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Palliative and Hospice Care
Caring for a Loved One
Dying is often compared to birth, both natural processes for which the body is genetically designed. Like birth, the dying process has common patterns that can be described in stages, each marked by predictable changes that are less frightening when understood. In the case of dying, symptoms are largely due to the body’s efforts to conserve energy. Energy is shifted away from functions that are less urgent for short term survival, such as digestion, elimination and circulation to the extremities. The most vital functions are preserved for as long as possible, including the heartbeat, breathing and brain function. In the later stages of dying, the vital organs begin to shut down in a relatively systematic order.
But this does NOT mean that dying looks or feels orderly, or easy. For both the dying person and their loved ones, dying represents an extraordinary physical, emotional, spiritual and psychosocial process that can feel quite chaotic; there is likely no richer or more complex human experience than the natural end of life. (Cynthia Spence 2023 Palliative Touch, Massage for People at the End of Life)
Palliative vs Hospice Care
When someone has a terminal illness, they might receive palliative care, which is designed to make the remainder of their life as comfortable as possible. It includes pain relief, emotional support and other treatments to improve the patient’s quality of life and is committed to neither hastening nor postponing death. They may also receive hospice care, which is care when a person is not expected to life longer than six months. Hospice care does not focus on treatments to cure the terminal illness and in most facilities, patients must choose to forego or stop curative treatment prior to hospice enrollment. A majority of those admitted to hospice are in pain so pain and symptom management are key, along with emotional support.
Common terminal conditions include heart disease, cancer, dementia, Parkinson's, liver disease, renal disease, COPD, stroke, ALS and Alzheimer's.
Stages of Dying
Early Decline (3-6 months before death)
The patient in early decline is likely to be experiencing one or several symptoms, including fatigue, pain, anxiety and/or insomnia. Opioids and other medications are likely introduced to address these symptoms and new side effects may result. The degree to which people function in early decline is quite variable, depending on diagnosis, age, and overall health. Reduced appetite is common as the body shifts energy away from the work of digestion. The emotional adjustments can be extreme, as patients come to terms with a diagnosis that is likely to be fatal. There can be denial, disbelief, anger and fear. Loved ones will also experience a wide range of feelings and there may be conflict between family
members regarding whether to stop or continue active treatment.
Late Decline (1-3 months before death)
Every organ is working harder and losing efficiency. The dying person has less energy, further loss of
appetite and reduced fluid intake. Symptoms experienced previously may increase in severity and new
symptoms are likely to emerge. Patients in late decline are often on opioids and other medications to
control pain, anxiety and other symptoms. A growing supply of medical equipment may be needed,
causing the home environment to change. Symptoms may include increased sleep of 16-20 hours a day,
sore muscles and joints, pain, poor appetite, growing weakness, dehydration, dry skin, edema,
incontinence and constipation. Pride and personal dignity may suffer as the patient becomes dependent
on others for care and anxiety increases.
Pre-Active Dying(1-2 weeks before death)
The patient’s level of consciousness and arousal begin to change. There may still be moments of lucidity,
but the patient primarily becomes semi-responsive. They have little appetite or thirst. The patient will
still have fecal matter and urine decreases and becomes darker in color. They may begin to experience
changes in breathing and edema may occur or worsen in the upper or lower extremities. Blood pressure
decreases, heart rate may be faster or slower, body temperature changes, respirations become
irregular, fatigue grows extreme, swallowing becomes difficult, dehydration increases and the patient is
likely bed-bound. During this phase, the patient may reach for things unseen and may seem to see or
hear people who are not present to others.
Active Dying (1-3 days before death)
There is no mistaking this last phase and family or staff will often say “There’s been a change.” One of
the hallmarks of active dying is that the dying person may appear to be sleeping deeply, as if they are in
a coma. They may not respond to their name, but might still respond to pain by grimacing, moaning or
crying out when repositioned. Comfort care will include sponge baths, cleaning and moistening the
mouth. It must be remembered that the dying person may be acutely present even if they don’t seem to
be. It is agreed that hearing remains until the end. Changes in skin color and temperature are another
indication of active dying. Mottling is common, typically beginning in the lower extremities. The lips, tips of the ears, fingers or nail beds may be tinged with blue, indicating cyanosis from lack of oxygen. The skin may appear waxy or pale. The timing of death remains mysterious but can be predicted with more certainty as it draws closer. During this phase a “death rattle” can be heard, which is a gurgling sound as air passes over secretions in the throat due to the patient no longer being able to swallow or cough. The head is typically extended with the mouth open. The last breath is typically peaceful.
My Services
I provide End-of-life massage therapy for both palliative care and hospice. End of life massage gives the patient dedicated one-on-one time and has proven to help improve mental health, provide comfort and relaxation. Massage can help them feel cared for, nurtured and comforted. If a patient is experiencing too much pain with any kind of pressure, therapy can consist of simply holding parts of the body to bring warmth and comfort; this can be as simply arm and hand holds bringing warmth ad comfort. End of life massage uses slow, purposeful, repetitive, gentle and beautiful touch therapy. Hospice patients in particular can benefit immensely from massage and has proven to provide significant improvement for pain, anxiety and health-related quality of life, depression, difficulty sleeping, stress, nausea and fatigue.
I travel to in-patient facilities and patient's homes. I can also provide Palliative care massage therapy in my office located in downtown Denison (wheelchair accessible).
(Services offered throughout North Texas)
