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Developed with the generous support of The
To prevent and relieve suffering and promote quality of life, at every stage of life, through patient and family care, education, research and advocacy.
Learn more at www.palliativemed.org
Paula McMenamin, MSW
Connie Carr, CNP
Frank Ferris, MDPaula McMenamin, MSW
JJ Nadicksbernd, MSW
Patricia Strunk, RN MSN
Barbara Greenstein, MA
Kendra Haddock, MA
Lisa Wortman, MA
Jessica Barr, BS
Care at the End of Life
Module 3After Death
Module 1Managing Resident Care
Module 2Preparing the Family
IMPORTANT: Every state has different laws regulating LTC, and it is your responsibility to know your specific job duties. The content presented in this course is comprehensive and not tailored to meet the specific needs of LTC professionals in any one state. If you are unsure how it applies to you, ask your supervisor.
Module OneManaging Resident Care
Bite 1:Environmental Control
Bite 2:Signs and Symptoms of Dying
Bite 3: Giving Comfort
Bite 4: Foods and Fluids
Module One | Bite 1
Have you ever been present when someone died?
What was that experience like for you?
Did you feel the resident was comfortable when they died?
What is a good death?
Have you been present at a bad death?
What was the experience like for you?
Did you feel the person was at peace when they died?
What is a bad death?
Be a source of comfort & support
Observe and report changes in condition
Facilitate family care conferences
Facilitate communication between the family and hospice team
Mr.Sanfordisa67yearoldmalewithadiagnosisofdementia. Hiswifepassedawayseveralyearsearlier.Hehas2sonswhoallliveoutofthearea,butcalltocheckonhimregularlyandvisitonce a year. Mr. Sanford has not informed anyone of his end-of-life wishes and is now unable to because of his dementia. AsMr.Sanfordnearsdeath,hehasstoppedeating,drinking,andishavingdifficultybreathingasaresultofpneumonia. Onesonrequestedthathebetransportedtoahospital,whereafeedingtubewasplaced.Whenthesecondsonfoundoutaboutthis,herequested the feeding tube be removed, but not until he had a chance to visit his father. Mr. Sanford died in the hospital shortly before his son arrived.
Module One | Bite 2
Mrs.Garciaisa92year-oldfemalewithadiagnosisofcongestiveheartfailure.Herappetitehasbeensteadilydecreasingoverthelastfewmonths.Sherecentlylostherabilitytowalkandisnowwheelchair-bound.Mrs. Garcia becomes very short of breath with any activity. Twodaysago,shewasunabletositupandappearedveryweak.Whenbeingfed,sheholdsthefoodinhermouthbutdoesnot cheworswallow. Mrs. Garcia is very lethargic and sleeps most of the day, but can still be awakened for brief periods.
Module One | Bite 3
How have you provided comfort to your resident's families?
How have you made your residents comfortable at the end-of-life?
How have you avoided making your residents uncomfortable?
To provide assistance
To ease physically; to relieve
To provide solace
Moving the resident
Check-on the resident and their family frequently
Giving food or fluids
Tell the family what you are doing
Talking about death
Use positive words
Bathing the resident or taking their vital signs
Identify and manage symptoms
Mr.Nguyenisan84yearoldmalewithadiagnosisofprostatecancer.Mr.Nguyenhasbeensteadilydecliningoverthelastseveraldaysandisnowunresponsive.Heappearstobeactivelydying.Hisdaughter,son,and4grandchildrenalllivenearby,andareawareofhiscondition.AlthoughMr.Nguyenappearscomfortable,familyis asking what they can do to help him at this time.
Food and Fluids
Module One | Bite 4
May cause aspiration or increase patient anxiety
Does not relieve thirst or dry mouth
Does not prolong life
Coat lips with lip balm
Moisten mouth with a damp toothette
Rinse mouth out every 15 to 30 minutes
Ms.Blackstoneisa78yearoldfemalewithadiagnosisofendstagecardiacdisease. Sheappearstobeactivelydyingwithonlyafewdaystolive.Sheisunresponsive.Todaywhenyouarriveforyourshift,thefamilyisintheroomandisconcernedthatMs.Blackstoneishungrybecauseshehasnoteatenin3 days. They ask about trying to feed her.
Module One Assessment