Posts Tagged ‘Terminal illness’

Symptom Relief for Terminal Illness

Thursday, November 19th, 2009

Caring for a loved one.

Caring for a loved one.

If you are a caregiver, you may have had training in symptom relief for terminally ill patients. But, many family members now take care of their loved ones at home, and training may come through experience only. If you are one of those latter individuals, spend some time at the library, as many books about caregiving can be found on the book shelves. Also, calls to local hospice organizations or training programs offered by hospitals can help provide information as well.

Some basic information about symptom relief is listed below, and these solutions apply to any person at any age — even if they do not have a terminal illness. These problems may frighten a caregiver at first, but they are common problems, and solutions are available. Remember to rely on a trained hospice worker, a trusted nurse or a doctor for specific directions for your ‘patient’ before you take extreme measures.

Constipation: This is a common problem during the last stages of terminal illness, because the patient may not be physically active. Some solutions include increasing fiber in the diet with foods such as prune juice and bran cereal. Sufficient fluids also help to resolve the problem in many instances. Only give stool softeners or laxatives as a doctor may recommend. He or she may recommend them, as constipation can be a side effect of some medications. The warning sign for severe problems – one that warrants a call to the doctor – is constipation for more than three days or blood in the stool.

Eating and Drinking: Smaller and more frequent meals may resolve the eating problem. Some physical activity, if the patient can tolerate it, also helps stimulate appetite. Fluids are, sometimes, the most important issue. Dehydration can develop rapidly in people who do not drink enough fluids. Use a straw or offer ice chips to suck. Be aware that too many fluids also are dangerous and providing intravenous fluids to a person who is dying may result in respiratory distress. Follow a doctor’s instructions on how much food and fluid is ‘normal’ for your patient’s situation.

Breathing Problems: Breathing problems can occur during the final stage of any illness and may require oxygen. Another way to help open breathing passages is to elevate the head of the patient’s bed or to move the patient to a recliner. A doctor may prescribe small doses of liquid morphine or bronchodilator drugs. Follow orders for these prescriptions carefully. Opening a window on a mild day or running a fan in the patient’s room also can help improve air circulation.

Nausea and Vomiting: This problem may occur as a side effect of some medications or as a result of the disease. Do not force a nauseated person to eat. Use ice chips instead of drinking to help retain body fluids. Overt vomiting is an issue, however, as the patient may not be able to keep down medication. A doctor may order medication in suppository form if the patient continues to be nauseated.

Dry Mouth: A dry mouth can be caused by medication or by the disease or by a lack of fluids. Go by the doctor’s advice on the amount of fluids to provide, and if the patient continues to have dry mouth, contact the doctor. You may need to provide glycerin swabs or artificial saliva for the inside of the mouth and a lit coating of lip balm for dry or cracked lips.

Itching: Dry skin, a new reaction to a laundry product, medications or the disease may cause rashes, dry skin and discomfort. To stop the itching, you can apply a soothing  skin cream (alcohol-free, as alcohol-based products can further dry the skin) or calamine lotion to itchy areas. Cornstarch, baking soda or baby powder may work, too. Use a humidifier during the fall and winter when heat is used to help moisten the air. You may need to experiment if none of this solutions work. Change laundry detergent or avoid dryer sheets to see if those solutions help.

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Posted in Caregivers, Hospice, Hospice Basics, Patients | No Comments »

Medicare Part A and Hospice Care

Thursday, April 2nd, 2009

Medicare Part A is the portion of Medicare that is available premium-free to all eligible individuals. This part of Medicare benefits provides services associated with hospital, hospice, skilled nursing care and home health care. While you may have read that Medicare Part A covers all costs incurred with hospice, or palliative, care, this is not the case when it comes to custodial care.

Medicare does not cover care that is or becomes primarily custodial, such as assistance with bathing and eating.

Hospice care is death-care for a terminally-ill person, and Medicare Part A provides comprehensive coverage, at home, for symptom management and pain control. In other words, Medicare Part A will not cover custodial care, but it does cover symptom management and pain control. And, several criteria must be met before coverage is allowed as well:

  • The health-care provider must be certified by Medicare to provide hospice care
  • The patient’s doctor and the hospice care director must certify that the patient is terminally ill (i.e., has a life expectancy of six months or less)
  • The patient must elect hospice coverage for the terminal illness instead of standard Medicare benefits, although Medicare will continue to cover care provided that it is not related to the terminal illness
  • Services include nursing care, medical appliances and supplies, prescriptions, home health aide and homemaker services, medical social services, and counseling

If family members need a respite from custodial care, the family – or the patient – is responsible for that cost. The hospice may arrange for the hospice patient to be moved to an inpatient facility for up to five days at a time to provide respite to the hospice care personnel and the family. In this case, the Medicare beneficiary may be charged a nominal daily fee for the inpatient care.

When you interview a hospice service to learn about their program, ask them your questions about Medicare Part A. A professional service is experienced with this benefit and can answer your questions in detail.

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Posted in Hospice, Insurance Plans and Hospice Care | 1 Comment »

On Death and Dying: Stages of Grief

Monday, November 24th, 2008

Depression is one stage of the grief process.Until the 1970s, many physicians were intent on keeping the living alive, rather than listening to patients’ death wishes. That changed when Elisabeth Kubler-Ross began to listen to the dying and to their family members. Her extensive work led to the book, On Death and Dying, in 1969.

Dr. Kubler-Ross first introduced and explored the idea of the five stages of dealing with death. Through sample interviews and conversations in this book, she provides the reader with a better understanding of how death affects the patient, the patient’s family, and the professionals who serve the patient. Now, Kubler-Ross’ stages of grief are used in many situations where a person deals with real or imagined loss – including alcohol and drug rehabilitation, post-traumatic stress disorder (PTSD) and amputation.

Here are the five stages of grief, along with a brief explanation on how a person who has been diagnosed with a terminal illness might react:

Denial and Isolation: When a person faces news that is a shock, such as a diagnosis of a terminal illness, the first reaction is denial. This is the body’s natural reaction to news that proves unbearable. Some patients, for instance, may react by ignoring treatments or by ignoring a doctor’s advice. Family members may become frustrated or frightened over the patient’s cavalier attitude during this phase. The patient also may try to isolate others, so that patient cannot hear the truth from others.

Anger: Once the patient begins to experience symptoms of that disease, or once the reality of treatment options begins to sink in, the patient may become angry. “Why me?” is the question, and no amount of comfort may dent this anger. Anger is an emotion that arises when someone wants something to change, but a terminal illness is difficult to change. On the bright side, a terminally-ill patient who shows anger means that this person has moved beyond denial.

Bargaining: When the patient realizes that anger isn’t going to change anything, a phase begins where a patient begins to bargain against the problem. A religious person might bargain with God, asking for a cure if only the patient changes his or her ways. Other patients may begin to explore other treatment options in hopes that alternatives will cure them. Family members may become worn out during this phase, as the patient often becomes peevish or overactive in their search for a way out of the disease.

Depression: All phases of grief are heartbreaking to the family member, but this phase, perhaps, is the most disheartening. The patient loses interest in treatment and sincerely doesn’t care about the present or the future. Guilt also figures in this phase, as the patient begins to feel responsible for the sadness and, even for the disease. Guilt is anger turned inward, against the person who feels it. Depression is a result of deep guilt and anger. While family members may feel as helpless as the patient at this point, remember that this is the last stage before the patient accepts the current situation.

Acceptance: A patient can reach acceptance at any point, but some people take longer than others to reach this goal. Family members may need to face the possibility that their loved one may never reach this phase before death. On the other hand, acceptance of death and dying may come months before the actual death and it may come on the actual deathbed. In this phase, the patient is ready for whatever happens next.

Remember that family members also go through the five stages of grief upon news about a family member’s illness or death. This is why many professionals suggest counseling for entire families that are involved intimately with death and dying. This counseling is affective even for those who have lost a limb or mobility or for family members who face difficulties dealing with their loved ones’ losses.

To get ’stuck’ in any one of the phases is a possibility as well, so counseling can help many people move into the next phase. Grief, after all, is a healing process and – like any other healing process – progress can move forward and backwards at unpredictable rates. But, one of the best medicines for moving forward (even for the terminally ill patient) is to take care of yourself with good self-care habits.

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Posted in Death & Dying, Grief and Grieving | 5 Comments »