ERIE'S ORIGINAL HOSPICE: INDEPENDENT AND NON-PROFIT.
The Phoenix symbolizes the human spirit's ability to rise above life's most painful moments.
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THE FINAL DAYS
LOVE MATTERS MOST
Your loved one's comfort and dignity will always be our priority. We will consult and work with the physician and family to meet your loved one's needs until they pass on. Staff is always available to talk with you about your feelings, especially regarding difficult issues.
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Read the information provided below to prepare yourself your loved one's final days.
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"We cannot teach the dying how to die. If we are there, however and if we are paying attention, they will teach us."
-Judith Viorst
WITHDRAWAL
ONE TO THREE MONTHS PRIOR TO DEATH
Your loved one does not make a conscious decision to withdraw form the world and the people around them. It just happens.
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Continue to keep your loved one well informed, especially of family matters and former areas of interests. They may not respond, but that does not mean they are not hearing the information. If your loved one does appreciate visitors, shorter contacts (10-15 minutes) will be less tiring. It is good to allow your loved one to make their own choices.
INCREASED SLEEP
ONE TO THREE MONTHS PRIOR TO DEATH
This is the beginning of a time when a person withdraws from everything outside of one's self and goes inside - to "review" their life, sort things out, and hopefully come to peace with the life they lived. With this comes increased sleep (or the appearance that the person is sleeping). A morning nap may be required as more time is spent in bed.
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We want to encourage you to allow your loved on to sleep more and respect their need to be alone. Their "awake" times will be more beneficial and meaningful to you and your family/friends.
LESS COMMUNICATION
ONE TO THREE MONTHS PRIOR TO DEATH
Don't take it personally if your loved one does not want to talk. They have less energy and focusing on a conversation can be difficult. Words are seen as being connected with the physical life that is being left behind.
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You may wish to be silent and along with your loved one during these times. Hold their hand or lie beside your loved on, communicating the comforting assurance your presence brings.
DECREASED FOOD
ONE TO THREE MONTHS PRIOR TO DEATH
Your loved one's metabolism will continue changing, food is no longer being processed toward energy and health, so it is perfectly natural that eating should decline and gradually stop. This should never be confused with starvation. At this particular time your loved one's life, it is part of a bodily process of "letting go." A different energy is now needed that usually flows from a person's spiritual beliefs. This will sustain your loved on.
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Offer suggestions of small food or snacks at intervals throughout the day. Don't force food. Let your loved one be in control.
MENTAL CONFUSION
ONE TO TWOÂ WEEKS PRIOR TO DEATH
When a person is approaching death, it is common to become increasingly confused and have less of a sense of time, place, and even the identity of close and familiar people. The person often talks to people and about places and events that are of the past or unknown to others. They may be disturbed by dreams or see and converse with loved ones who have died.
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Hospice can assist in making sense of this process, helping family and friends find peace in this natural process. You may want to listen closely to your loved one, because he or she may say a word or phrase that contains significant information or requests. Remind your loved one of where they are, the day and time, who is present in the home and who is talking to them. This is best done in a casual and calm conversational manner. Your presence and frequent touch is reassuring at this time.
RESTLESSNESS
ONE TO TWOÂ WEEKS PRIOR TOÂ DEATH
As the oxygen supply to the brain decreases, your loved one may become restless and/or agitated. You will notice them possibly picking or pulling at their blankets or bedclothes, and demonstrating random arm movements. There is a seeming aimlessness to all physical activity.
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You may want to talk calmly and assuredly with your loved one to not startle or frighten them. Reassure your loved one of your presence. Soft music or a back-rub may be helpful.
INCONTINENCE
ONE TO TWO WEEKS PRIOR TO DEATH
Your loved one's body becomes relaxed, sometimes due to the dying process, sometimes due to comfort medications. It is not uncommon for a patient to lose control of bowel and bladder function.
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It is important to explain to your loved one that what has occurred is a result of medications being taken or of their weakened condition. This is an embarrassment to your loved one and they should never be blamed. Keep chux or waterproof padding under the patient. Adult Depends or adult diapers can also be used (always refer to them as "adult"). These protective pads should be changed, when soiled, to keep the patient comfortable. Gently wash the groin and rectal areas after each urination or bowel movement.
BREATHING CHANGES
ONE TO TWO WEEKS PRIOR TO DEATH
You may notice that your loved one's breathing patterns change from time to time. It can become irregular, with periods of no breathing for 10-30 seconds. These periods are referred to as "apnea." This symptom is very common and indicative of a decrease in circulation and buildup in body waste products. Respiration may increase and then again decrease, presenting no discomfort to the patient.
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If your loved one is resting comfortably, allow them to continue to rest. You can raise the head of the bed if your loved one breathes more easily this way, or offer to change their position.
BODY TEMPERATURE AND PULSE
ONE TO TWO WEEKS PRIOR TO DEATH
As your loved one's body continues to be unable to maintain itself, the pulse beat will usually increase significantly from a normal of 80 to upwards of 150 beats per minute. As the heart "wears down," the beat will then begin to decrease and slow down until it can no longer be felt or detected. The body temperature can also fluctuate between hot (fever) and cold due to the body's inability to control its own temperature. Perspiration can increase, often with clamminess. As circulation slows down, the patient's arms and legs will become cool and may be bluish in color, especially the nail beds.
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Blankets can be provided or removed as needed for the patient's comfort. Never use an electric blanket at this time. Sponge the patient with a cool washcloth if this promotes comfort. Change perspiration-soaked garments and bed linens. Tylenol (liquid or suppositories) may be ordered for the patient if the patient's temperature rises to a level of discomfort.
SPEECH, VISION AND HEARING
ONE TO TWO WEEKS PRIOR TO DEATH
As your loved one makes efforts to communicate with you, you may experience a sense of frustration as their speech may become difficult to understand. The lack of understanding may make you feel as though you are not "pleasing" your loved one. Vision can also fail and your loved one's eyes may become dry, sunken or glazed over in an apparent stare. The last sense to be lost is hearing, and it may remain acute up until the time of death. Never say anything in the patient's presence that would make him or her feel uncomfortable or uneasy.
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If you have difficultly understanding your loved one's speech, let them know you are having difficulty and it's due to their weakness. You may want to have a list of basic needs that they can respond to with "yes" or "no." Reassure your loved one that someone will always be around to provide their care.
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If it's apparent that vision is failing, keep your loved one well informed as to who is present, and of the day and time. A warm damp cloth can be used to remove any eye secretions, and eye drops may be given if necessary. Keep the room as light as the patient wishes, even at night. Carry on all conversations as they can be heard, but don't ask unnecessary questions of your loved one if verbal communication is difficult or impossible. Soothing music may be enjoyed, as well as conversation from family and friends.
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This is an excellent time to express love and caring. Though it is also a good way to be with a patient by giving a gentle massage or simply holding the patient's hand.
DAYS TO HOURS PRIOR TO DEATH
THE FINAL HOURS
The last few days of your loved one's life can sometimes be more "tolerable" if your attitude is one of letting go and releasing your loved one from this life. Both of you are facing a separation and can frequently work on this painful task together. We encourage that you give your loved one "permission to die." In this way you release your loved one from the struggle of feeling "I know I can't stay and I don't feel like I can leave." Let your loved one know you'll miss them, but you will be okay. Saying "good-bye" is your final gift of love, and is one of the greatest gifts you have to give. Saying "good-bye" can be done in many different ways.
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Don't hide your tears or apologize for crying. Tears express your love and can help you let go.
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