Sunday, September 5, 2010

End of Life Care


When a person's health is in a position where they aren't expected to live for more than 6 months, then end-of-life care comes into play. We all think of hospice care as a facility like a hospital, clinic or a home. It is, in fact, a service rather than a facility. In 90% of the cases, hospice care is provided in the individual's own home.

Under hospice care, a team of people are involved, including the doctor, nurse(s), therapists, volunteers social workers and nurses aids. When deciding on hospice care, the patient and the family has made a decision to refuse additional treatment to cure the ailment. The focus of the team is to make the patient comfortable and relieve any pain he/she may be experiencing.

A big part of the hospice service is the counseling either through faith-based by pastors or via psychologists to prepare the patient and the family members for the expected passing of the individual. And the approach differs based upon a person's cultural and religious beliefs. The Christian, who believes in redemption may seek the following (as expressed by a speaker from Hospice Hawaii): 1. I forgive you. 2. Will you forgive me? 3. Thank you. 4. I love you. 5. Goodbye. That completes the acceptance process of death for that belief system.

A person of another belief system may look at impending death as if one would be looking in a mirror, which reflects how one lived. I would guess that making a list of what the dying person contributed to society and his fellow man would help him/her accept that his/her life was good. Either way, the grief counseling helps them to complete their unfinished work in their relationships.

Someone much wiser than me once said that those facing death usually don't have regrets for what they did in life, but what they did not do. Those who have regrets generally fear death.

By far, most people who utilize hospice care have cancer, followed by end stage heart diseases, end stage liver disease, dementia, lung disease and end stage kidney disease. In many cases, the family members and loved ones are impacted to a greater degree than the one facing death. And certainly, many suffer severe disabling depressions after the death. I know of a number of people, mostly women, who suffered from PTSD as well as schizophrenia. Some can't even leave the house to go to the grocery store unless heavily medicated.

Family members or informal caregivers provide a number of functions to help. They provide companionship, assist in running errands, help in organizing medications, communicating with doctors and nurses, preparing meals, provide transportation and helping to manage the finances. Hospices are always looking for volunteers to help with these functions.

Hospice organizations are always in need of people to work in the office organizing, filing, inputting information on the computers and freeing the paid staff to do other work. Two people, Gail and Phil have been volunteering at St. Francis West for as far back as I can remember. The staff truly appreciate their services.
Phil and Gail in the lobby of St. Francis West

Two organizations in Hawaii that do a good job are St. Francis hospice and Hospice Hawaii.

Even though one of the hospice organizations listed above is a Catholic organizations, the services and spiritual counseling offered are diverse. Both my parents passed away at St. Francis Hospice's facilities and they were both members of the Buddhist faith. So there are no pre-packaged hospice services because everyone comes from a different cultural, economic and religious backgrounds.

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