Is it always better to die at home? - page 2

I recently lost two patients. One to cancer and the other to COPD. It was known they were dying, and still, they would be sent to the ER with exacerbation of symptoms and neither of my patients came... Read More

  1. by   AtlantaRN
    I just recently started at a home hospice program. they have what is called a "comfort pack" and they are designed for specific life limiting illnesses, there is the standard pack, the chf pack, and seizure pack. each has meds in them to ease symptoms of life limiting illnesses.

    If a patient wants to die at home, that is their wish. Yes, some families find comfort in the hospital setting, but it's all about the patient, so we can help the families through it....

    in the final days, other than being in a facility, there is nothing that can't be accomplished in the home setting....

    linda
  2. by   Sabby_NC
    Yes Weetziebat,
    You are so right in mentioning a Hospice Home.
    They are worth their weight in gold but we need many more of them because the waiting list is long for patients to get in there.
    We are in the process of getting ready to build a 20 bed facility but I know it will always be full.
    These facilities usually only take people that are close to death as in less than a week.
    You can get some private paying patients that can stay longer but expensive. OUCH!
    Hospice Homes make the surroundings so much more like home. If for what ever reason my hubby or myself could not die at home then this is what we would choose.
    Death is starting to get talked about more in homes so knowing what your partner or family member desire at this stage in their lives is most beneficial.
    Great topic and thread I have to say.
  3. by   llg
    The nursing home where my mother died was extremely nice and included hospice care within its facility. She was able to live at home (with support from the hospice service) until 10 days before her death.

    Not all nursing homes are bad. Yes, it helps to have money ... but then, some people do have money and choose to spend that money on hospice care within a facility rather than at home.
  4. by   weetziebat
    Quote from llg
    The nursing home where my mother died was extremely nice and included hospice care within its facility. She was able to live at home (with support from the hospice service) until 10 days before her death.

    Not all nursing homes are bad. Yes, it helps to have money ... but then, some people do have money and choose to spend that money on hospice care within a facility rather than at home.
    llg, sounds like this is a real sore spot for you, and I'm sorry if I added to your grief by my response. In hospice work, I only deal with folks who want to die at home, if at all possible.

    Of course, it sounds like your mother made her decision, had enough money to do things the way she wanted and, in the end, died just as she wanted to. Nothing wrong with that! That is the entire concept of hospice - to let the people who are dying call the shots.

    A 'good' death is what we all want for our patients, and that means honoring whatever the patient feels best with. You have no reason to feel guilty or defensive - your mom had a 'good' death, and thats all that matters, no? :icon_hug:
  5. by   yooper30
    Quote from augigi
    I don't think it's about the family at that point - wherever the patient wants to die, that's the best place.
    My wifes grandmother just died this past friday at home. She had pneumonia, which was the 6 or 7th infection of some sort this past year. She wanted to be home not in a nursing home or hospital. The family decided a week prior to let her go. She died in her own home with her family around her 24/day. This was probably the best comfort measure she could have received.
  6. by   Sabby_NC
    Hi Yooper,
    Although in part I agree with what you are saying it still has to involve the family. For what ever reason there are families out there that can not do the care that is required. It does not mean that they love their family member less but they are not equipped to do the job. Some try it for a short time and are so over whelmed they are phoning for assistance to the point they say 'enough is enough' I just cannot do this!!
    The patient must come first in any given situation whether in their own home, nursing home, hospital or Hospice Home to die with dignity, in peace and as pain free as possible is paramount.
    May I pass on my condolences to your wife on the passing of her Grandmother.
  7. by   yooper30
    Hello Sabby NC I understand what you are saying, and I should have been more specific. I am not in anyway against hospice care. As a paramedic I have transported many patients to hospice facilities where they could pass on with dignity. In the situation of my wifes grandmother, family was able to keep her at home. There are many circumstances where family can not be with their loved one, whether it is because of distance, other obligations, or that they can not watch the one they love die.
    My father passed away at 59 from heart disease. This was 4 years ago, and I was not able to be there with him. I am jealous of my brother and sister because they were there. They were able to say good bye and be with him.
    My hat goes off to you and all of the other compassionate people that can take care of those who are in your care so that they can die with dignity and the least painful way possible. It takes a strong heart and a strong soul to do that. :icon_hug:
  8. by   EmptytheBoat
    When I first read the original post, I thought it may be a tester, especially
    since it was posted on the Hospice forum. I decided to sit back and see
    how others would respond. I was very surprised! thus, I'm reluctant to
    speak my mind, espcially having been shot down on another post.
    But, I can't stand it any longer. Dying at home, surrounded by family,
    friends and loved ones, free from the institutions, and being cared for
    by those who truly care, is what life, Hospice and dying are all about.
    Why is it, that we believe differently? Do we not want to be bothered?
    Are we too busy wrapped up in ourselves, that we can't be with and
    take care of our loved ones?
    I would agree, that in some circumstances i.e. symptoms could not be
    managed in the home (for whatever reason), that it may be best for
    the patient to die other than the home; but, these circumstances
    are usually far and few between.
    Please forgive me if I offend thee, but I believe my "job" is to assure
    that my patients are given the care, dignity, and ability to die a peaceful,
    comfortable death amongst their loved ones in a safe, peaceful and
    familiar surrounding, and this usually is their home!
  9. by   Sabby_NC
    Hi Yooper
    Thank you for your post.
    I am sorry to read of your Father's passing. It is so much like mine as my father died at the age of 59 from sudden but fatal MI. I did not get to say goodbye even though I was in the same area as him. It was sudden and I was so angry for sometime that I did not get to say the things I so wanted too.
    I think that is where I encourage my patients and loved ones to not hold back, say what is in their hearts etc.
    Gosh Yooper I could go on and on about this. I am so passionate about my patients, ensuring their care and goals are met on a daily basis. What a joy and a priveledge to be accepted into patients homes and help them in the most important time of their lives.
    It boils down to the need for a whole lot more education out in the general community. Educating that Hospice does not mean imminent death but a time that is so important in all our lives. We have control over our lives and choices. Why not have control over how we wish to die? Living wills etc come in to play here as well. We all need to be responsible and have our wishes planned out so all I's are dotted and all T's are crossed.
    Ok it is time for Sabby to get off her soap box for at least tonight. LOL
    Thanks for your imput and comments.:Santa1:
  10. by   llg
    Quote from EmptytheBoat
    When I first read the original post, I thought it may be a tester, especially
    since it was posted on the Hospice forum. I decided to sit back and see
    how others would respond. I was very surprised! thus, I'm reluctant to
    speak my mind, espcially having been shot down on another post.
    !
    I certainly respect your cultural beliefs and your right to live and die as you and your family prefer. I also support the development of services to allow for that to happen. But as a nurse, I believe we all need to recognize that other people may have different cultural beliefs and practices that also are worthy of respect and support.

    In my culture, people rarely die at home. Hospice services help the person stay at home up to a certain point and then continue to support the patient and family within a local facility that is viewed as a good, caring, place. There is nothing wrong with that -- and families who choose that option should never be made to feel as if they have done something wrong.
  11. by   EmptytheBoat
    Dear Ilg,
    I respect cultural differences, my post was not in
    response to your posting, but was my viewpoint to
    answer the original post.
    My mom died last year of cancer, in her home,
    with my dad and her children tending to her every need
    and want. The decision to utilize Hospice was made
    after my my mom expressed her wishes that she never
    wanted to go back to the hospital. Her wishes were
    followed.
    As a Hospice nurse, I've taken care of patients in
    hospitals, nursing homes and Hospice in-patients units.
    I tend to them with the same compassionate care, and
    do not discriminate.
  12. by   Sabby_NC
    Hi Ilg,

    Thanks for bringing up the cultural differences aspect. A very important one especially in times of sickness and death. I appreciated your imput.

    Sabby
  13. by   leslie :-D
    i think dying at home is an ideal, if the home situation is ideal.
    unfortunately that is not always the case.
    furthermore, i've talked w/my kids about one dying at home.
    my 16 & 17 yo didn't say anything.
    my 13 yo mentioned he wouldn't want to live in a house where i died.
    my husband would provide me with all the personal care i needed at the end, w/o apprehension.
    but kids have such a different perspective. (gen'l statement).
    i would have to consider them first and foremost.

    leslie

close