END OF LIFE CARE

June 2011Group 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

• Comfort 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 2ND 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 3RD 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 4TH 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.

5th 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.

• Pain• Decreased circulation= Skin of extremities

might be cool to the touch or deepen in color (cyanosis).

• Oral secretions= “Death rattle”• Restless Behavior• Apparent Confusion

SOCIAL SYMPTOMS OF DEATH

• Cognitive/Social• Withdrawal= Unresponsive• Decreased socialization• Unusual communication• Vision-Like experiences

Making a Smooth Transition

Talking to loved ones

HOW TO BEGIN

• Start with yourself. – 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

• October 31-November 2

• 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

Question 1

• Which US President’s pet was removed from his funeral for swearing in 1845?

A)Barack Obama B)Abraham Lincoln C)Andrew JacksonD)Henry Ford

Question 2

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?

A)Mr. PeanutsB)Mr. GoodBarC)Willy Wonka D)Robert Hershey

Question 3

• What are you most likely to be killed by?

A) Poisonous Spider B)Public SpeakingC)A computer virus C) Champagne Cork

Question 4

• In which country do people dig up the bones of their loved ones and dance with them?

A) United StatesB) Madagascar C) PhilippinesD) Germany

Question 5

• What household product do some humans turn into after they die?

A)SoapB)Shaving Cream C)Birthday Candles D)TV Remote Control

Question 6

If injected intravenously, what spice can kill you?

• A) Cayenne Pepper • B) Cinnamon • C) Tumeric • D) Nutmeg

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”