Decades ago, most people died at home, but medical advances have changed that. Today, most Americans are in hospitals or nursing homes at the end of their lives. Some people enter the hospital to get treated for an illness. Some may already be living in a nursing home.
There is no right place to die. And, of course, where we die is not always something we get to decide. But, if given the choice, each person and/or his or her family should consider which type of care makes the most sense, where that kind of care can be provided, whether family and friends are available to help, and how they will pay for it. Below are explanations of some of the care options available to people at the end of life.
End-of-Life Care in Hospitals
In a hospital setting, medical professionals are available who know what needs to be done for someone who is dying. This can be very reassuring. In addition to the regular care team, some hospitals may have palliative care teams that can assist with managing uncomfortable symptoms and making medical decisions for patients who may or may not be at the end of life.
The doctor wants to move my relative to the ICU. What can we expect?
The ICU (intensive care unit) and CCU (coronary care unit) are types of critical care units. These units are parts of a hospital where seriously ill patients can benefit from specially trained staff who have quick access to advanced equipment. The medical staff in ICUs and CCUs closely monitor and care for a small number of patients. Doctors who work in these units are called intensivists.
Patients in the ICU or CCU are often connected to monitors that check breathing, heart rate, pulse, blood pressure, and oxygen levels. An IV (intravenous) tube may supply medicines, fluids, and/or nutrition. Another tube called a Foley catheter may take urine out of the body. A tube through the nose or stomach area may provide nutrition and remove unwanted fluids. A breathing tube may be attached to a ventilator or respirator to help with breathing.
Often, these external supports—designed to be used for a short time—will maintain vital functions while the body heals. But sometimes, even with intensive care, the body can’t heal, and organs start to fail. When this happens, survival is unlikely. In this case, the healthcare team might talk to the family—and the patient if he or she is conscious—about considering whether or not to continue intensive treatment.
End-of-Life Care in Nursing Homes
More and more people are in nursing homes at the end of life. In a nursing home, nursing staff are always present. Unlike a hospital, a doctor is not in the facility all the time, but may be available by phone. Plans for end-of-life care can be arranged ahead of time, so when the time comes, care can be provided as needed without first consulting a doctor.
If the person has lived in the nursing home for a while, the staff and family probably already have a relationship. This can make the care feel more personalized than in a hospital. Additionally, if the person is enrolled in hospice, the hospice team will be available to assist nursing facility staff with end-of-life care.
As in a hospital, privacy may be an issue in nursing homes. You can ask if arrangements can be made to give your family more time alone when needed.
End-of-Life Care at Home
Home is likely the most familiar setting for someone who needs end-of-life care. Family and friends can come and go freely. Care at home can be a big job for family and friends—physically, emotionally, and financially. But, there are benefits too, and it is often a job caregivers are willing to take on. Hiring a home nurse is an option for people who need additional help and have the financial resources.
Talk with your healthcare provider about the kind of care needed. Frequently, this care does not require a nurse but can be provided by nursing assistants or family and friends without medical training.
To make comfort care available at home, you will have to arrange for services (such as visiting nurses) and special equipment (like a hospital bed or bedside commode). Health insurance might only cover these services or equipment if they have been ordered by a doctor; make sure you check with your insurance company before ordering.
Work with the doctor to decide what is needed to support comfort care at home. If the seriously ill person is returning home from the hospital, sometimes a hospital discharge planner, often a social worker, can help with the planning. Your local Area Agency on Aging might be able to recommend other sources of help.
A doctor has to be available to oversee the patient’s care at home—he or she will arrange for new services, adjust treatment, and order medicines as needed. It is important to follow the doctor’s plan in order to make the dying person as comfortable as possible. Talk with the doctor if you think a treatment is no longer helping. Hospice is frequently used to care for people who are home at the end of life.
Questions to Ask About End-of-Life Decisions
Choosing among the different options for care at the end of life can be difficult. Here are some questions that might help you determine what is best for you and your family.
- If we continue the current course of treatment, what do you expect will happen next?
- What kind of end-of-life care is needed?
- Is the most likely caregiver able to give that kind of care?
- Where would the person who is dying want to have this end-of-life care—a facility or at home, for example?
- What is the best place to get the type of care he or she wants?
- Who will pay for this care?
- Can we get help paying for respite care?
- Is there a good chance that treatment in an intensive care unit will reverse the dying process, or instead draw it out?
Source: National Institute on Aging: www.nia.nih.gov