Alpha Hospice Care

373 Van Ness Avenue, Suite 160-180,
Torrance, CA 90501

310.771.0838

Blog

Added July 2, 2013:

One of the most difficult decisions hospice patients or their families often face is whether to begin or discontinue artificial means of receiving nutrition and/or hydration.  When the patient is no longer able to eat or drink on their own, health care providers will sometimes present the option of receiving food and/or fluids intravenously (IV), through a nasal-gastric (NG) tube or directly into the stomach via a gastric insert (G-tube).

While there may be moral implications in this decision-making process depending on one’s religion or other belief system, it is important for patients and family members to be educated regarding the process of decreased food and fluid intake during the dying process.  As a terminal illness advances, nutritional needs change and fewer calories are needed by the body.  The experience of eating and/or drinking can change from a pleasant one to a distressing one for a patient.

Dying patients rarely feel hungry or thirsty because the natural process of dying shuts down normal functions, including appetite.  It can be difficult for family members to accept that their loved one is no longer eating or drinking.  However, patients should never be “forced” to eat or drink or be made to feel guilty if they don’t try to eat or drink.

Diminished appetite and intake are natural parts of the dying process.  Cravings come and go.  Liquids are increasingly preferred to solid foods.  Meats are typically the first to go, followed by vegetables and other hard-to-digest foods, until even soft foods are no longer tolerated.

Similarly, increased difficulty with swallowing is a normal process that the body goes through as throat muscles weaken to the point that swallowing cannot be accomplished.  Trying to force a dying person to eat or drink can cause them to choke or experience other distress.

A common fallacy regarding terminally-ill patients is that dehydration is thought to be an uncomfortable state.  At the end of life, patients rarely complain of thirst, and aggressive artificial nutrition and hydration via IV or tubes can be more uncomfortable and can produce life-threatening symptoms such as swelling and infections.

Decreased nutritional intake stimulates increased production of endorphins, and dehydration leads to increased dynorphin levels.  Both endorphins and dynorphins are natural analgesics that can reduce pain and increase comfort levels.  Numerous studies show that patients who are dying predominantly have electrolyte values that run in the normal range.  Evidence from clinical trials demonstrates that patients without intravenous therapy live as long as those who do not have intravenous support.

REFERENCE: Maillet, Jo.  Ethics.  In Merritt R, ed. The A.S.P.E.N. Nutrition Support Practice Manual, 2nd ed.  Silver Spring, MD: A.S.P.E.N. 2005, pp. 378-382.

 

Added March 28, 2013:

An article in the Los Angeles Times last month discussed a recent research study that showed more terminally-ill patients are increasingly choosing hospice care over aggressive treatment or “heroic measures.”  This is good news, but the study also revealed that their choice of hospice usually follows a month “in which they endure procedures that are often as invasive and painful as they are futile.”  Ultimately, most of these patients and their loved ones only received the benefits of hospice care for a few days.

The 10-year study of Medicare patients cited in the article showed a dramatic growth in the number of U.S. hospice programs (from 2,300 to 3,500) during that time, and that the number of patients electing hospice care nearly doubled from 22% in 2000 to 42% in 2009.  However, many of these patients were first bounced around from private homes to nursing homes, from nursing homes to hospitals and back to nursing homes or rehabilitation facilities, then often back to the hospital before finally returning to their private or family home to die.  This is not what the patients themselves wanted in many cases, but their family members and/or doctors made such treatment decisions when these patients weren’t able to do so themselves.

As a physician quoted in the LA Times article states: “The time to begin conversation with family members and doctors about end-of-life care is well before the final crisis begins…If a patient’s wish to avoid aggressive treatment is clear, you need to prevent him/her from getting into that cycle of acute care because once they get into the hospital, it’s really hard to get them out.”  Those of us in hospice work would concur with this doctor’s observation.

The sooner a patient with a terminal or life-threatening illness selects hospice, the sooner we can provide them with effective pain management and personalized attention that has been shown in some cases to actually extend their prognosis.  If a hospice patient improves substantially or later decides they want to pursue aggressive treatment, hospice care can be revoked.  Choosing hospice care should not be regarded as “a death sentence.”  We are first and foremost concerned about our patients’ comfort and the quality of their daily lives, not how much time they may or may not have left.

If you have any questions about the benefits of hospice care for yourself or a loved one, please don’t hesitate to contact us at (310) 771-0838 or through this website.

 

Added January 10, 2013:

Happy new year!  As 2013 begins, many of us are naturally excited about the possibilities and opportunities the future may hold for ourselves and our loved ones.  For those living with a terminal illness and their families/caregivers, though, the future may feel very uncertain.  This is normal under the circumstances but uncomfortable.  It also helps to put things in perspective when we realize that the future is not guaranteed for any of us.  In some ways, terminally-ill people might be considered fortunate in that they have been given foresight and with it the opportunity to plan, say good-bye and appreciate more fully their remaining days.  Any one of us seemingly healthy people can suddenly die as a result of unexpected events such as a car accident, a heart attack or an act of violence.

Life is a precious gift, one that we can fail to appreciate or can take advantage of in an unhealthy way.  Many people make resolutions at the beginning of each new year to eat healthier, exercise more, or kick a bad habit like excessive drinking or smoking.  We hospice workers certainly encourage such resolutions, especially since we often see the end results when people haven’t taken care of their health.  Terminal illness can in some cases be avoided completely with healthier habits.  On the other hand, we can all be considered “terminal” since life is finite and it will end for each of us one day.

Studies have revealed that many people take better care of their pets than they do of themselves.  We love pets and want them to be taken care of too, but what good are we to them or our children or other people who depend on us if we aren’t taking care of our own health?  Let’s all resolve to make 2013 a HEALTHY new year, both for our personal benefit and the benefit of all those for whom we care…and who care for us.

 

Added November 20, 2012:

Greetings of peace to you.  The traditional holiday season incorporating Thanksgiving Day, Hanukkah, Christmas and Kwanzaa is about to begin.  For those of us who have lost a loved one in 2012, however, this will likely be a less-happy season than in years past.  With good reason, the holidays are often among the most emotionally difficult of times for people who have experienced the death of a spouse or partner, a parent, a grandparent, a child, a sibling, a favorite aunt or uncle, or a dear friend.  Holidays are intended to be a time of great joy, family togetherness, gift-giving and gratitude.  Yes, if someone who was long in your live has recently died, the holidays can evoke extreme sadness, loneliness and emptiness.  Many of these feelings are normal and natural under the circumstances.  Things are not the way they were.

Here are some “helpful hints” to make this season a little easier and more enjoyable:

Set limits for yourself.  Try to simplify traditional events and gift-giving so you won’t feel overwhelmed.  Do only as much as you can manage emotionally and physically.

Express your feelings.  Just because this is normally a joyful season for families doesn’t mean you can’t talk about your loss and grief.  It is ok to do so.  This is also a good way to honor the memory of your loved one.

Ask for what you need.  Unless you tell them, other people can’t really know what you need or are feeling.  Ask for help with shopping, gift wrapping, cooking and cleaning if you need it.

Resist isolation.  Being with those who love you can nourish you and aid in your healing.  If possible, spend time with younger children or grandchildren during this festive time of year.

Break from tradition?  Traditions which emphasize the absence of your loved one may not be appropriate this year.  If you do keep with certain traditions, allow for minor changes such as where you spend the holidays or with whom.

Start new traditions.  Creating new rituals may be more healing for you and the rest of the family than rekindling past activities.  Involving other family members may help heal their grief as well.

Light a candle.  From a religious standpoint, the December holidays are about new life, the triumph of light over darkness, and new beginnings.  Light candles in honor of this and of your absent loved one(s).

With time and healing, the holiday season CAN and WILL become joyful once again!  Happy holidays to you and yours.

 

Added October 30, 2012:

We are always appreciative when we receive feedback from the families we have served.  Here are some comments from a couple of our patients’ loved ones we would like to share (Names have been omitted in the interest of patient confidentiality):

Thank you for providing such competent & tender care to my Mom.  It brought us such joy, knowing everything was being done to keep her comfortable.  Special thanks to L., for her empathy & spiritual support; to M., for her competence and willingness to put us at ease; and to J., for her gentleness, sweetness and ability to make Mom feel comfortable & special.  In a situation that could have been very difficult, we were sent 3 angels who made our lives and Mom’s remaining 2 1/2 years as easy & pleasant as possible.  God bless you all for giving & caring when we needed you the most.

And from the friend & primary caregiver of another patient:

I wish to thank everyone for the care and consideration provided to N. and me during her illness.  When I think of all of you who were associated with N., the words KINDNESS and CONSIDERATION come to my mind.  Over and above your professionalism, these thoughts stand out.  THANK YOU.

It is our privilege to be of service when terminally-ill patients and their loved ones need us most.

 

Added September 13, 2012:

Those of us on Alpha’s staff have been very touched by this reflection, knowing how accurate it is, by John Chuchman in his book “Sacred Quest: Growth Through Loss and Love”…

People ask me, “What is hospice?”  I almost cannot answer, certainly not glibly or very succinctly.  Hospice honors dying, not so much death as dying.  It is where the dying come to rest, to be cared for, to be honored.  It is where the dying come to find peace, to prepare for the new beginning.  It is where the dying come to die in community, the community of friends, family, ancestors, descendants, and the community of nature and  of spirit.

Hospice is where the dying come to leave their great gifts for others and to be thanked for all their gifts of wisdom.  Hospice is where the dying come to tell stories, share memories and gain perspective.  Hospice is where the dying come to receive and grant forgiveness and sum up a lifetime with friends, family, community.  Hospice is where the dying come to connect with the Life Source and to contact ancestors and spirit guides to help with their transition.  Hospice is a place of active dying, not leaving it in the hands of others or drugs or machines.

Hospice can be Oneness, Joy, Ecstasy.  Hospice can be Peace and Letting Go.  Life began in a garden called Eden–Let mine end in that garden called hospice.

 

Added August, 2012:

Welcome, and thank you for checking out our brand-new new website and blog!  We will soon have a Facebook page and other opportunities for visitors to comment, ask questions and, hopefully, “like” what Alpha Hospice Care has to offer.  Although hospice care in the United States has been growing since the 1970′s, many people still have misconceptions and fears about exactly what hospice is. Some equate hospice care with assisted suicide, which it most certainly is not.  There is also an enduring taboo in some cultures when it comes to discussing death and dying.  It is our hope that this blog and other coming online opportunities will help in at least a small way to help dispel these fears.  We plan to update this blog page every week or two, so please keep coming back!  Thanks again!