As a carer it is very important to look after yourself, your health and wellbeing especially if you have cared for a client who has recently passed away or remain caring for other clients who require end of life care needs. We at the Myhomecare team are here to support you during these difficult times and will provide you with support and guidance every step of the way.
What is end-of-life care?
End-of-life care is the term used to describe the support and medical care given during the time surrounding death. This type of care does not happen only in the moments before breathing ceases and the heart stops beating. Older people often live with one or more chronic illness and need significant care for days, weeks, and even months before death.
The end of life may look different depending on the person’s preferences, needs, or choices. Some people may want to be at home when they die, while others may prefer to seek treatment in a hospital or facility until the very end. Many want to be surrounded by family and friends, but it’s common for some to slip away while their loved ones aren’t in the room.
Generally speaking, people who are dying need care in four areas:
Mental and emotional needs,
Of course, the family of the dying person also need support in terms of practical tasks and emotional support.
End of life: Providing physical comfort
Discomfort during the dying process can come from a variety of sources. Depending on the cause of the discomfort, there are things you as a health care provider can do to help make the dying person more comfortable. For example, the person may be uncomfortable because of:
• Breathing problems
• Skin irritation, including itching
• Digestive problems
• Temperature sensitivity
Shortness of breath or the feeling that breathing is difficult is a common experience at the end of life. GP’S call this dyspnea. To help ease breathing for your client, try raising the head of the bed, opening a window, using a humidifier, or using a fan to circulate air in the room.
There may be times when a dying person has an abnormal breathing pattern, known as Cheyne-Stokes breathing. The person’s breathing may alternate between deep, heavy breaths and shallow or even no breaths. Some people very near death might have noisy breathing, sometimes called a death rattle. In most cases, this noisy breathing does not upset the dying person, though it may be alarming to family and friends. You may try turning the person to rest on one side or elevating their head.
Skin problems can be very uncomfortable for someone when they are dying. Keep the person’s skin clean and moisturized. Gently apply alcohol-free lotion to relieve itching and dryness.
Dryness on parts of the face, such as the lips and eyes, can be a common cause of discomfort near death. These tips may help:
• Apply a balm or petroleum jelly to the lips.
• Gently dab an eye cream or gel around the eyes.
• Try placing a damp cloth over the person’s closed eyes.
• If the inside of the mouth seems dry, giving ice chips (if the person is conscious) or wiping the inside of the person’s mouth with a damp cloth, cotton ball, or specially treated swab might help.
Sitting or lying in one position can put constant pressure on sensitive skin, which can lead to painful bed sores (sometimes called pressure ulcers). When a bed sore first forms, the skin gets discoloured or darker. Watch carefully for these discoloured spots, especially on the heels, hips, lower back, and back of the head.
Turning the person in bed every few hours may help prevent bed sores and stiffness. Try putting a foam pad under the person’s heel or elbow to raise it off the bed and reduce pressure.
Nausea, vomiting, constipation, and loss of appetite are common issues at the end of life. Swallowing may also be a problem. The causes and treatments for these symptoms vary. Medicines can control nausea or vomiting or relieve constipation, all of which are common side effects of strong pain medications.
If the person loses their appetite, try gently offering favourite foods in small amounts. Serve frequent, smaller meals rather than three larger ones. Help with feeding if the person wants to eat but is too tired or weak.
But don’t force a dying person to eat. Losing one’s appetite is a common and normal part of dying. Going without food and/or water is generally not painful and eating and drinking can add to a dying person’s discomfort. A conscious decision to give up food can be part of a person’s acceptance that death is near.
When a person is closer to death, their hands, arms, feet, or legs may be cool to the touch. Some parts of the body may become darker or blueish. People who are dying may not be able to tell you that they are too hot or too cold, so watch for clues. For example, someone who is too warm might repeatedly try to remove a blanket. You can remove the blanket and place a cool cloth on the person’s head.
Hunching their shoulders, pulling the covers up, and shivering can be signs the person is cold. Make sure there is no draft, raise the heat, and add another blanket. Avoid electric blankets because they can get too hot.
It is common for people nearing the end of life to feel tired and have little or no energy. Keep things simple. For example, a bedside commode can be used instead of walking to the bathroom. Providing a stool so the person can sit in the shower, or sponge baths in bed can also help.
What to expect if someone is dying at home
Caring for a dying person at home is very rewarding, but it can also be very hard.
Things to consider as a person is dying:
• When close to dying, many people stop wanting to eat or drink, their lips and throat can sometimes get dry. This is normal, but it can be upsetting for those who care about them. You can help them by gently wetting their mouth and lips. Applying a lip balm can also help. This will usually be enough to keep the person comfortable.
• Sometimes the person who is dying can become restless. They may be anxious,or make repeated movements like pulling at their blankets or clothes. This is usually because of physical changes in the body.
• The person’s hands and feet may feel cold and may change colour. This is because their heart is sending blood to the vital parts of the body and isn’t reaching their arms and legs. You can put extra blankets over the person’s hands and feet to keep them warm and comfortable.
• They may spend more time sleeping. When they’re awake, they may be tired and sleepy, with little energy. They may not want to speak. They may slip in and out of consciousness. This is normal.
Communicating while wearing personal protective equipment (PPE)
Wearing personal protective equipment (PPE) can make it harder to communicate and some clients may find it frightening. You can reassure clients and the people important to them by:
• warning them in advance that you'll be wearing PPE
• explaining why you need to wear it
• wearing a name badge
• showing them a photo or video of yourself without PPE
• showing your face through the window before putting on PPE and going inside
• telling them what you're thinking or feeling if it's not clear when you're wearing PPE.
Here are a few tips that may help manage mental and emotional needs of the person who is dying:
• Provide physical contact. Try holding hands
• Set a comforting mood. Some people prefer quiet moments with less people. Use soft lighting in the room.
• Play music at a low volume. This can help with relaxation and lessen pain.
• Involve the dying person. If the person can still communicate, ask them what they need.
• Be present. Visit with the person. Talk or read to them, even if they can’t talk back. If they can talk, listen attentively to what they have to say without worrying about what you will say next.
Your presence can be the greatest gift you can give to a dying person.
International Epilepsy Day takes place on February 14th 2022.
Epilepsy can be different for each person, so the need for care can vary greatly. Some people with epilepsy do not need any additional care from others to live independent lives. Other people with epilepsy may need a lot of care, some or all of the time. Some people only need care when they have had a seizure. Even if they don’t have seizures very often, the need for care during or after a seizure may be urgent. Seizures can be unpredictable – someone with epilepsy may be unlikely to be able to plan when they will need help.
If you care for someone with epilepsy, the things you do to support them may include:
• Keeping them safe during a seizure
• Calling for medical help, or giving first aid or emergency medication
• Staying with them or seeing them home safely after a seizure
• Noting any pattern or trigger to their seizures, which may help if they don’t recall their seizures
• Helping with their routine of taking anti-epileptic drugs (AEDs)
• Providing descriptions of seizures to the person with epilepsy and/or their family of not present
• Helping them to adapt their home or lifestyle to provide a safe living environment.
We have included two information links below which will be hugely beneficial in learning more about epilepsy and caring for someone with the diagnosis.
Hypertension may also be called High Blood pressure and is a common but serious condition diagnosed in many older adults. There is no cure for high blood pressure, but there are ways to manage it effectively. Prescription medication will often play a large part in this, together with lifestyle changes that can improve a clients health and, in turn, their quality of life.
Hypertension care is vital, and if left untreated and unmanaged, it can significantly raise the risk of a range of different conditions, some of which can be extremely serious and, in some cases, life-threatening. These include:
– Heart attack
– Coronary artery disease
– Heart failure
– Vascular dementia
– Vision loss
– Kidney failure or disease
– Peripheral artery disease (PAD)
– Shortness of breath
In relation to Covid-19 ensure you are kept up to date on the most recent guidance from the HSE & HSPC websites. Remember:
• All staff must wear gloves, apron and surgical mask for all visits in a clients home. Correct donning and doffing of PPE must be completed on entering and leaving the home. Change of PPE if needed between tasks such as personal case is permitted once clean PPE is put on.
• Handwashing must be completed on entering the home and leaving. In between tasks carried out
• All carers are to wear enhanced PPE (surgical face mask, goggles/visors, full gowns, gloves) when working with a client who is Covid positive. Please contact your local client care manager/nurse manager so this can be provided to you. If you are made aware a client is awaiting a test result or is symptomatic we can provide full PPE in the interim. If negative result basic PPE then will resume.
• All your clothes should be washed daily using a minimum 60 degree cycle. If possible, leave your work shoes outside or in the car.
Please remember to self-monitor for COVID symptoms minimum twice daily as per guidelines. If you have a sore throat, blocked/runny nose, cough, aches/pain, tiredness/fatigue, loss of taste/smell, severe headache or any other unusual symptom please contact your GP and Myhomecare immediately for advice before continuing your client calls.
You must inform the office if you are displaying any symptoms of Covid-19, are a close contact or have received a positive antigen test. If you are awaiting a PCR test you cannot return to work until result has come back and it is negative.
Some helpful links are outlined below with guidance and video resources available
It is important that you record your tasks and care provided in the notes section daily for each client. If you have any issues using the system, please contact your local team who will be happy to help!