This past month has been exceptional in regard to the number of deaths we have encountered: three close family/friends, and then a client who lost two family members back to back. Death, that final passage of our lives, our final transition, is never easy for those of us left to grieve. But in truth, it IS a natural part of our lives, and an experience we will all have at some point.
My personal attitude and perspective on death was greatly impacted by a short period of time that I spent working as a hospice administrator. I did not provide direct patient care, but spent many hours talking with and processing with those nurses, certified nursing assistants, chaplains and social workers who did provide care. I learned that the experience of death is quite often a holy or spiritual experience and that the caregivers were often very grateful to be present during that time. So, I thought I would use this blog post to address some of the questions that many of us will have to face in our lives, especially when it comes to arranging or providing care for our loved ones in their latter days.
There are several levels of care before one gets to the level of hospice care. We have recently posted several blogs on the topic of long-term-care insurance, whether we actually need it or not, and some of the costs involved, etc. But many may be unfamiliar with what “care” actually looks like.
What Is Home Care?
The first level of care is referred to as Home Care. This is when a caregiver comes to the home to assist with daily needs, which can include personal care, preparing light meals, light housekeeping, laundry and even transportation to appointments. Some start slowly, just one or two days per week for a few hours. These caregivers are typically Certified Nursing Assistants, so they have had some training in providing care, and are under the supervision of a Caseworker. We encourage many of our older friends to take advantage of this amazing service. They often become quite attached to their caregiver and say, “I don’t know why I waited so long to do this!”. They can truly be lifesavers, whether for a single individual or a couple, reducing the stress levels of those living with the patient needing assistance, and increasing the sense of freedom and time for the rest of the family. It enables the family to just enjoy time spent with loved ones, rather than trying to catch up on all the things that need to be done.
What Is Independent and Assisted Living?
The next level of care would be Independent or Assisted Living. Sometimes this is an easy transition for certain individuals who no longer want to deal with the hassle of owning and maintaining their own home, with yard upkeep, repairs, and cleaning. Some choose to downsize to a smaller home with less yard at this stage, while others want to turn all the responsibility for their living space over to someone else.
- Independent Living is for seniors who are able to live on their own in an apartment or house, but want the convenience of living in a community that provides amenities and services that enrich their lives.
- Assisted Living: This is a senior community that provides assistance with some aspects of daily living, such as medications, eating, hygiene care, etc., but the resident does not need constant supervision, or constant medical care.
Another factor in this decision, which is especially true for single or widowed individuals, is the loneliness they experience on a daily basis. Even if they see their children and grandchildren regularly, they usually do not see them daily, and it is often for short visits. An Independent or Assisted Living community can provide a great deal of social interaction and activities, and provide meals, along with all of the maintenance of their living spaces.
What Is Nursing Home Care?
One of the later levels of care, which may or may not ever be needed, is the 24-hour nursing home care, though we hope that most can avoid this setting for their final days. Nursing Homes are also called skilled nursing centers and are usually for adults with serious medical needs, though many only require their services for brief periods of rehabilitation. Nearly half of all residents in one study had dementia, and care must be available 24 hours daily.
What Is Hospice?
The final level of care would be hospice services. Once an individual qualifies for hospice, the costs for it are covered by Medicare or Medicaid. There will be no out-of-pocket expense to the individual or family. Many do not know that hospice services can be provided pretty much anywhere, whether it is a home, Assisted Living or even Nursing Home. Contrary to what many assume, you do not have to be “close to death” to qualify for Hospice, at least as most people think of it. Every illness or disease has its own criteria to help the physician determine if a patient meets hospice qualifications. However, it can be helpful to know that the criteria are generally covered by this: If your disease or condition (physical or mental) follows its normal progression, you are expected to live 6 months or less.
It is a great idea to raise the question of a hospice referral with your family’s physician, once you or your loved one have decided not to pursue any more life-saving or treatment measures, such as chemotherapy or other treatment and CPR, etc. The hospice will evaluate the patient to determine if they meet the criteria and then the individual or family can sign up for their services.
In addition to providing home health aides for personal care, a nurse and/or physician will come out to see the patient regularly, including reviewing and ordering the medications needed to maintain comfort. Ordered medications are delivered to the residence, and any medical equipment needed to keep the patient comfortable will also be provided, such as a hospital bed, bedside commode, and oxygen. The Chaplains and Social Workers will work with the family to provide spiritual and emotional support and help them to make any remaining decisions that need to be made. Needless to say, I am a huge proponent of hospice care, and do not believe enough people take advantage of these tremendous services that are available to them.
These last days that we have with our loved ones can be full of joy and remembrance as we take this final journey with them. My hope for all of us is a peaceful death, surrounded by those we love the most.