Is it always better to die at home? - page 4

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   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?
  2. by   CapeCodMermaid
    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...
  3. by   EmptytheBoat
    Quote from llg
    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!
  4. by   EmptytheBoat
    Quote from motorcycle mama
    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.
  5. by   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
  6. by   EmptytheBoat
    Thanks Sabby,
    I've not run across much cultural diversity in my Hospice career.
    Agnosticism, but not much else.
  7. by   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.
  8. by   Jo Dirt
    Quote from EmptytheBoat
    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.

  9. by   AtlantaRN
    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
  10. by   llg
    Quote from EmptytheBoat
    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!
    Thank you for reading my posts with an open mind. Some people can't seem to imagine that an institution (such as a nursing home) can be a good place and can be seen as an integral part of one's community that is "home."

    My family is very lucky that religious group has set up a beutiful, caring retirement community only a mile away from the small town in which I grew up. Many of our senior citizens retire there and lead active lives for many, many years. They live on the "campus" in independ housing. As they more assistance, other types of housing are available -- on the same campus. They can move into an apartment building, or asisted living, or a total care nursing home. The local Visiting Nurse Association leases space on the same campus for its local offices.

    A community such as that offers the residents (and their families) great service and great peace of mind. All the resources are there to close-at-hand to help any resident that needs them -- all coordinated to help the senior citizen and the residents lead a high quality life up to the end of life.

    My parents moved (about a half mile from their home) into that retirement community as soon as they hit age 65 -- as did many of their friends. I'll probably move there myself, someday. It's a nice place.
  11. by   Sue Damonas
    I took care of my mother for a number of years, dealing with all the complications of End Stage Cardiomyopathy. During the last hospital admission we knew where she was headed and brought her home on hospice. It was so hard on me with the endless Roxanol, etc, and sleep deprivation but she was so grateful to be at home. If I had to do it all over again I'd do the same thing because of what it meant to her.

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