Hospice
Becoming a hospice patient means giving up hope.
Myth.
Hospice is about helping people enjoy the best possible quality of life. Hospice patients are encouraged to live life to the fullest.
To qualify for hospice, you must need to demonstrate needing extra support of an aid for personal care.
False.
To qualify for hospice, you must have a life-limiting illness (i.e., cancer, heart disease, stroke, or end stage Alzheimer's) w/a life expectancy of 6 months or less, if the disease were to run its normal course.
Forgiveness
Correct.
May seek forgiveness, be asked for forgiveness, or need to reconcile differences.
Help them achieve this if possible and reassure them of forgiveness.
Warmness
False.
Coolness - circulation decreases and skin may feel cool and appear blotchy or blueish.
Keep them covered with a blanket, though they may not want to be covered.
Give medications, bath or do anything you need to do first - no need to explain first.
False.
Tell the patient when you will be doing something such as changing the bed, or bathing and explain each step als you go.
Hospice is for those who are close to death or actively dying.
Myth.
The earlier the need for hospice is identified, the more benefit the patient may potentially get from the care. This leads to a higher quality of life for patients with life-limiting conditions.
Increased assistance is needed with activities for daily living.
Fact. When there is a decline in completing the activities below, it becomes an indicator of decline.
Eating: Ability to feed oneself using utensils.
Bathing: Maintaining personal hygiene.
Dressing: Putting on clothes, including managing buttons and zippers.
Toileting: Using the toilet safely and maintaining continence.
Grooming: Brushing teeth, hair care, shaving, and nail care.
Ambulating: Moving around, including walking, standing, sitting, and climbing stairs.
Calmness
False.
Residents may appear to be restless or agitated.
Give them words of comfort, be calming and talking about favorite experiences.
Sleeping or confusion/restlessness
True.
Increased sleeping and unresponsiveness; when awake may not know where they are; increased confusion may make them appear restless.
Keep them company and speak in a normal volume, identify yourself and speak calmly to reassure them.
When experiencing confusion, leave the resident alone for prolonged periods of time.
False.
Confusion may happen for a number of reasons, including low blood sugar, high fever, disease process, metabolic changes, lack of exogen, too much medication or severe pain.
Confusion worsens at night. It is helpful for a confused person to have familiar people around. Call hospice if the person becomes confused all at once.
Patients must sign a DNR (do not resuscitate) form.
Myth.
Patients to not have to have a DNR or other advance directive to receive hospice care with Heartland Hospice (but may with other providers).
Multiple falls
True.
Falls in medically fragile individuals often precede a transition to hospice care due to their significant physical and psychological consequences.
Mobility and strength issues: Weak muscles and frailty reduce balance and stability.
Coordination and gait problems: Neurological conditions like Parkinson’s or stroke affect movement.
Sensory deficits: Impaired vision increases the risk of missteps.
Footwear and foot health: Poorly fitting or slippery shoes contribute to falls.
Medical and cognitive conditions: Chronic diseases, cognitive impairments, and polypharmacy can increase fall risk.
Blood pressure changes: Orthostatic hypotension may cause sudden loss of balance.
Visions or Unusual Communication
Fact.
Comments may be made out of character, speaking to people not visible to you.
Do not argue with their claims but assure that the feelings are normal and natural.
Fluid or Food Increase
False.
Decreased desire to eat or drink is normal.
Do not try to force any food or drink, but offer ice chips or frozen juices.
Giving the patient control even in small ways, becomes very important. Being flexible helps.
True.
Loss of control over aspects of life (i.e., when to eat, when to sleep, bathe, or move around) sometimes make the person feel irritable, angry or sad.
The Medicare hospice benefit covers only six months of care.
Myth.
The Medicare Hospice Benefit covers the care of a hospice patient as long as the patient is considered terminally ill with a life expectancy of six months of less.
Skin breakdowns
True.
As patients near the end of life, the body redirects blood flow to vital organs, resulting in reduced circulation to the skin and extremities.
Combined with factors such as weight loss, dehydration, immobility, loss of subcutaneous fat, and incontinence, the skin becomes thinner, cooler, fragile, and highly susceptible to pressure injuries, tears, bruising, and infection
These changes are natural and do not indicate poor care; even with diligent preventive measures, skin breakdown can occur.
Withdrawal
True.
Unresponsiveness, or detaching from people and surroundings.
Continue to talk with them in normal volume as they may still be listening to you as they begin to let go.
Congestion in the lungs or throat.
True.
Gurgling sounds or inability to cough up secretions' sound like marbles rolling around, possibly loud.
By turning the head to the side to allow gravity to drain secretions or gently wipe the mouth with a moist cloth.
Explain away and contradict any nearing death awareness they may be experiencing.
False. Don't contradict, explain away, belittle or argue with them. These experiences can be very comforting to the patient.
Be present with them. Simply sit at their bedside. Listen attentively and sensitively and acknowledge the experiences.
Ask gentle questions about what they are saying or doing. "Who do you see?" "What are you seeing?" "How does that make you feel?"
Hospice care is expensive.
Myth. Hospice is a covered Medicare Benefit, and most private insurance and Medicaid will also cover services.
In addition, medical equipment and prescriptions related to the life-olimiting condition are often covered under these benefits. Hospice care is available to all eligible patients regardless of their ability to pay.
Increasing shortness of breath.
True.
Increased shortness of breath (dyspnea) is a common and often distressing symptom that can signal the progression of the underlying illness or changes in the patient’s physiological state.
Holding on
True.
They may want to hold on to make sure those left behind will be alright.
Release them from their own concern and let them know they may let go whenever they are ready; saying goodbye or "I love you".
Regular breathing patterns
False.
Irregular patterns with periods of no breaths for 5-30 seconds, up to a minute called Cheyne-Strokes breathing; also rapid, shallow breaths or panting.
Try elevating their head or turning them onto their side; hold their hand and speak gently to them to let them know you are there.
Allow the person to speak openly and honestly about their feelings and issues.
True.
The resident may fear being alone, of dying, of going to sleep.
Dying is an emotional and spiritual journey. Each person involved may feel a wide range of emotions. You and the person facing the OEL may experience emotional and spiritual reactions as you prepare for death.