What is End of Life Care?

End of life care or palliative care is given to patients that are terminally ill or chronically ill and are in the final stages of life. The care given to the patient focus heavily on quality of life as opposed to recovery. It also involves The spiritual side and mental care for patients and those close to them. Grief counseling can offer support both before and after end of life occurs.

What does end of life care look like?

The setting for end of life care ranges from hospice homes to live-in care. It can be performed in the individual’s home, a family member’s home, a hospice home or even a retirement home. The need and location really depend on the individual and family needs. For some the option of having their loved ones move in with them is not an option. In this case they would either need a live in caregiver for their loved one’s home or transfer them to a hospice home. 

As stated previously, end of life care focuses on making the individual as comfortable as possible. Medication is given to relieve pain but must be administered by an individual certified to do so, such as a nurse or a QMAP. Spiritual leaders and other councilors will come to offer support and guidance. This can be a great support to the family as well as the patient. Nutritional and dietary restrictions are often lifted; in the famous words of Marrie Antoinette “Let them eat cake” becomes the mantra.    

So, what are the final stages and signs that death is imminent?

While the final stages of death vary greatly from person to person and illness to illness there are a few common symptoms. Remember not everyone will have all or even some of these symptoms. That being said here is a list of frequently observed signs:

Symptom Description and Care Option
Skin changes
  • The skin will become cool to the touch, most notably in the hands, arms, feet, and legs.
  • The skin may also change color and become mottled.
  • You may make the person more comfortable by placing warm blankets on.
    However, do not use heating pads or electric blankets as these can burn the skin.
Disorientation and confusion
  • The person may not know where they are or what’s going on.
    They may be unable to identify people in the room.
  • Reassure them that everything is ok and remind them of your name.
Sleepiness
  • They will have an increased amount of fatigue and will want to sleep often.
    They will be hard to arouse and become uncommunicative.
  • Continue to talk with them and tell them how much you love them.
    If you are able to maintain physical contact such as holding their hand or stroking their hair.
Incontinence
  • Just before or just after death bowel retention will cease.
  • Keep the person as clean and comfortable as possible.
Fidgeting and restlessness
  • The person may make repetitive motions such as pulling at the bed linen or clothing.
    This is due in part to decrease in oxygen.
  • Do not interfere with these movements or try to restrain them.
    Speak in a quiet, natural way. Lightly massage their forehead. Read to them.
    Play soothing music.
Changes in breathing
  • The person may take shallow breaths with periods of no breathing for a few seconds to a minute.
    They may experience periods of rapid, shallow panting.
    There may be gurgling sounds inside the chest.
    These patterns are common and indicate decrease in circulation.
  • Elevating their head or turning them on their side may bring comfort. Hold their hand. Speak gently.
Fluid and food decrease
  • Your loved one may want little or no food or fluid.
    The body will naturally conserve energy required for the task ahead. Food is no longer needed.
  • Do not force them to eat or drink if they don’t want to.
    It only makes them more uncomfortable. Small chips of ice or frozen juice chips might be refreshing.
    A cool, moist cloth on their forehead might help.
Hallucinations/visions
  • The person may talk to people that are not in the room, people that have passed on or people they know from your past.
  • If they become agitated attempt to call them down. Reassure them that everything is ok.