is now down to her needs. None of you should be supplementing financially, Medicaid is there to help her.

IMO you are overthinking all of this, you are doing more than enough for her, there should be no thoughts of "I didn't do enough" that thought process is uncalled for.

Most of the time when those thoughts come to mind it is really about what others think you didn't do and one superimposes that into their sub conscious mind.

She is 94 in terrible health, exactly how long do you think she will or can live?

Me, I would rescind and get out of this toxic circle.

Sending support your way.
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My mother was on Eliquis for years, until she started getting SUCH horrible nosebleeds I can't even tell you. Picture being saturated in blood from head to toe, that was mom. On the 4th trip to the ER, I found the doctor taking a photo of the blood clot that came out of her nose. It was the largest he'd ever seen, the size of a plum. He was going to post it on the bulletin board for the staff to see, believe it or not. The doctor strongly recommend mom be taken OFF Eliquis to stop these nosebleeds, and so I agreed. She was about 90 at the time.

The nosebleeds stopped immediately and so did all the ugly bruising she had all over her extremities from the drug. She wound up having a small stroke sometime afterward, we don't know when, but it showed up on a CT scan a couple years later.

Mom died at 95+ from advanced dementia and CHF while on hospice care. I agreed to take her off all meds but her anti depressants once she went on hospice, because she was thought to have 6 months or less to live. What's the point of using life extending meds at end of life??? I actually prayed to God to take mom Home on a daily basis during the last year of her life, she was so miserable.

Your siblings can argue till the cows come home about what meds to continue or discontinue for mom now. But the truth is, God determines when mom dies, not them or hospice or anyone else. She'll pass when it's her time to go, with or w/o blood thinners.

Best of luck to you.
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The doctor can/will let your sister know that it is not these medications that are keeping your mom alive, in all likelihood, but her strong genetic background. He will explain which medications are dangerous to withdraw, if any are (I doubt they are).
Your mother will die of something eventually and no amount of medication or lack of same will change that. I would leave this in the doctors hands. I would tell the doctor that you are MPOA and that your sister's disagree with one another; that therefore, you as MPOA are going to ask HIM/HER to make this decision, and you as MPOA will follow his/her recommendation. Let your sisters know YOU ARE IN CHARGE, and that not everyone can be made perfectly happy at this point, but that as the person making the decision you will make it, and you will live with the consequences. Let your sisters know that being 94 with stage 4 kidney failure is more or less the definition of dying. Let them know that you will not be going to dialysis (which I hope and pray your Mom is not on at this point) and other heroic measure to prolong life.

I am afraid you are in a position of authority you must embrace. You will not and cannot keep everyone perfectly happy.
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My fil was on this, and had a brain bleed from it.
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I took my mother off Eliquis because she fell and had a head wound and lost a huge amount of blood. The ER physicians said she was a fall risk and she could sustain internal bleeding if she continued on it. So we took her off. We tried to speak to our mothers cardiologist about tge ER doctor’s recommendation but he never called back. So we just went ahead and did it. Nothing bad happened.

I think it is a good idea to consider the transition to a NH facility. Since she is so frail it will probably happen soon.

It’s always best to think ahead. Things just go along for a long time and then suddenly there is a new normal.

Your sisters need to start getting used to the idea.
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Under Hospice Care, the patient usually stops all medications such as Eliquis. They have medication for pain and anxiety only, known as 'comfort meds'. This should have been explained to your by her Dr.

Once placed in Hospice, the pt no longer has regular Dr visits--maybe only for a UTI, or if the hospice choice is to treat or not treat any kinds of infections.

She's 94 and doesn't sound like she has much quality of life. If this were my mom I would get the Dr to sign off on Hospice and dx all meds except for what I mentioned.

We're there with my MIL. Almost a year now since we were told she had 2-3 weeks. She dxxed her HBP med, her cholesterol med, and she takes 2 different kinds of benzodiazepenes and tramadol for pain. (she doesn't seem to be in pain, but I have to admit I do not see her).

She chose to continue with her shots for Macular Degeneration.

You know, everyone hears that 'if we move mom she'll die'. I personally have never seen or heard of anyone who DID pass simply b/c they didn't want to be moved.
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MJ1929 Dec 15, 2023
Not true. My mother was on all her meds and even started a new one while she was on hospice care. The only thing they took her off was a multivitamin.

We stopped the meds when they stopped working seven months later.
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Care by family committee rarely works. Your mom is 94 and has lived a full life. From what you say she's pretty much apartment-bound and has no quality of life.
Sometimes the POA is selected not because they were the 'favorite', but because the person who asked you to be POA trusted you to have a the ability to step back and look at the big picture, and make hard decisions. You've presented your pros and cons very succinctly here. When your mother requested a DNR I'm guessing she was healthier, and as you say, she didn't have a dementia diagnosis. Dementia in itself is a terminal disease. Hospice is usually recommended when you may be reaching your last 6 months (though people can go on and off of hospice for years).
My mother is 94 with dementia, probably stage 5-6, Otherwise healthy. But if she ends up in the hospital she's going to get fairly basic treatments. I've backed off on a lot of her meds. She wouldn't want to be in stage 7 dementia. She'd be horrified.
So for me, I'd go with the doctor--they're giving you an easy out with your sister because you can say you've decided to follow their reasonable recommendation, given that she's a hospice candidate.
Best wishes.
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I am POA for my mom. My one sister is one board with what I suggest for mom and she's just so thankful that she is NOT POA or responsible in any way for mom's care (she's in AL). When my mom gets to the point of being on hospice, I will be happy to discontinue as many meds as possible. With moderate dementia, incontinence, etc., her life is already pretty miserable and I would not want to do anything to unnaturally extend it.

You and your sisters should not be paying for mom's care. Over $800/month each is A LOT! Time for mom to move to a medicaid nursing home. A move will not kill someone, IMHO. It's never easy for them to adjust but it will be OK. She is 94 and obviously that is quite old by any standard. She is not going to recover. So keep her comfortable and don't confuse quantity with quality. My biggest goal would be to keep her pain free and hopefully content.

If your sisters don't agree with some of your decisions, so be it. Time to do what's right and don't worry about pleasing them. Especially the one you don't along with well anyways.

Best of luck.
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Stop the medication. Regardless of what type of mother she was or your own memories and experiences of her, she has lived a full life and is now approaching the end of it. Keeping someone "alive" with medication is never a good option for anyone, especially the one being kept alive without any standard of living.
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They start withdrawing meds once in hospice. The hospice doc will make that decision. Just get her in hospice.

Also, the quickest way to bankrupt yourself is to pay $900 a month because your mother didn’t plan well for her golden years. Do not pay one dime toward her care. That is your money for your rainy days.
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When my mom was in her end of life hospice care home she was taken off all of her medication except Seroquel and Ativan. She was given morphine for pain.

If your mom can barely walk why is she trying to move around? My mother’s hospice staff had a catheter placed in her and she wore depends. They changed her as needed.

How often is the hospice staff visiting your mom in the assisted living facility?

If you can move mom to an end of life hospice facility or care home that is your best option. My mom received excellent care in her hospice care home.

If you are the POA, you should make the decisions regarding your mother’s care. Your sisters are entitled to their opinions but you were appointed as the person who has the authority to make important decisions.

Don’t be concerned about how your sisters react. Tell them that you are following the doctor’s advice.

Wishing you peace as you continue on in your caregiving journey. It’s never easy. You have our support here on the forum.
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A few points:
1) “I'd be blamed for Mom's death if I were to decide”. M is going to die which ever decision you make. It could be soon or not soon. The Eliquis could kill her, coming off Eliquis could kill her, a fall could be the end, and so could just increasing old age. Whether or not you are blamed, her death will not be your fault.
2) Can all three sisters meet the Doctor for information. Ask the D about the risks on or off the drug, in or out of any facility. Ask if she is still AL level care, or if she would need NH. Then you all go away and talk about it.
3) For the talk, decide the terms on which you will continue to care for her, if that’s the decision, and ask them to do the same. It includes visit length and times, and financial contributions. Make it clear if you aren’t willing to continue your daily visits – that’s not something for them to decide.
4) If YS wants to continue this, she has to commit the same length of time for visits (no matter how inconvenient), and the same $ (or substantially more $ to make up for contributing less time). This is not ‘you being difficult’, it’s the choices all siblings have to make about care. YS can’t opt out of the problems but force her own choices.
5) When you know how each of you would be willing to contribute, and to what, you should know if it's a workable arrangement. If it's not, then you have to use your POA.
6) If it's not clear, and you really don’t want to be the decision maker, you can always flip a coin. Make it valid for 3 months? 6 months? Then to be reconsidered. But in the meantime, you change to ‘the terms on which you will continue”. If your terms don’t include daily visits, you don’t continue them.
7) When this is clear, you personally inform the Doctor of the decision as POA.

Would this strategy work for you?
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We stopped my mother's meds when it became clear they were no longer working.

They won't work forever, so ask the doctor if she's getting any benefit at all from them.
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I know Coumadin causes internal bleeding. There is a problem with the blood not clotting too. If Mom has stage 4 kidney disease she is going to pass anyway. The kidneys will not be able to filter her blood so toxins will build up. She will get sepsis and pass. IMO, I would put her on Hospice. She is 94.
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Thank you for all the thoughtful answers. I appreciate it.
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Southernwaver Dec 15, 2023
My 40 year old friend just died in part because she was taking elliquis. (She had a recent serious medical event). She ended up having a brain bleed and they couldn’t stop the bleeding because she was anti coagulated from elliquis.

Elliquis is not without risks. Perhaps your sisters should look into that.
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Your mother gave you her answer with her DNR. She has declared she doesn't want to be forced to linger.

To your half-sister who wants her to continue living, she needs to realize forcing a woman to continue living this way--and worse is likely in her future--is selfish and cruel. To force a woman to live this way is also an indignity solely because "I want her to".

The bottom line as POA, your decision must benefit your mother.
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Isthisrealyreal Dec 15, 2023
This!!
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some scripts to say to family

"Mom's Doctor wants Mom off of the Eliquis. We are going to a half dose for a month and then we will discontinue per Mom's Doctor."

"Mom's Doctor wants Mom off of the Eliquis. We are discontinuing per his instructions."

"I've had additional conversation with Mom's Doctor. He reconfirmed to stop the Eliquis so we are stopping the Eliquis."
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TopsailJanet Dec 15, 2023
I agree. I would never have made it a topic for discussion, if I'm medical POA, I don't need their input. It is really not helpful. It is too late now, but I would try to listen to their opinions, thank them for their input, and go on as I think best.
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I also freaked out when my mom's doctor advised reducing some of the medications she had relied on for decades because I was sure without them she would stroke out, and the possibility of a non fatal stroke was my worst nightmare. But my mom continued on exactly as she had been; maintaining her gradual, unrelenting descent into frailty and dementia, and in the end it wasn't heart disease or stroke that caused her death.
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AlvaDeer Dec 15, 2023
I think you are so right. You know folks often thing that medications will either help or will do nothing, but the truth is that they can all have bad side effects. My partner has battled GERD for years and a doc put him on very heavy doses of pepcid (famotidine) and I kept saying to him "That's way too much. If 20 mg twice a day doesn't do it, either will THIS much) and he kept saying "You can get it over the counter and it's clearly perfectly safe and MY DOCTOR SAYS............." So I gave up. So he gets a new doc when that one retires and the new doc says "Whyever are you on this much famotidine!!!!" He said "Well, the GERD". And the new doc says "Well, yeah, the GERD is one thing, but this stuff can DESTROY your kidneys at this dose over time". HA! And not funny.
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I read somewhere recently that people reaching EOL and once taken of meds and eat less or almost nothing is not such a bad thing.
Apparently they often reach clarity and happiness as all those chemicals leave their system. Makes sense to me.
Perhaps if there is conflict between siblings it will be best for doctor to make decision.
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Whoever has the health proxy should decide. Looking forward, she will soon become bedbound so falls will not be a problem. However once this happens, the AL will soon push for NH or bumping up need for additional private help. Then comes inability to swallow pills. So it becomes you and your siblings willingness to continue prolonging her life and watching her suffer.
Getting back to your health proxy. I recommend that you make the decision and not fill in the details to sibs. This leads to less discord and prevents your sisters second guessing and elevating tensions that may be long lasting.
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That drug is not keeping your Mom alive! My Dad’s doc put him on a variation of that after ONE afib instance, IN HIS LIFE! One month later I called and asked about his high fall risk, 90 yrs old, very weak in assisted living, had to argue with the doc! He was covering his own a**. I took him off. Here we are two years later, MULTIPLE FALLS (can’t count them all!) no heart issues. He could’ve bled out on a lot of those falls. Nuts! Gotta make your own informed decisions. They call it PRACTICING mediocre a reason! Good luck. I know what you’re going through.
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