I have been writing lately about some of the practical steps that you can take to prepare for the death of a spouse, and what you need to do after they die, and I was just writing down my thoughts about grief and some of the ways to cope with it and to support people who are grieving. But I realized that I was missing a step: What about what happens during the dying process? This may be a disquieting topic for some, but it literally applies or will apply to everyone.
One of the greatest and unexpected gifts I have received in my life was the opportunity to work in hospice for a couple of years. My work was in an administrative capacity, but I absorbed so much from the interactions with our care teams about the process of death and dying that it radically changed my perceptions.
One of the biggest changes that I now understand more fully, is that death is just another phase or final transition of our lives. It will happen to all of us, and though we do not all get the choice (as in the case with sudden or accidental deaths), in many cases we get to decide how we embrace this change for ourselves and our loved ones.
What Hospice Provides:
Once an individual or family member receives what is referred to as a terminal diagnosis, the choices can begin. How do we want to deal with this? One of my first recommendations to families is: Talk to Hospice. Medicare and Medicaid will cover hospice services if the terminal diagnosis is expected to lead to death within six months, and most insurance plans have some provisions for hospice care, if not on Medicare.
There are many, many people who have misconceptions about hospice that lead them to miss out on the full experience and benefits that hospice has to offer. For example, did you know:
- In addition to the availability of hospice for the six- month period noted above, the services can be extended if symptoms are indicated and the patient meets the criteria?
- That Certified Nursing Assistants (CNAs), Nurses, Chaplains, Social Workers, and in some cases even Physicians will come to the patient’s home or residence to provide services?
- The care providers are available on-call, 24-hours per day for emergencies?
- That they provide durable medical equipment, including hospital beds, bedside commodes, and oxygen?
- That they provide the medications needed to keep the patient comfortable and as pain-free as possible?
- That the family is entitled to grief counseling services for a full year after the patient’s death?
The Goal of Hospice:
The goal of hospice is to provide comfort and reassurance for the patient and family and to ease the transition as much as possible. It is not designed to treat the terminal illness, and in fact, all such treatments such as chemotherapy are stopped in order to qualify for hospice, unless needed for pain.
Hospice providers will often help the family and patient to openly talk about their impending death, and to share their thoughts and feelings with one another as they are working through it. To share memories and regrets. To ask for and receive forgiveness, when needed. In essence to gain closure; to make their peace within themselves, their loved ones and their God. My belief is that this process is the most valuable service that hospice provides and that people who wait until the patient’s death is imminent, or just a few days prior to death to start hospice services never receive it. Most people truly need this time to prepare themselves, if they have the option.
Angels in Disguise:
I came to feel that many of the hospice nurses and CNAs that I knew were what I would call “Angels in disguise”. They truly felt that it was a privilege to be with a patient and their family at the time of death, and relished the opportunity to provide medical and emotional comfort. Many equated it with a spiritual experience and endeavored to help facilitate what they called a good or peaceful death.
How to Receive Care:
How can you find out if your loved ones are eligible for hospice? Talk to your medical providers. Ask them to be completely honest with you about the prospects for recovery, and how long you can expect to live. Ask them to refer you or your family member to hospice, if it does not look like you will recover.
Unfortunately, there are still a few medical providers who believe in pursuing treatment regardless of the prospects for recovery, all the way until death. In my mind anyway, this is not how I want to spend my last days, in a hospital, sick from all of the treatments, knowing I was going to die anyway. But most physicians have an appreciation for the role of hospice, and can recommend one that they work with. Otherwise, you may wish to contact a hospice provider directly and ask them to contact your physician, or to evaluate your appropriateness for hospice services.
The individuals I can recall who received the full hospice benefit were immensely grateful for the services they received, and were amazed at the level of care provided to the patient and family. Death and the thought of death is never easy to contemplate for any of us, and yet when we are all ultimately in that situation, how wonderful to know that there are options to make the process as comfortable as possible.