HOSPICE VOLUNTEERS - A VITAL PART OF CARING FOR THOSE WHO ARE DYING

What is Hospice?  

"At some time, in some way, we must all face the end of life, and most of us share a common hope that when death comes to us, or to a loved one, it will be peaceful.  We hope to be surrounded by those we love, feeling safe, comfortable and cared for.  When our life has ended, we hope that our loved ones, who are left behind, will be comforted and supported through their grief."  Living Lessons

Hospice volunteers come with a wide range of life experiences and skills that enable them to offer practical assistance and supportive care to meet the special needs arising out of the physical, emotional, spiritual, social and economic stresses experienced during the final stages of living, and during caregiving and bereavement.

Hospice volunteers work as part of the Hospice Pallative Care Team (consisting of the patient, their family and friends, healthcare professionals and volunteers) to ensure the needs and choices of those dealing with end-of-life issues are sensitively met.

Volunteers who have completed the training program are eligible to work with clients and their families providing compassionate care and support in the community in a variety of settings.  

They may work as:

• A home visiting volunteer providing support and respite for the terminally ill, their families, and caregivers.
• A volunteers on the Pallative Care Unit
• A bereavement support volunteer working in formal and informal group programs.

Individuals, who wish to contribute on a volunteer basis without taking the training program provided may become "Friends of Hospice" and participate in non-client related activities such as:

• Board Membership
• Fundraising Activities
• Office & House Support
• Thrift Shop

Hospice is not only a place -- it is a philosophy of care.  We believe that life is a precious and fragile journey of growth and development and that, although death may be a time of sadness and separations, dying is a part of life's journey that can be embraced with dignity, serenity and hope.

Volunteer Training

Hospice volunteer training is experimental in nature and active participation in the group process is necessary.  Facilitators provide a safe environment for participants to share an are available for debriefing after and between training sessions.

Training includes:
                             Communication Skills
                                 Comforting Skills
                       Community Pallative Care Team
                             Issues of Death & Dying
                            Dealing with Grief & Loss
                                 Pallative Care Unit 
                                    Care of Self
                                  Care of Spirit

Following 40 hours of training, volunteers receive orientation and work with patients and families on the Pallative Care Unit with support of an experienced hospice volunteer.  

The generosity of our community enables us to offer our pallative and bereavement programs at NO COST to the participants.

Information taken from Volunteer Training Program Nanaimo Community Hospice Society  brochure --- More inforamtion at www.nanaimohospice.com or contact them via email

info@nanaimohospice.com

What to Expect when Your Loved One Is Dying

Journey's End: Active Dying
Pallative Care Article

 What to Expect When Your Loved One 

Is Dying

Some people in a palliative care program will get better and move on with their life. When people have a terminal condition – when death is expected – palliative care helps to improve life quality for patients, caretakers, and loved ones.

When members of your palliative care team recognize the signs that a person is within months or weeks of dying, they may recommend transitioning to hospice.

"When they are in hospice, they will get the same comfort care, but more services will be provided for both the patient and the family," Ursula Braun, MD, MPH, director of the palliative care unit at the DeBakey Veterans Administration Medical Center in Houston, tells WebMD.

As death approaches, the role of the caretaker changes, says Phil Higgins, director of palliative care outreach at Boston's Dana Farber/Brigham & Women's Cancer Center.

"Where before you did a lot of hands-on care, now your role may be to be present, to comfort and reassure your loved one with soothing words and actions that help maintain their comfort and dignity as they approach death," Higgins tells WebMD.

Symptoms and Signs 

that Death Is Near

Barbara Karnes, RN, an expert on the dynamics of dying, lists the usual and normal physical signs and symptoms of approaching death in her book Gone From My Sight: The Dying Experience.

One to three months prior to death, your loved one is likely to:

•   Sleep or doze more.

•   Eat and drink less.

• Withdraw from people and activities previously found pleasurable.

• Be less – or if they are a child, more – communicative.

One to two weeks prior to death, your loved may be bed bound and may be experiencing:

•  Increased pain, which can be treated.

• Changes in blood pressure, respiratory rate, and heart   rate.

•  Continued loss of appetite and thirst and difficulty taking medications by mouth.

•  Decline in bowel and bladder output.

•  Changes in sleep-wake patterns.

• Temperature fluctuations that may leave the skin cool, warm, moist, or pale.

•  Constant fatigue.

• Congested breathing from the build-up of secretions at the back of the throat. "The sounds this makes can be very distressing for family members, but it's not painful and can be managed in a variety of ways, including with medications," says Braun.

• Disorientation or seeing and talking to people who aren't there. These hallucinations and visions, especially if they are of long-gone loved ones, can be comforting. "When they are pleasant for the person, don't try to convince them that a loved one isn't there. That can make someone who is pleasantly confused become agitated and combative," says Andrea M. Holtzer, RN, palliative care nurse coordinator at St. Mary's Hospital in Amsterdam, New York.

When death is imminent – within days or hours:

•  Your loved one may not want food or drink.

•  There may be little or no bladder or bowel activity.

•  Pain may show as grimaces, groans, or scowls and should be managed.

•  Eyes may tear or become glazed.

• If not already unconscious, your loved one may drift in and out of consciousness. "They are probably still able to hear and feel," says Braun. "So it's important to talk to them and to hold their hand."

• Pulse and heart beat may be irregular and/or difficult to detect.

• Body temperature will drop and the skin of the knees, feet, and hands will become a mottled bluish-purple. "Once the mottling starts, death is often within 24 hours," says Holtzer.

• Breathing, punctuated by gasping starts and stops, will slow – until it stops entirely.

"For children and teens, the signs and symptoms are more or less the same as for adults. However, the course of dying is harder to predict in children", says Jennifer K. Clark, MD, professor of palliative medicine at the University of Oklahoma College of Community Medicine, Tulsa.

"Children are so resilient that they are often fairly active – and asking a lot of tough-to-answer questions – until the end is near," Clark tells WebMD.

In the last days or hours, your loved one may experience what doctors call terminal delirium: heightened activity and confusion often accompanied by hallucinations so distressful they may cry out, strike out, or try to climb out of bed.

"This isn't merely distressing for family members. Their loved ones could hurt themselves, so it's important to nip it in the bud with medications or non-pharmacological interventions," Holtzer says.

Holtzer advises making sure the room is well lit, but not brightly lit; ensuring that the room is as quiet and peaceful as possible; and constantly assuring your loved one that you are there.

Ironically, in the last days or hours, a loved one may also experience a period of clarity and lucidity.

"Once in a while patients rally, and know exactly who you are and can talk with you. When this happens, it's a real gift to the family," Braun says.

During the journey to death, 

the signs and symptoms 

of approaching death 

are unique to each person 

and his or her condition.

"Some people will have a very gradual decline. Others may have a more rapid decline, and their signs and symptoms will usually be more pronounced," says Carol Lovci, RN, vice president at San Diego Hospice and The Institute of Palliative Medicine.

When to Say Good-bye

One of the hardest questions is when to call in family members to say good-bye and to make memories for the future.

With those things in mind, Lovci recommends family be notified as soon as it becomes evident that death is approaching. This allows the care team to provide them insight about what to expect – both in terms of their loved one's decline and their own physical and emotional reactions – and it enables family members to support one another and their loved one.

Don't assume, however, that calling the family in means they will be there at the end.

"Families often sit late into the night, and then, when they have gone home, the person dies. It's as if their loved one couldn't let go while they were there," says Holtzer.

Resources:

These resources may be of particular help to caregivers, families, and friends of a person who is dying:

• Aging in the Know: Palliative Care and Hospice.     DyingWell.org

• Family Caregiver Alliance, End-of-Life Choices: Holding on and Letting Go

•  American Geriatrics Society: Dying at Home

• Hospice and Palliative Nurses Association, Patient/Family Teaching Sheets: Final Days

•  Hospice Foundation of America, The Dying Process: A Guide for Caregivers, revised, 2007 (free).

•  Karnes, B. Gone From My Sight: The Dying Experience, Barbara Karnes Books Inc. (cost: $3, includes shipping and handling).

http://www.webmd.com/palliative-care/journeys-end-active-dying

A Life Worth Ending

The era of medical miracles has created a new phase of aging, 

as far from living as it is from dying. 

A son’s plea to let his mother go.

By Michael Wolff

On the way to visit my mother one recent rainy afternoon, I stopped in, after quite some constant prodding, to see my insurance salesman. He was pressing his efforts to sell me a long-term-care policy with a pitch about how much I’d save if I bought it now, before the rates were set to precipitously rise. For $5,000 per year, I’d receive, when I needed it, a daily sum to cover my future nursing costs. With an annual inflation adjustment of 5 percent, I could get in my dotage (or the people caring for me would get) as much as $900 a day. My mother carries such a policy, and it pays, in 2012 dollars, $180 a day—a fair idea of where heath-care costs are going.

I am, as my insurance man pointed out, a “sweet spot” candidate. Not only do I have the cash (though not enough to self-finance my decline) but a realistic view: Like so many people in our fifties—in my experience almost everybody—I have a parent in an advanced stage of terminal breakdown.

It’s what my peers talk about: our parents’ horror show. From the outside—at the office, restaurants, cocktail parties—we all seem perfectly secure and substantial. But in a room somewhere, hidden from view, we occupy this other, unimaginable life.

I didn’t need to be schooled in the realities of long-term care: The costs for my mother, who is 86 and who, for the past eighteen months, has not been able to walk, talk, or to address her most minimal needs and, to boot, is absent a short-term memory, come in at about $17,000 a month. And while her LTC insurance hardly covers all of that, I’m certainly grateful she had the foresight to carry such a policy. (Although John Hancock, the carrier, has never paid on time, and all payments involve hours of being on hold with its invariably unhelpful help-line operators—and please fax them, don’t e-mail.) My three children deserve as much.

And yet, on the verge of writing the check (that is, the first LTC check), I backed up.

We make certain assumptions about the necessity of care. It’s an individual and, depending on where you stand in the great health-care debate, a national responsibility. It is what’s demanded of us, this extraordinary effort. For my mother, my siblings and I do what we are supposed to do. My children, I don’t doubt, will do the same.

And yet, I will tell you, what I feel most intensely when I sit by my mother’s bed is a crushing sense of guilt for keeping her alive. Who can accept such suffering—who can so conscientiously facilitate it?

“Why do we want to cure cancer? Why do we want everybody to stop smoking? For this?” wailed a friend of mine with two long-ailing and yet tenacious in-laws.

In 1990, there were slightly more than 3 million Americans over the age of 85. Now there are almost 6 million. By 2050 there will be 19 million—approaching 5 percent of the population. There are various ways to look at this. If you are responsible for governmental budgets, it’s a knotty policy issue. If you are in marketing, it suggests new opportunities (and not just Depends). If you are my age, it seems amazingly optimistic. Age is one of the great modern adventures, a technological marvel—we’re given several more youthful-ish decades if we take care of ourselves. Almost nobody, at least openly, sees this for its ultimate, dismaying, unintended consequence: By promoting longevity and technologically inhibiting death, we have created a new biological status held by an ever-growing part of the nation, a no-exit state that persists longer and longer, one that is nearly as remote from life as death, but which, unlike death, requires vast service, indentured servitude really, and resources.

This is not anomalous; this is the norm.

The traditional exits, of a sudden heart attack, of dying in one’s sleep, of unreasonably dropping dead in the street, of even a terminal illness, are now exotic ways of going. The longer you live the longer it will take to die. The better you have lived the worse you may die. The healthier you are—through careful diet, diligent exercise, and attentive medical scrutiny—the harder it is to die. Part of the advance in life expectancy is that we have technologically inhibited the ultimate event. We have fought natural causes to almost a draw. If you eliminate smokers, drinkers, other substance abusers, the obese, and the fatally ill, you are left with a rapidly growing demographic segment peculiarly resistant to death’s appointment—though far, far, far from healthy.

Sometimes we comb my mother’s hair in silly dos, or photograph her in funny hats—a gallows but helpful humor: Contrary to the comedian’s maxim, comedy is easy, dying hard. Better plan on two years minimum, my insurance agent says, of this stub period of life—and possibly much more.

Continuing article by Michael Wolf can be found at

http://nymag.com/news/features/parent-health-care-2012-5/

Living Will - Your choices for End-of-Life Decisions

A living will spares family members the anguish of having to make difficult decisions, and it helps them to discuss situations in advance and come to terms with the loved one's wishes.

Doctors themselves are concerned about these ethical issues and living wills provide needed direction. Living wills can also assist the medical profession struggling between the ability to save life, and the need to reduce suffering.

No one really likes dealing with their own mortality, but a living will allows control over medical treatment in near-death situations, and it removes the stress and guilt associated with these decisions from family members and friends.

A living will form may be provided to your physician and other healthcare providers, allowing them to follow your wishes for medical care. The form states whether you wish your life to be artificially prolonged if you are a patient with a catastrophic illness or accident. The form must comply with the laws of your state, since the laws vary by state. A form for a living will may require two witnesses to attest to your signature and/or that the form be notarized.

When living wills are combined with the appointment of a healthcare agent, they are often referred to as advance directives for medical care. If the advance healthcare directive provides for the appointment of an agent to make care and treatment decisions, the agent should not also serve as a witness. Many forms also allow you to appoint a successor health care proxy in case the first health care agent is no longer able to serve. The person you select as your agent should be someone you trust and doesn't need to be a family member. The representative should be someone who understands and shares your values and lives in your area.

Living wills may also be used to express your wishes for organ donations and final arrangements.

A healthcare power of attorney or other medical directive doesn't take effect until a medical expert determines you are permanently unconscious.  An advance directive form may be freely revoked while you are still competent and not incapacitated.   A copy of your advance medical directive form should be provided to any healthcare agent you appoint, your doctor and other healthcare providers, and any close friends and relatives whose cooperation may be needed.  Some provinces and states also have a living will registry for living wills and other advance health care directives.

Medical Treatment Options for You to Decide Upon

When you make an advance directive for healthcare or form for living will, you will need to make medical care decisions in advance. The following are some of the medical treatment options and healthcare decisions you should consider if you were to become hospitalized in a persistent vegetative state:

 · Cardiopulmonary resuscitation (CPR) is a method of reviving a patient's heart by a device that delivers an electric shock to stimulate a heart that has stopped beating.

 · Artificial ventilation is a procedure for providing oxygen to you through mechanical means when you are unable to breathe on your own.

 · Artificial nutrition and hydration provides fluid and nutrition through intravenous means or a tube when the patient is unable to be fed.

 · Dialysis cleans your blood and maintains proper fluid levels when your kidneys fail.

 · Pain medication can ease discomfort for a patient but may affect awareness of surroundings.

Other Advance Directives

Some other forms individuals may use to give advance instructions to make healthcare decisions on their behalf and state medical treatment preferences include:

Do-Not-Resuscitate Order (DNR)- this form states your preference not to be resuscitated and instructs healthcare providers not to use CPR if your heart stops beating.

Mental Health Care Directive - the patient may state treatment preferences for mental healthcare, such as consent to psychoactive medication, electroshock therapy, restraint, isolation, or medication in this advance directive.

Conclusion

You can save your loved ones much additional trauma in an already difficult situation by creating advance directives for medical decisions or a living will. By taking the time to complete a form for a living will, you can have the peace of mind of knowing that your wishes for medical treatment and life-prolonging procedures will be followed and that those closest to you will be spared from having to make difficult medical care decisions.

It’s not easy to talk about how you want the end of your life to be. But it’s one of the most important conversations you can have with your loved ones.  This FREE Starter Kit will help you get your thoughts together and then have the conversation.

http://theconversationproject.org/starter-kit/intro/

 

For more information

For BC Canada go to http://www.trustee.bc.ca/pdfs/STA/It%27s_Your_Choice-Personal_Planning_Tools.pdf

 For our friends in the United States you can go to http://www.uslegalforms.com/livingwills/?auslf=livcom