Final Goodbyes to a Dying Patient in Hospice Care

When a person learns they have a limited time left to live, they go through a grief process. Concerns about loved ones who will be left behind, practical matters that must be addressed, and accepting death are all major concerns for the dying patient.
Patients in a hospice program have access to professionals that not only care for their physical needs but also address other end of life issues.

Fear of death is a common concern, but most people fear even more the pain associated with the progression of their terminal illness. Teaching can prepare the patient and family as to what they can expect as the disease progresses, what measures can be taken to assure comfort and freedom from pain. This teaching can be done by the patient’s physician, as well as hospice nurses in the patient’s home.

Many family members try to protect the patient by requesting they not be told of their terminal diagnosis and that hospice workers not refer to “hospice” when they are in the home. This is detrimental to the patient in most cases. By the time a person gets to the stage that hospice is called, they are aware of their prognosis whether or not it is discussed. Denial usually serves the family more than the patient, and is really unfair to the dying person. Each person deserves to have the knowledge they need to make informed decisions about the remainder of their life, to say their goodbyes, and to prepare himself for death.

Discussing death is never easy and tears are to be expected, but one should not let fear of emotions prevent them from saying the things that need to be said. This is a time to make needed apologies, express one’s love for another, and discuss practical matters such as finances and funeral plans. Death is much easier when a person knows the family won’t be left with all the burden of making arrangements.

Hospice provides a licensed social worker who will visit the patient’s home and assess the social needs of the patient. Social workers can help with Living Wills, Powers of Attorney, funeral arrangements, and in the case of financial hardship can direct the family to government and community programs that can provide assistance. Many people do not understand the scope of social services a social worker is trained to provide. Social Workers can also assess the psychological and social needs of the patient, recommending nursing home care when requested, aiding the caregiver in many practical matters.

A dying patient, even when he or she has never been a religious person, will usually have spiritual concerns. No matter what their beliefs they want to have peace spiritually when facing death. A hospice chaplain can visit and discuss these concerns and provide guidance and comfort. Rather than promoting a certain religious dogma as many ministers do, a hospice chaplain meets the person where they are spiritually and helps them make peace in a personal way. If a family requests visits from a priest or minister, the chaplain can also arrange that. Chaplain can lead the patient in a life review, which can relieve any feelings of guilt from the past and provide a peaceful departure from this life.

As the illness progresses, visits from hospice workers increase in number, and pain management becomes a major concern that is constantly monitored and adjusted as needed. Pain medication by mouth or rectally, or by IV can be administered. Pain medication is prescribed by the patient’s physician and monitored by the hospice nurse. She is able to contact the physician twenty-four hours a day to request additional comfort measures as needed. Hospice nurses are trained to look for non-verbal signs of discomfort, such as wincing or grimacing. Every effort is made to keep the patient as comfortable as possible.

When the patient dies, the hospice nurse consoles the family, calls the funeral home of the family’s choice, contacts the required legal authrorities such as the coroner, and notifies the physician. The chaplain is available and can conduct the funeral if requested. Bereavement services are then provided to the patient’s loved ones for up to a year as needed.

Dying does not have to be a painful or frightening process, if the patient is allowed to be informed, make decisions as long as possible, and be made comfortable. Hospice can make the transition easier by easing some of the burden the patient and family may face.

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