Is it always better to die at home?

[Jo Dirt]

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 home this last time.

I was talking to a nurse who doesn't really think it is always such a good thing for the patient to die at home, as this can create more stress and isolated feelings for the family.

I know, of course, it depends on the family, but in general, what do you believe?

I'm not so sure I want to die at home, after the discussion we had. Maybe she is right?

[Jo Dirt]

My mother felt the same way, I'm sure. She said many times that she didn't want any sort of "viewing" as part of the funeral. She said, "I don't want anybody looking at me when I'm dead." I'm sure she did not want people watching as she died. She hated that sort of attention.

I would like to go how your mom went. Your mom and I sound like we had something in common. And I certainly don't want any kind of viewing. I don't want a funeral. I don't want a "memorial service." I want to be cremated and my ashes turned to the wind.

I chose not to look at my grandparents or my father after they died. I would rather remember them in a good way, and looking at a corpse in a casket doesn't bring good memories. After I told my sister-in-law I didn't look at my father in his casket she said she wished she had done the same, because the image of him in that casket kept haunting her.

I'm also offended when families of former patients will see me around town and whip out pictures of the deceased patient in his/her casket. This has happened to me more than once, and I believe it is tacky. Some people feel very comforted by having these types of photos, but I believe this is something that should be kept private and not flaunted around like photos of a Disneyworld vacation.

[llg, PhD, RN]

I would like to go how your mom went. Your mom and I sound like we had something in common. And I certainly don't want any kind of viewing. I don't want a funeral. I don't want a "memorial service." I want to be cremated and my ashes turned to the wind.

.

My moms ashes got scattered in 2 places.

1. The pond at the retirement community

2. The ocean where we used to go on vacation on the Outer Banks of North Carolina. We toasted her with champagne as we scattered them during happy hour.

My dad's ashes are at the golf course at the country club. My family donated money for a little garden and bench between one of the greens and the next tee. there is a little plaque on the bench with his name on it. His ashes were scattered in the garden one evening when no one was looking. As that is "his hole," some of his friends have donated some trees in his memory to surround the back of the green. People who know that his ashes were scattered there tell us they sometime say "hi" to him as they play their round.

For each (They died about 5 years apart), we had a short memorial service open to the public with just a few hymns and a few words -- and then everyone was invited for a buffet lunch at the club (with an open bar, of course) to visit with friends and family and talk. Everyone agreed we set a new standard for funerals in my town. :-) My parents would have totally approved.

[aimeee, BSN, RN]

The viewpoints expressed in this thread just prove how individual and varied we are. Its a great reminder not to impose our own agendas on our patients and families.

[req_read]

Leslie...

Your preferences sound much like an old cowboy I was once told of. I did not know him personally, but people who did said he had been healthy and active all his life and lived to a ripe old age. One day he saddled up his horse and rode out... he did not come back. When they went to look for him they found where he had gotten off his horse and stretched out under a tree on some grass. His arms were folded over his chest and the look on his face was perfectly content.

This hints at an interesting question: To what degree can a dying person choose when they leave?

[CapeCodMermaid, RN]

I find it odd that several people say they would rather die in a hospital than in a nursing home. If you're a full code and want to be on a vent then fine...go to the hospital. If you are comfort measures only, stay at the nursing home. I've had dozens of patients over the course of my career beg to stay where they are and NOT be sent to the hospital to be taken care of by strangers. They've lived at the facility and know all the staff and WANT to stay there while they die.

Not one right or wrong answer to the posed question. For you perhaps home is the best place to die...for her..the hospital...for me not at home where my family would always remember the pain of seeing Mom in the bed and keeping that memory...

[EmptytheBoat]

My mother felt the same way, I'm sure. She said many times that she didn't want any sort of "viewing" as part of the funeral. She said, "I don't want anybody looking at me when I'm dead." I'm sure she did not want people watching as she died. She hated that sort of attention.

She died in a very pretty private room of the LTC, having spent the last week of her life there -- in a room overlooking the duck pond, on the grounds of the retirement community in which she had lived for approximately 10 years. She received excellent care there and was kept clean and comfortable. She had been having trouble waking up in the mornings for the last 2 weeks or so and they finally just decided to let her "sleep away." My step-father sat by the bed and read the newspaper. Eventually, he realized that she wasn't breathing any more. That's the way she wanted it.

There is nothing wrong with the way she planned her death and I won't allow peole to say that anything was wrong with it because she chose not to die at home.

Ilg, as I read your post it is apparent to me that your mother did die at home. Home, as I refer to in my posts, is not necessarily a physical

address, but home is wherever thy heart lies. God Speed!

[EmptytheBoat]

Empty, the worst thing you can do is try to impress your own beliefs about what is best on other people as being what is the right thing to do. This persuading can push people into situations they do not feel comfortable with. And I hope you would never, ever give such a spiel to your clients and suggest the reasons they do not get as involved in the dying process as much as you think they should are because they don't want to be bothered. Not everyone is as comfortable with dying as you are, and they should not be made to feel guilty because of how they cope with the death of their family.

And, yes, I'm sure I will have plenty of peace under my tree.

motorcylce mama, I'm sorry if you took my reply(s) as an effort to impress

my beliefs on you or others. I'm sharing my personal opinion, I believe this is what this forum is about. I'm a Hospice nurse, I have grown to accept death as a natural transition in one's life, and my opinions are shared with this forum for edification purposes, mine more so than others. Guilt is not always a bad emotion, I try to use it productively to become a better person/nurse.

By your name, I would venture to guess that you may like motorcycles.

So do I, I ride a Suzuki Volusia 800, and I really like this bike. I don't like

Harley's, but only my personal opinion, I'm sure others will disagree.

[Sabby_NC]

hi emptytheboat

sorry i did not get to this earlier.

i too am a christian from australia living and working in the usa.

in my job we look after different cultures who have specific traditions when it comes to death and dying. some cultures we are not allowed to look after any male patients, some you cannot look in the face when speaking to them. etc. some you are not allowed to touch after death. others have rites that only their 'elders' are allowed to do.

i find this so very fascinating and a learning process for all nurses who work in hospice nursing especially.

these rites and rituals are very important in death as to whether their spirit leaves this world.

when hubby and i have finished unpacking all our books i will find the name of the book that explains all this diversity very well.

take care

sabby

[EmptytheBoat]

Thanks Sabby,

I've not run across much cultural diversity in my Hospice career.

Agnosticism, but not much else.

[NurseMMM]

Dying at home versus Dying in hospital? It depends upon the patient who is dying and the factors surrounding the eventual death. For most people, dying at home is more dignifying for them. They reach a point where there is acceptance. Where going into the hospital will no longer be valuable to them. Where they are ready to meet their demise with dignity and respect for there wishes. If the patient wants to continue to fight, than hospitalization is necessary. But if there is no fight left, than the home is necessary. An important factor is the age of the patient also. A twenty-six year old dying of osteosarcoma slowly may change her mind about dying at home. Even within the last few days of her life because she see's what it is doing to her family and doesn't want them to suffer with her dying at home, etc. She may choose hospitalization because she doesn't want the memory of death to haunt her family. Where they have to live daily with the notion that their daughter died in the next room, etc. You see every patient is different, every circumstance is different. Just like every death is different. There are no set rules. Most people prefer to die at home after a long struggle, nowadays. Thank god they have a choice and hospice care is better than it once was. I remember the days when we were unable to obtain a level of comfort for patients while at home. As well as in the hospital. I remember one of my patients back in the early 90s. She wanted to go home. They wouldn't let her. She had pancreatic cancer. But they were only medicating her with NUBAIN! I remember caring for her and her begging me to stop touching the bed and fixing her covers even. She was riddled in pain as I watched her die. I felt so helpless. Because they didn't ease her suffering. Nothing. I remember her clenching her teeth and clenching the side rails, until her last breath. I wish never to that sort witness the agony again by a patient. It was and is a horrible memory and experience. I wish I could forget.

[Jo Dirt]

motorcylce mama, I'm sorry if you took my reply(s) as an effort to impress

my beliefs on you or others. I'm sharing my personal opinion, I believe this is what this forum is about. I'm a Hospice nurse, I have grown to accept death as a natural transition in one's life, and my opinions are shared with this forum for edification purposes, mine more so than others. Guilt is not always a bad emotion, I try to use it productively to become a better person/nurse.

Just make sure your opinion stays where it is appropriate. Guilt is a necessary emotion, but no one should be made to feel guilty for the way they are able to cope with dying.

[AtlantaRN, RN]

it just depends...if that is what the patient wants, then that is what should happen. A strong support system is essential to help the family through the dying process.

Some folks find comfort in the hospital setting, but in my opinion, floor nurses just don't have the time (i know, i've been one for 10 yrs and with budget cuts, and each nurse on day shift having up to 7 patients, there just isn't TIME). I believe that if you have a patient actively dying in the hospital setting, the nurse to patient ratio needs to be cut in half, at least. The family wants you with them, because they are afraid; they don't want the patient to hurt, they need reassurance that the patient isn't hurting; they NEED US THERE. that just isnt' possible if you have 6-7 patients, that is 8-10 minutes per patient per hour, not counting pulling meds, and calling docs, and woundcare treatments, etc.

personally, no, I don't believe dying in the hospital is a good thing. again, it just depends on the patients wishes and the individual situation.

Linda