Journal of Nursing
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Mothering My Dying Friend

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By Carol D. O'Dell

You think your doctor will tell you when your loved one needs hospice?

They should know, right?

Not always the case.

Three signs That Indicate Your Loved One is Ready for Hospice:

1. The disease has progressed to the point that there’s no cure, and you’ve (and your loved one) has decided to manage the pain and be comfortable and not actively seek to treat the disease.

2. You and your loved one chooses to forego any further testing of hospitalizations–by this choice, you allow the dying process to happen naturally. Body functions/organs may begin to diminish.

3. You’re ready to begin to let go, say good-bye and follow the oath of hospice, which is to “neither hinder, not hasten death.”

I knew my mother was ready for hospice before any of her medical team suggested it.

I had asked my mother’s doctor about hospice (Alzheimer’s and Parkinson’s) months beforehand and was “poo-pooed” away. Mother had a great way of rallying herself together for doctor visits, but I lived with her, cared for her 24/7, and I was beginning to see a shift.

I knew my mother had taken a turn. I knew that both of us were over the tests, treatments, and hospital rigmarole. I knew, in essence, that she had given up the will to live.

Whether your loved one has cancer, Parkinson’s, heart disease or dementia, whether they’re young–or old–it’s hard to let go. Even when you know they’re suffering and you want them at peace, it’s hard to let go.

What’s the difference in hospice and palliative care?

First, the working definition of hospice or palliative care is: your loved one has a “life limiting condition.” Their words, not mine. While it’s technically correct, and I can’t think of a better way to say it, it still sounds odd.

In layman’s terms, most people think it means your loved one has a diagnosis of less than six months to live, and with some hospice situations, a year. While that’s technically true, some people receive hospice or palliative services for much longer.

The difference in hospice and palliative care is that palliative care specializes in the relief of the pain, symptoms and stress of serious illness.

Hospice care can provide palliative care if your loved one needs it.

Hospice focuses on terminally ill people who no longer seek treatments to cure them and who are expected to live for a year or less.

Anyone can inquire about hospice services. You or your loved one may call a local hospice and request services. The hospice staff will then contact your physician to determine if a referral to hospice is appropriate. Another way to inquire about hospice is to talk with your physician, and he or she can make a referral to hospice. Hospice can begin as soon as a ‘referral’ is made by the person’s doctor.

The hospice staff will then contact the person referred to set up an initial meeting to review the services the hospice will offer and sign the necessary consent forms for care to begin. Usually, care is ready to begin within a day or two of a referral. However, in urgent situations, service may begin sooner.

When is the right time to ask about hospice?

Now is the best time to learn more about hospice care and ask questions about what to expect. Although end-of-life care may be difficult to discuss, it is best for loved ones and family members to share their wishes long before it becomes a concern. This can greatly reduce stress when the time for hospice becomes apparent.

Even the medical community denies and avoids death. Accepting that the end is near, that you will begin to have to let go, to sit quietly by a loved one’s bedside, to not go into “heroics” and throw on the paddles or rush to the ER is very, very difficult.

The last month of my own mother’s life was in many ways one of the most peaceful times of my life. It was also excruciating. As a society, we’re no longer taught to sit with death. We’re no longer taught to let nature take its course, to relinquish our control. Learning to do this, to hear the clock tick, to let my family come and go as I sat by my mother’s bed and wiped her brow–

It was a finishing of something I had begun.

It was bone deep and cathartic, and gave me time to think and process.

I began to see the whole of my mother’s life. I understood that both of us need to let go.

Hospice isn’t about giving up. It’s about giving in.



 
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Editor-in Chief:
Kirsten Nicole

Editorial Staff:
Kirsten Nicole
Stan Kenyon
Robyn Bowman
Kimberly McNabb
Lisa Gordon
Stephanie Robinson

Contributors:
Kirsten Nicole
Stan Kenyon
Liz Di Bernardo
Cris Lobato
Elisa Howard
Susan Cramer