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?

[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

[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

[zena231]

My personal preference(at this time) would be to not die at home. What I think I would need would be to have loved ones around me wherever I am. When my mother in law (who lived with us) went in the hospital and eventually died there, I remember thinking later on that I was glad that she had died there and not at home. It would have been more painful on us as the family to find her dead in her room and we still have enough pain as it is years later.And many people do consider their family's feelings about these things. By looking out for their family, they are still being able to do something at a time when they feel loss of control over so much. But anyway, that is my personal preference. Plus, I think it does help to have full time people around who can help the patient in ways that their family may not be able to help.

[EmptytheBoat]

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

Ilg,

Per Sabby_NC, and cultural differences, I apologize for not allowing the

opportunity for you and Sabby to expound. What culture(s) are we

speaking of? Please share with us cultural differences. I say I"m respectful

of other cultures but that may have been a knee-jerk, peace-making response. I forget sometimes that this is world-wide web. I'm

from the U.S.A., which is essentially a Christian nation, I believe in

Christian values, which essesntially expounds to love your neighbor

as yourself and honor your parents, to name a few.

Although, I may want to profess that I respect culture values (as taught

in nursing school), in this day and age, and with many of my fellow Americans

sacrificing their lives for freedom, and losing life over cultural differences,

I'm now remiss to proclaim that I respect all cultural differences. So, please,

please, share with us your cultural differences. Thank you!

[EmptytheBoat]

My personal preference(at this time) would be to not die at home. What I think I would need would be to have loved ones around me wherever I am. When my mother in law (who lived with us) went in the hospital and eventually died there, I remember thinking later on that I was glad that she had died there and not at home. It would have been more painful on us as the family to find her dead in her room and we still have enough pain as it is years later.And many people do consider their family's feelings about these things. By looking out for their family, they are still being able to do something at a time when they feel loss of control over so much. But anyway, that is my personal preference. Plus, I think it does help to have full time people around who can help the patient in ways that their family may not be able to help.

Dear Zena231,

I acknowledge your personal preference, was not dying at home your mother-

in-law's prefernece? Was she surrounded by loved ones in a private room when she died at the hospital? Are we saying that the pain caused to the

family is more important than the pain caused to your mother-in-law? Are

full-time people more important than full-time family? Why wouldn't the family

have been able to help? This is what Hospice is all about, teaching the family

how to help, and allowing them the satisfaction of doing so. God Speed!

[EmptytheBoat]

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

Dear earle58,

I know of no ideal situation when if comes to end-of-life. I know you

don't believe in capitalization , so please forgive me my anal-attentive

reply. Let's see how you feel in 20-30 years when your 13 y/o is 33-43

y/o, maybe you will consider yourself first and foremost, and so will

your kids. Take care!

[Jo Dirt]

SabbyNC, I would love to read what youare saying, but could you tone it down with the fonts...hurts my eyes!

Maybe I'm a bad person, but I don't believe it should necessarily be whatever the patient wants. And usually, anyway, whatever the patient wants is usually whatever the family wants, too.

The last thing I want is to make my family more uncomfortable, and if I know dying away from home will make it easier for them to carry on their lives (after all, they will be the ones to continue, not me) then by all means ship me wherever.

We can talk about how beautiful death can be and how it is a natural part of living and how we are all going to die, but reality is that most people do not see it this way. Death terrifies most people and having seen patients draw their last breaths I can't say it was a pleasant experience. I'm guilty of feeling this way, somewhat. I was with the family of a dying patient in a nursing home and it was not comforting to watch the patient die. It was very disturbing to some of the family members to see the strange facial contortions and sighing and periodic gasps for air, which were most likely just reflexes at that point.

In fact, I really don't want people hovering over me as I die. The old Indians had the best idea, I think. The old ones would go away from the tribe and lay under a tree and wait for their time. Maybe it's the Indian blood in me. I think that's a good way to go.

[EmptytheBoat]

SabbyNC, I would love to read what youare saying, but could you tone it down with the fonts...hurts my eyes!

Maybe I'm a bad person, but I don't believe it should necessarily be whatever the patient wants. And usually, anyway, whatever the patient wants is usually whatever the family wants, too.

The last thing I want is to make my family more uncomfortable, and if I know dying away from home will make it easier for them to carry on their lives (after all, they will be the ones to continue, not me) then by all means ship me wherever.

We can talk about how beautiful death can be and how it is a natural part of living and how we are all going to die, but reality is that most people do not see it this way. Death terrifies most people and having seen patients draw their last breaths I can't say it was a pleasant experience. I'm guilty of feeling this way, somewhat. I was with the family of a dying patient in a nursing home and it was not comforting to watch the patient die. It was very disturbing to some of the family members to see the strange facial contortions and sighing and periodic gasps for air, which were most likely just reflexes at that point.

In fact, I really don't want people hovering over me as I die. The old Indians had the best idea, I think. The old ones would go away from the tribe and lay under a tree and wait for their time. Maybe it's the Indian blood in me. I think that's a good way to go.

Well, motorcycle mama, stick with your home health, Hospice wouldn't

be for you. I hope you peace up under a tree.

[Jo Dirt]

Well, motorcycle mama, stick with your home health, Hospice wouldn't

be for you. I hope you peace up under a tree.

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.

[zena231]

Dear Zena231,

I acknowledge your personal preference, was not dying at home your mother-

in-law's prefernece? Was she surrounded by loved ones in a private room when she died at the hospital? Are we saying that the pain caused to the

family is more important than the pain caused to your mother-in-law? Are

full-time people more important than full-time family? Why wouldn't the family

have been able to help? This is what Hospice is all about, teaching the family

how to help, and allowing them the satisfaction of doing so. God Speed!

I guess I should have clarified that this wasn't a hospice case, so it would probably be a quite different situation. Her's was a week and a half hospitalization after afib, blood clot, bowel surgery, ileostomy... she was supposed to come home the next day. But I get your point. I think in a hospice situation it would be important for the patient and family to have good communication about what they want. And, nurses can do so much to teach and enable the family. Thanks for your input. I think am learning a lot from this site.

[llg, PhD, RN]

In fact, I really don't want people hovering over me as I die.

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.

[leslie :-D]

i'm a hospice nurse and not only do i want to die away from home, i too want to be alone.

i've always visualized laying on a patch of green, staring at the vastness of the sky and stars.....peacefully slipping away.

i seriously doubt my family would go along with this.

but i'm sure they'd sit around 10 ft away from me, weathering the elements apart but together.

yet they know that i spend alot of time alone w/nature.

so we'll see what happens. :)

leslie