FINAL DAYS
AS CARE NEEDS INCREASE: LEVELS OF CARE
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Process of Dying
General Inpatient Hospice Care General Inpatient level of care (GIP) is for patients who require symptom management at an advanced level that cannot be managed at the home or facility where the patient lives. Four Seasons can arrange for the patient to be transferred to our specialized hospice inpatient facility, Elizabeth House, or other contracted facility. It’s expected that once symptoms are brought to a manageable level so that the patient wil no longer require such advanced care, they can return to wherever they call home. The patient’s condition is assessed on a daily basis by your care team to determine medical needs and eligibil- ity for GIP. There are certain criteria set by Medicare that your team will consider when deciding which level of care is appropriate. Your social worker and Care Team will help assist you or your loved one on next steps. Some patients may have such an advanced illness that they remain at Elizabeth House until death occurs. It is our goal to support you and/or your loved one in whatever way is important and meaningful for you. Four Seasons Elizabeth House At Elizabeth House, the patient receives specialized around-the-clock hospice care in a home-like setting.
Death is a process of physical, emotional, social, and spiritual changes. The end-of-life may approach rapidly or gradually over many days. Each person is unique and the transition towards death often reflects the person’s life and personality. The goal is to honor and respect these changes, and to comfort and support the family through this process. Four Seasons values life and does not hasten nor prolong the natural process of dying.
Physical Signs of Approaching Death:
• Increasing sleep, though night and day sleep may switch; eventual inability to wake up. • Increasing weakness, more time resting in bed or in a comfortable chair. • Time and usual routines become less important. • Withdrawal from activities such as visiting with people or watching TV. • Decreased eating and drinking; eventual inability to swallow. • Slower or irregular breathing with pauses be- tween breaths (apnea). • Skin may be cool, become grey-blue, or be splotchy (mottled). • Skin may be very warm often due to low or high- grade fevers not caused by infection.
• No control of emptying bowels or bladder. • Decrease in amounts of urine and urine that is dark in color. • A relaxed face and forehead suggests that the patient is comfortable. Frowning or grimacing suggest they are having some type of discomfort. • Limited or no swallowing, causing drooling or noisy breathing because of pooled saliva in the back of the throat mouth/throat. • Visions, often of people who have died, are com- mon and can be comforting to the patient. • Restlessness or agitation, such as reaching into the air, picking at blankets, or trying to climb out of bed.
Rooms at Elizabeth House are private. All rooms are equipped with sleeper sofas for family members who wish to stay overnight. Visitors may come 24 hours a day, 7 days a week. Children and pets may visit, within certain guide- lines. A family kitchen, laundry, great room, meditation room, and garden are available for patient and family use. Specially trained hospice nurses, social workers, spiritual care providers, and volunteers staff Elizabeth House around the clock. Medical providers are available to ensure that the needs of patients are always met.
How to Help:
• Create a quiet, peaceful, private area. • Limit visitors or lengths of visits if the patient seems agitated. • Continue to offer words of love, support, care, forgiveness, and encouragement that the fam- ily will be sad, but okay. Hearing is the last sense that leaves us, so be aware the patient could hear what is said nearby even when they cannot re- spond. At the very least, they hear familiar voices even if they can no longer understand the words being said. • Gently continue to provide personal care, keep- ing skin clean, and the mouth moist. See the ear- lier sections on basic care.
• Give medications with the guidance of your hos- pice nurse as advised by the medical provider. Many medications can safely be stopped, but some should be continued to provide comfort. • Elevate the patient’s head slightly with pillows or by raising the head of the bed, especially if noisy breathing or vomiting occurs. • Take care of yourself. Eat, rest, and drink fluids. Ask for the help you want or need. Four Seasons is here for you.
Respite Care Respite care is a period designed to relieve the family member or other persons caring for the patient. The patient is admitted to a nursing center (possibly Elizabeth House) only on an occasional basis, for no more than five consecutive days at a time. The hospice Medicare benefit also pays for this short stay. Talk to your Care Team to request care. See page 34 for more information. Family and friends are allowed to be present as much as they and the patient choose, respecting other pa- tients and families who are present. If the patient dies while at Elizabeth House, the Care Team will support family and friends. If you would like to speak with someone at Elizabeth House, please call 828.692.9633. The team at Elizabeth House will help the patient and family be prepared to return home if at all possible. Sometimes patients will go to an assisted living or nursing facility after their stay at Elizabeth House. Either way, the patient will still have a Four Seasons Care Team after they leave Elizabeth House.
866.466.9734 • FourSeasonsCare.org
866.466.9734 • FourSeasonsCare.org
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