The mission of this site is to provide information about elder mental health.

This page will be a place to learn about end of life care and mental health issues which arise during the dying process for elders and their personal/professional caregivers.

A terminal illness may cause many reactions including:

• Pain and discomfort
• Fear and loneliness
• Concern about family and friends
• Anxiety about the future

This page will be used to address some of those and other concerns.

 

HOSPICE

INTRODUCTION AND BACKGROUND

Within our society dying has historically happened at home. However, this has changed and now most people die in medical institutions(hospital, nursing home, etc.).
it is the goal of medical care to cure people - to make us better.  There can be a focus on one aspect of a person's life.
Hospice care wants to help us to have a dignified death. This approach tends to be more holistic.

DEFINITION

This is a way to care for people with a terminal illness and also their loved ones.

It strives to meet all of an individal's needs:

• Physical
• Emotional
• Social
• Spiritual

Hospice also works with loved ones.

It enables people with terminal illnesses to make decisions about how and where they want to spend the rest of their lives.

GOALS OF CARE

The overall goal is to help people to live as comfortably as they can for as long as they live and to help their family/caregivers to live with them.

Pain Control

This is a major fear of many who are seriously ill. Hospice will attempt to achieve control over pain without impacting level of alterness.

Living Life

Individuals are helped to achieve physical and emotional comfort in order to concentrate on living.

Treating individuals and Their Loved Ones as a Unit

An individual's loved ones feel the pain of the terminal illness. Hospice provides relief to caregivers.

COMPONENTS OF CARE

Physical Needs

Hospice tries to help individuals to use their physical abilities as fully as possible. People can be more comfortable with:

• Pain and symptom relief
• Changes in body position
• Back rubs
• Attention to personal hygiene

Social Needs

Seriously ill individuals may not be as active as they used to be but we are all still social beings and hospice can help with:

• Favorite foods
• Listening to music
• Sharing time with family and friends
• Being well dressed and groomed
• Putting financial matters in order

Emotional Needs

Individuals and their families cope with loneliness, isolation and fear. Hospice:

• Treats them so they know they are important to each other.
• Gives honest compassionate answer to their questions.
• Encourages all to express how they think and feel.
• Help families and friends to express their emotions.

Spiritual Needs

Spiritual matters are important for the terminally ill individual and others. Hospice can help:

• Contact the individual's own spiritual leader
• Bring in the hospice's own chaplain

Medicare has a hospice benefit for those who are at home, in a hospital, or  a nursing home. The following describes the requirements and characteristics of this benefit. Services are available for cargivers.

Requirements to obtain the Medicare Hospice Benefit:

• Must be eligible for  Medicare Part A.
• A MD and also the Hospice medical director certifies there is a terminal illness and that there is only six months to live.
• Sign a statement to choose Hospice care instead of other Medicare benefits to treat the terminal illness.(Medicare continues to pay for health problems unrelated to the terminal illness).
  

Coverage covers:

• Medical care
• Nursing care
• Social worker
• Home Health aide and homemaker
• Physical and Occupational therapy
• Speech therapy
• Dietary counseling
• Grief and loss counseling(including the family)
• Medical equipment and supplies
• Medications(for symptom control and pain relief)
• In-patient care(short term for symptom management)
• Respite care(for caregivers)
  

Coverage Does not Include:

• Treatment to cure the terminal illness
• Medications to cure the terminal illness(rather than for symptom control or pain relief)
• Room and Board(for example, in a nursing home Medicare will not pay for these services. This  may have  to be paid out of pocket).
• Care by other prioviders
• Care in an Emergency room, ambulance, inpatient facility unless arranged by the hospice team or if the medical problem is unrelated to the terminal illness.

Team

Care is provided by a team which may include:

• Doctor
• Nurse
• Home Health aide
• Homemaker
• Social Worker
• Counselors
• Chaplin
• Volunteers

*MEDICARE
1-800-633-4227(MEDICARE)
www.medicare.gov

HOSPICE ORGANIZATIONS

NATIONAL HOSPICE & PALLIATIVE CARE ORGANIZATION
1-800-658-8898
www.nhpco.org

HOSPICE ASSOCIATION OF AMERICA
1-202-546-4759
www.nahc.org/haa

Within Mass.
HOSPICE & PALLIATIVE CARE FEDERATION OF MASS
800-536-6300

CENTRAL MASSACHUSETTS PARTNERSHIP TO IMPROVE CARE AT
THE END OF LIFE
www.betterending.org

Back to top

SPIRITUALITY

We struggle to make meaning of our losses and to comprehend what may feel like senseless tragedy.

We may pose what are rich and possibly unanswerable questions as we yearn for explanations.

We may find support and healing in the ideas, rituals, and traditions of our faith or philosophy. For others the death of a loved one often moves them to examine, to question, and sometimes to move away from their spiritual beliefs.

              Bereaved individuals who did not embrace a spiritual belief system or who have withdrawn from a religious doctrine or belief may find themselves urgently seeking answers to existential questions such as:

• Does God exist?
• Why is there suffering?
• Is there an afterlife?
• Why did this have to happen?

              Many times when a loved one dies, those who grieve for them find themselves angry with God or a Higher power of their understanding. They may:

• Feel a deep sense of unfairness at a person having to die at this time.
• Feel furious that their loved one and they have been unduly punished in this way.
• Ask how God could allow their loved one to be in so much pain?

In the midst of grief there are activities which can bring one comfort and peace.

For those who are part of a faith community solace and fellowship may be found in sacred services or gatherings. Members of a congregation or spiritual community may embrace and support the grieved person and that can be nourishing and restorative.

              For anyone there can be:

• Spiritual teachings
• Music
• Silent contemplation
• And other activities which provide inspiration and balm for the soul.

Some steps which a grieved individual can take are:

Prayer

This can be a source of sustenance and provide a sense of connection in a person's life. Even if it has not done so before it may now offer the bereaved peson some strength.

Mediation

This involves focusing attention inward and encompasses a variety of techniques

which assist in developing:

• mindfulness
• concentration
• trauquility
• insight.

This may incorporate guided imagery and visualization.

Ritual

This can be a powerful way of finding meaning in loss and also provide a method for connecting physical, mental, emotional, and spiritual expression. Rituals can be healing for both body and soul.

They can be symbolic affirmations that a significant change has taken place and enable the bereaved person(s) to create a sense of balance and focus in the midst of overwhelming feelings.

They can help us remember love ones in ways which allow for self reflection and to connect with others even as we find the strength and courage to continue on our journey.

Forgiveness

Many grieving individuals have feelings of guilt, regret, anger, and resentment toward the one who has died or towards themselves. Forgiveness of self and the loved one can serve to release people from the chains which prevent them from healing.

As a result of the controversy about Terry Schiavo's last days there have been many questions about advanced directives.
The following will speak to some of these issues:

1. What is an advanced directive?

2. How would it be used?

3. What are the types of advanced directives?

1. What is an Advanced Directive? -

It is a written statement about future medical care by an individual who directs others to follow their choices when that person is unable to communicate.

• It must be in writting.
• it will direct others to make a specific decision(s).
• It may identify another individual to make decisions on behalf of the person.
• Thiis will be used only when an individuall cannot speak up independently.

2. How Would it be Used?

Some examples are:

A. Resucitation
It directs others to carry or not to carry out CPR(cardio-pulmonary resucitation)- to restore or not restore breathing or the heartbeat.

B. Hospitalization
Do or do not hospitalize.

C. Feeding Tubes
Do or do not use feeding tubes.

D. Respirators
Do or do not use machines to maintain breathing.

E. Pain Relief
What should be done to address pain relief.

F.Dialysis
Should this be allowed or not.

G.Intravenous(IV) Therapy
Provide food,water and/or medication though a tube placed in a vein.

 

3. What are the types of Advanced Directives?

A. Living Will

Identifies an individual's decisions about what to do at or near the end of life. Instructs others about what that person wants to see happen.

B. Health Care Proxy(Health Care Power of Attorney)
Designates a particular person(Health Care Agent or Proxy) who will make someone's healthcare decisions.

It goes into effect when the person can no longer make decisions

A lawyer is not needed for a health care proxy.

You(or the person who does this) can change the decision.

.

C. Durable Power of Attorney
Designates an individual to act on behalf of and under someone's direction(financial and or health care decisions). It is durable because the responsibilities continue after the individual can no longer give directions due to incapacity.

Laws in different States sometimes prohibit specific advanced directives. You should check to determine what is allowed in your State.

Any advanced directive can be changed or modified. For example, a directive for a DNR can be changed to be full code or vice versa.

Back to top