END OF LIFE CARE June 2011 Group 6
CAREFUL CONSIDERATION (TYPES OF CARE)
HOSPICE CARE Focuses on relieving pain, controlling symptoms, and meeting emotional needs and personal values of the terminally ill.
Can be given in a patient's home, hospital, nursing home or a private hospice facility.
PALLIATIVE CARE Treatment of a terminally ill patient's symptoms in order to make dying more comfortable.
May be given at any time during a person's illness, from diagnosis onward
CURATIVE CARE Consists of treatments and procedures directed toward curing a patient's disease
However, when the patient's disease is incurable and death is imminent, Hospice and Palliative care may serve the dying patient better
WHAT SERVICES ARE PROVIDED? • Manages the patient’s pain and symptoms by providing necessary drugs and supplies. • Assists the patient with the emotional, psychosocial and spiritual aspects of dying • Coaches the family on how to care for the patient • Delivers special services like speech and physical therapy when needed • Makes short-term inpatient care available when pain or symptoms become too difficult to manage at home
• Provides bereavement care and counseling to family and friends of the patient
GOALS OF THE CARE TEAM Support the quality of life of the patient Honor the patient's wishes Maintain dignity of the individual
Support family through the grief process
THE COSTS OF CARE Covered by Medicare, Medi-Cal, HMO's, and most private insurance providers
No one is refused service due to the inability to pay
WHERE CAN I FIND CARE SERVICES?
"You matter because of who you are. You matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but also to live until you die." - Dame Cicely Saunders
THE STAGES OF GRIEF… A normal life process “ Grief can't be shared. Everyone carries it alone, his own burden, his own way.” --- Anne Morrow Lindbergh
DENIAL…THE 1ST STAGE “ This is not happening to me.”
When given the terminally ill diagnosis, they do not want to face the reality. Patients blames the doctor or hold on to the beliefs that there was a mistake made in the diagnosis.
ANGER THE 2 ND STAGE “ How dare God do this to me?”
When denial no longer works, patients will resort to rage and resentment. The patient cannot believe that their bodies are failing and of losing control of their lives. There might be a period of anger towards their “Gods” and a loss of faith in their belief system.
BARGANING THE 3 RD STAGE “ Just let me live to see my son graduate.” Patients might startnegotiating with their doctor, caregivers or mainly their “God” in hopes to be given additional
time to get their affairs in order. Considered an end-of-life crisis, where the patient might want to do or say things that they could not do while still alive and healthy.
THE 4 TH STAGE- DEPRESSION “I can’t bear to face going through this, putting my family through this.”
The most common reaction for patients who know what they have to face; such as physical pain and loss of material possessions and wealth. The patient knows what they have to lose, such as family members, spouses, and the legacy of their life they leave behind.
5 th Stage--Acceptance
“I’m ready. I don’t want to struggle anymore.”
The 5 Stages of Grief When the patient has worked his/her way through the previous stages, the patient might be at peace with dying and gradually accepts their dying as a process in life.
Certain patients might hold on to other stages of grief or the acceptance stage can be taken quickly.
SIGNS THAT DEATH IS NEAR Slower metabolism= Fatigue, sleeping more, eating and drinking less. Altered senses= Irregular breathing, changes in breathing patterns such as periods of apnea lasting 10-30 seconds or more, Cheyne-Stokes breathing patterns consists of irregular shallow breaths alternating with apnea, happens when death is a matter of minutes or hours. Heavy breathing with mouth open and sleeping with eyes open. Altered Seeing= Clarity of physical vision decreases.
Unpredictable hearing= Hearing is the last sense to be lost.
PHYSICAL SYMPTOMS Elimination= Constipation due to decreased activity, decreased food and drink or increased use of pain medications. Decreased circulation= Skin of extremities might be cool to the touch or deepen in color (cyanosis).
Oral secretions= “Death rattle”
SOCIAL SYMPTOMS OF DEATH
Making a Smooth Transition Talking to loved ones
HOW TO BEGIN Try to confront and understand any fears you might have: Do they relate to the possibility of pain? Loss of dignity while undergoing treatment? Not being clearly understood? Being alone? Being overly-sedated or in a lingering state of unconsciousness? Leaving loved ones or unfinished projects behind? Leaving your loved ones without adequate financial resources?
Dying in a strange place?
TALKING ABOUT END OF LIFE Whom should make decisions for you on both financial and health care decisions? What medical treatments/care are acceptable? Cardiopulmonary Resuscitation ( CPR ) Do Not Intubate Order ( DNI ) Artificial Nutrition and Hydration Do Not Resuscitate or ( DNR ) Prefer hospital, home or elsewhere care?
Costs associated with care? (Insurance)
WHAT’S NEXT? What actually happens when a person dies?
Will your loved ones be prepared to make decisions?
ADVANCE DIRECTIVES “ Advance directives” a legal document that allows you to plan and make your own end-of- life wishes known in the event that you are unable to. Consist of: (1) a living will —describes your wishes regarding medical care. (2) a durable power of attorney —you can appoint a person to make healthcare decisions for you in case you are unable to speak for yourself.
Every state recognizes advance directives, but the laws governing directives vary from state to state.
DURABLE POWER OF ATTORNEY The durable power of attorney names someone to make medical decisions for you when you are not able. The person you designate is called an agent. Document deals with all medical decisions . Your agent will have access to your medical records unless you limit this right.
Select someone you trust, family member or good friend, who understands your wishes and feels comfortable about the type of medical care you want to receive.
LIVING WILL A living will is an advance directive that guides your family and healthcare team through the medical treatment you wish to receive if you are unable to communicate your wishes. According to your state’s living will law, this document is considered legal as soon as you and a witness signs it. A living will goes into effect when you are no longer able to make your own decisions.
Not all states recognize separate living wills as legally binding; California does not.
Different Perspectives- How do other cultures celebrate death?
DAY OF THE DEAD
Depending upon the region,the details of the celebration differ, nevertheless the spirit of honoring the dead remains the same
OBON JAPANESE FESTIVAL Obon is the festival of the dead in Japan which honors one's deceased ancestors for three days each summer
Celebrated typically around August 13-15.
OBON FESTIVAL CELEBRATION During the summer festival, special altars are made for the deceased, special foods are made and graves are cleaned Bon Odori(folk dance) is practiced
People send off their ancestors' spirits with the lanterns, lit by a candle inside and floated down a river to the ocean
P'chum Ben “ ANCESTOR’S DAY” Cambodia
P'CHUM BEN People cook meals for monks, bring offerings to the temple and throw rice near the temple early in the morning, believing that the ghosts of their ancestors will receive it.
According to Khmer belief, those who do not follow the practices of P'chum Ben are cursed by their angry ancestors
THINGS TO REMEMBER ABOUT DEATH… An intercultural and intergenerational experience Death is celebrated, not feared
The deceased are remembered
Which US President’s pet was removed from his funeral for swearing in 1845?
What was the name of the person who died when he fell into a vat of chocolate and drowned at a in Pennsylvania cookie factory?
Question 3 C) Champagne Cork
What are you most likely to be killed by?
In which country do people dig up the bones of their loved ones and dance with them?
What household product do some humans turn into after they die?
If injected intravenously, what spice can kill you?
THANK YOU! “ It’s sometimes unpredictable, but in the end is right. I hope you had the time of your life.”
Billie Day Armstrong, Green Day, “Time of Your Life”