Quality care at the end of life addresses a person's physical comfort, daily care, and emotional and spiritual needs. If you're caring for a family member or friend who's approaching the end of life, learn what to expect and how you can support end-of-life care.
Best practices in end-of-life care
If a friend or family member has a life-limiting illness or is nearing death, you'll likely hear the terms "palliative care" and "hospice care."
Palliative care is care to alleviate pain and manage barriers to a good quality of life while undergoing treatment for a serious illness, such as cancer. Palliative care may begin early in treatment and continue even after disease treatment ends.
Hospice care is a service for a person who has discontinued disease-fighting treatments and is preparing to die. Hospice care services provide a means to monitor end-of-life care needs, coordinate professional and family caregiving, and address the entire spectrum of needs at the end of life. This care can be provided in the home, assisted-living residences, nursing homes, hospitals and hospice-care facilities.
Palliative and hospice care depend on a team of people with different specialties, including:
- Home health aides
- Social workers or counselors
- Clergy or other spiritual advisors
A palliative and hospice care team can help you establish treatment goals and guide you through important decisions. This decision-making is intended to honor the wishes of the person who is dying, optimize his or her quality of life and support the family. Issues may include:
- When and if to discontinue disease treatment
- When to remove life-support machines, such as ventilators and dialysis machines
- Where to receive hospice care
- What support the family needs to provide care for the dying person
- How best to enable the dying person to spend quality time with family and friends
- What emotional and spiritual support is wanted by the person who is dying, family members and friends
Studies demonstrate that this person-centered approach improves care and the quality of people's lives in their last days.
Supporting spiritual needs
People who know they are near the end of life may reflect on their beliefs, values, faith or the meaning of life. They may have questions about how they will be remembered, or they may think about the need to forgive or be forgiven by another. Others may feel conflicted about their faith or religion.
You might listen and ask open-ended questions if the dying person wants to talk about spiritual concerns. You can read together, play music or share in a religious tradition the person values. A person who is dying may find solace in hearing why you value your relationship and how you will remember him or her.
Supporting emotional needs
A person nearing the end of life may be distressed or experience conflicting emotions. You can provide emotional support by listening and being present. Your physical presence — sitting quietly or holding hands — can be soothing and reassuring.
You can also arrange visits with people the dying person wants to see for saying goodbyes or sharing memories. Or you can arrange calls with or share messages from those who can't visit.
Creating a calm environment with low lighting and quiet music — and removing distractions — can improve mood, evoke memories and help the person relax.
Recognizing when death is near
While it's difficult to know when someone is going to die, there are common signs that may indicate the last days or hours of life. These may include:
- Restlessness, confusion or agitation
- Increased sleep or periods of drowsiness
- Loss of appetite
- Irregular breathing or pauses in breathing
- Swelling, coldness or blue coloring in the hands or feet
- Reports of seeing someone who has already died
- Gurgling or crackling sounds with breathing
It's important to know steps you can take to provide comfort during the last days and hours before death.
||Feed small spoonfuls of food. Use ice chips or a damp sponge to keep the mouth moist.
|Dryness around the face
||Use a damp cloth to relieve dryness around the eyes. Apply lip balm or petroleum jelly to the lips.
||Gently turn the person's head, adjust pillows or raise the head of the bed. Use a cool-mist humidifier. Ask the medical team about medication or the use of oxygen.
||Gently apply lotion to dry skin. Learn how to move and adjust the person safely in bed to avoid the development of sores.
||Learn how to change incontinence pads or ask about the use of a catheter.
||Speak calmly and be reassuring. Hold hands or use a gentle touch if it's comforting. Remind the person where he or she is and who is there. Ask the medical team for help if significant agitation occurs.
||Give pain medication as directed. Ask the medical team to adjust medication if needed.
|Sensitivity to temperature
||Pay attention to clues to whether the person feels hot or cold. Adjust the room temperature and bedding as needed.
Keeping vigil in the last hours of life is a way to show support and love for your family member or friend. If you decide to keep vigil, continue to talk to, touch and comfort the person. If you think he or she would want to share this time with others, invite family members or close friends to show their support as well.