Hospice care

One of my jobs at the nursing home is to take care of the hospice patients, along with my long term residents. The only real difference is that there is a help a phone call away when a patient is hospice. If you have a question all you do is call and they will walk you thorough the problem or situation and give you any needed guidance, or they are there to bounce off what you are thinking, in the middle of a problem that involves a hospice patient. I love working with the hospice staff when they are in the facility. They are a true blessing. 

We often will have assistance from hospice when the patient is getting closer to death. It can involve anything form 24 hour nursing care that hospice will prov ide for the resident to a volunteer sitting with the patient around the clock to give the family members a break, and be ensured that their loved one will not be left alone. It should be stated that once a patient becomes hospice the level of their care does not change by the nursing home staff. They are still care for as they were prior to them becoming hospice. Once they are hospice it does not change the fact that the patient is dying, but hospice does not prolong the process or hurry the dying process. It is an individual expericene that varies according to each person. They all progress through the same stages, but some go quicker or slower then others. The hospice patient can also last longer then what one may think. We have had several patients that were hospice, actually start to thrive and do well, thus they are taken off hospice since they are expected to live longer then the 6 months that was predicted when they were admitted to hospice.


As a nurse with hospice patients we deal with death and the administration of pain medication and other liquid meds that are ordered by the hospice MD. The purpose of these medications is to keep the patient comfortable as they progress closer and closer to death. We use the liquid meds when the patients progress to the point where they are not able to swallow pills or become unresponsive to verbal and tactile stimuli. At this point they are able to swallow the liquids and are able to get some relief from the pain and anxiety that they are experiencing as they progress in the dying process.

Part of our job at this point is to administer the medications every hour to every 2 hours around the clock to  control the pain of the dying patient as they progress closer and closer to death. Hospice is very good about controlling the pain in their patients. They meet with the patient often to ensure that they are not experiencing any pain and if they are they will adjust the medications accordingly. 


We are there to support the family as their loved one makes the journey to the other side or towards heaven. We assist in calling the minister to have them anointed, along with giving them emotional support at this time. We are there in the nursing home and are communicating with them what is happening to their loved one as they get closer and closer to death. 

After the death of the patient / resident hospice will continue to follow the family and provide counseling, and continued support for the family up to a year after the death. They will continue to help the family deal with the loss of their loves one. 

http://www.hospicenet.org/index.html


 

The Guilty Left Behind

Being a nurse that works with the elderly, I deal with dying a lot, not daily but often, it comes with the job. I end up watching my residents die and helping them in some sense move on to heaven. I am there to give the medications, keep them comfortable, when they are restless, talk to them, hold their hand, and let them know it is ok to let go and to move onto the other side. It all come with the job, yet there is an annoyance that come with all of this too.....that is dealing with some of the residents families! The ones that you haven't seen in years, the ones that never call or even bother with the resident, until the end is near. When you have to call the family to let them know that their dealy beloved is declining and dying, yet not telling them that they are dying all at the same time. As the days shorten and they move closer to death we call again to update the family that their beloved is approaching the end of their life. Then the fun begins.........they come in and now question every move and that you make, along with wanting to know why this is happening now, they were fine a week or so ago! Yet, did you call them a week ago? Have you been in to see them? Sadly, unless you are the residents power of attorney or on that list that says we can talk to you about the resident, we cant tell you a thing over the phone or in person with out permission. It is the law. Now with that said, when the families do come in, and some are a emotional wreck, while others I am not too sure of their status, other then they are there to watch them pass on. Until the guilty ones walk in, now they are the fun family members. They are the ones that cry at the moment and try to tell the nurse that their dying family member is not that bad, they will pull through this, that this is just temporary thing! Now they are here to visit, they wont leave the residents side other when aides and nurses need to tend to the resident. It is then that they will walk out of the room. Then promply return and sit in with the resident, this is the funny thing though, they are not talking to the patient that is dying, they are not telling stories to them, no stroking their hair, not holding their hand, NO! They are not there for the dying family member they are there because they are obilgiated. They are there to sit and talk among themselves about everything that is going on in the world other then the issue that is at hand. They are sitting in the room watching t.v and act as if it is the nursing job to wait upon them hand and foot! Now granted we bring in food, coffee and juice for them, but this is not a joyous time, they are dying! Yet, now they want to be all involved in there care, know everything that is happening, and yes they too expect us to know how long will this whole thing take? What? I don't have that answer, talk to God, I can judge a little, depending on what is going on but they all go when they are ready not when we think they are ready. They want to know why and we explain to them the dying process and answer all their questions, but asking me their care for the last 2 to 3 months is not going to change the fact that they stop eating, they stop participating in some activities. We cannot make them eat, drink or any other thing in the nursing home. It is all part of the dying process, they all go through the same steps, and if you are not here and do not call and check on them, we cannot force you to care for your family member that you left here for us. It is so sad to watch some o them go, but it is even sadder when the family is there and you can tell it is all out of obligation, and not out of love, care and concern for them. Then when your guilt sets in, we will help you grieve, but we are not there to take your guilty conscious away, that is now between you and the dying and God!