Some LTC facilities are reluctant to be involved in end stage care as they already have a reputation as the place the old go to die. Those that embrace it, require more staff, as the dying have rights to increased supervision, pain control and not dying alone..
Int J Older People Nurs. 2017 Mar;12(1). doi: 10.1111/opn.12125.
Dying and death within the culture of long-term care facilities in Canada.
Cable-Williams B et al
Measure are driven by belief pain should be controlled and no one should die alone.
Some factors involved include:
- Making sure directives in place
- giving opioids and anticholinergic agents – often including a subcutaneous lock
- discontinuing long term drugs not related to comfort
- less concern about oral intake; less concern about getting up
- more checking in and giving family a heads up when death is close ( family often upset at missing last good byes)
- frequent oral care and positioning
- arranging “palliative sitters” if family not able to vigil.
Comment – they quote a definition of culture:
‘a pattern of shared basic assumptions – invented, discovered, or developed by a group as it learns to cope with its problems of external adaptation and internal integration – that has worked well enough to be considered valid and therefore, to be taught to new members as the correct way to perceive, think and feel in relation to these problems’
In Canada, in some cases, it has become cultural for the sons to do as little as possible and the daughters to take on a heavy burden. This culture needs work…
Our end of care facility is top notch; though it is sad to say good bye to some old friends…