Hospice is a care plan to support a terminally- ill elder. To undergo this care plan, an elder must have less than six months to live as certified by a physician. The elder’s diagnosis could include cancer, renal failure, emphysema, Alzheimer’s disease, dementia, or any other terminal condition. In a Hospice, trained care teams provide holistic care (physical, emotional, social, and spiritual) to the elder. Family members of the elder may also need psychological counselling.
Hospice broadly focuses on comfort measures and not on curing the illness.
1-3 MONTHS PRIOR- Withdrawal Stage
Death is unique to every individual. It comes in its own time and own way. You may notice some of these changes in the elder nearing the end of his/her life:
Withdrawal: The elder starts withdrawing from the outer world and becomes more quiet and introverted. His world becomes smaller -often involving only close friends and immediate family. The elder takes more naps, stays in bed, and sleeps most of the time. He may even stop talking.
Food: Food is a source of energy that allows us to live. When the soul is preparing to leave, the body starts rejecting food. A steep decline in the appetite of the elder can be noticed. The elder starts preferring liquid diets over solids as it allows easy digestion. Cravings may still be present depending on the elder’s personality.
1-2 WEEKS PRIOR- Disorientation
The elder sleeps most of the time and cannot keep his/her eyes open for long. He remains in a confused state of mind. The elder may start reminiscing about his past and talk about people who may not exist anymore. The elder is in the transition stage to the next world.
Some physical changes as described below may occur:
Lower Blood pressure.
skin complexion changes.
Erratic breathing rhythm.
1-2 DAYS/HOURS PRIOR
Physical changes are more pronounced just one or two days before. These may include:
A burst of energy
A glow in the eyes, glassy haze. Eyes may be open or, semi-open.
Breathing patterns become slower and irregular. Chest congestion may be audible.
Hands and feet become purplish.
The elderly may not respond much.
Emotional Response of Family and Friends
Everyone uniquely displays their emotions; some may not display at all. That does not mean that they are not grieving. It is quite normal. Some differences in grieving are as under:
• Some are quite loud; some are quiet.
• Some accept the fait accompli; some just cannot accept
• Some may go in denial or shock; especially the spouse and children.
• Some may cry; some emotionless.
• Some get real angry; some may seemingly look happy.
Emotional Response of Care-Givers:
The caregiver maybe a family member or someone who was entrusted with the job. The caregiver established a bond, a connection with the departing soul and he or she also goes in grief just like a family member. The caregiver may try to leave the job or take a long break. Emotionally, these are difficult times for one and all. Ample emotional support, counseling by a professional may be required at this stage. Meditation in complete silence and prayers helps.
It helps to express your feeling verbally or in writing. One needs a release from choked emotions.
Religious and Cultural issues:
The care team should be aware of religious beliefs and cultural practices of the faith of the elderly they are providing care. These are sensitive issues that need careful handling especially at the time of death.